The impact of limited English proficiency and physician language concordance on reports of clinical interactions among patients with diabetes: the DISTANCE study.
OBJECTIVE
To assess the association of limited English proficiency (LEP) and physician language concordance with patient reports of clinical interactions.


METHODS
Cross-sectional survey of 8638 Kaiser Permanente Northern California patients with diabetes. Patient responses were used to define English proficiency and physician language concordance. Quality of clinical interactions was based on 5 questions drawn from validated scales on communication, 2 on trust, and 3 on discrimination.


RESULTS
Respondents included 8116 English-proficient and 522 LEP patients. Among LEP patients, 210 were language concordant and 153 were language discordant. In fully adjusted models, LEP patients were more likely than English-proficient patients to report suboptimal interactions on 3 out of 10 outcomes, including 1 communication and 2 discrimination items. In separate analyses, LEP-discordant patients were more likely than English-proficient patients to report suboptimal clinician-patient interactions on 7 out of 10 outcomes, including 2 communication, 2 trust, and 3 discrimination items. In contrast, LEP-concordant patients reported similar interactions to English-proficient patients.


CONCLUSIONS
Reports of suboptimal interactions among patients with LEP were more common among those with language-discordant physicians.


CONCLUSIONS
Expanding access to language concordant physicians may improve clinical interactions among patients with LEP. Quality and performance assessments should consider physician-patient language concordance.
Schenker
Yael
Y
Department of Medicine, University of California, San Francisco, CA 94143, USA. yael.schenker@ucsf.edu
Karter
Andrew J
AJ
Schillinger
Dean
D
Warton
E Margaret
EM
Adler
Nancy E
NE
Moffet
Howard H
HH
Ahmed
Ameena T
AT
Fernandez
Alicia
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003144:Communication Barriers; D032882:Comprehension; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D055815:Young Adult