Patient–Physician Language Agreement Improves Patient Outcomes

A paper published in the Canadian Medical Association Journal analyzed how patient–physician language agreement improved hospital outcomes. Understanding the impact of language on healthcare outcomes may assist in improving patient health.  

According to the researchers in this publication, “numerous studies have shown that people in North America with limited English proficiency generally have poorer access to healthcare and receive healthcare services of lower quality and safety, resulting in a higher risk of adverse events and increased health resource use. Despite these findings, few authors have considered the impact of patient–provider language concordance, whereby patients and providers have proficiency in a shared language.” 

In this retrospective population-based cohort study, individuals in Ontario, Canada, between 18 and 105 years old were observed.  

These individuals received publicly funded, long-term, home care services from April 1, 2010, to March 31, 2018, and had at least two comorbidities. 

Of this larger sample size, further exclusionary criteria were used to narrow down the population, and patients with an index hospital admission were further evaluated.  

The Resident Assessment Instrument–Home Care database and the College of Physicians and Surgeons of Ontario database recorded language data for patients and physicians, respectively.  

Index hospital admissions were characterized as language concordant or discordant.  

Of all trial participants, 84.1% were English speaking, 2.7% were French-speaking, and 13.2% were one of the top ten other languages.  

The study found that of the group of patients who did not speak English or French — referred to as allophones — interactions with physicians who had a concordant language led to a decreased risk of adverse events and mortality and shorter hospital stays.  

The odds ratio for in-hospital deaths for allophones who received concordant care as opposed to discordant care was 0.46. Furthermore, the average hospital stay for concordant allophones was 23% shorter than that for discordant allophones.  

Similarly, French-speaking patients had the same trends in outcomes with physician–patient concordance, yielding 7% shorter hospital stays.  

While the overall outcomes of French-speaking patients echoed that of allophones, the differences were not as significant. Researchers postulate that French-speaking patients may have a higher bilingualism rate than allophones leading to less drastic differences.  

“The lower risks of adverse events and in-hospital death observed among patients receiving language-concordant care may partially be explained by enhanced patient–provider communication (e.g., ability to elicit symptoms and obtain a complete medical history), which can improve the accuracy and timeliness of diagnoses made by physicians,” stated the researchers in the publication.  

Regardless of the reasoning behind the improved outcomes, the impact of language on healthcare outcomes may cause physicians to consider ways to mitigate the risk associated with discordant language care. Additionally, the American Academy of Family Physicians provides guidelines on the appropriate use of medical interpreters.