title: The impact of limited English proficiency and physician language concordance on reports of clinical interactions among patients with diabetes: the DISTANCE study.
abstract: 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.
authors.affiliation: Department of Medicine, University of California, San Francisco, CA 94143, USA. yael.schenker@ucsf.edu
authors.forename: Yael
authors.initials: Y
authors.lastname: Schenker
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: E Margaret
authors.initials: EM
authors.lastname: Warton
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Adler
authors.forename: Howard H
authors.initials: HH
authors.lastname: Moffet
authors.forename: Ameena T
authors.initials: AT
authors.lastname: Ahmed
authors.forename: Alicia
authors.initials: A
authors.lastname: Fernandez
mesh_terms: 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