Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors by National Academies of Sciences Engineering & Medicine

Author:National Academies of Sciences, Engineering & Medicine
Language: eng
Format: epub
Tags: Healthcare and Quality
ISBN: 0309381274
Publisher: The National Academies Press
Published: 2016-01-12T00:00:00+00:00

Language

Language typically represents language barriers, such as speaking a primary language other than English, having limited English proficiency (LEP), and otherwise needing interpreter services. Language barriers have been shown to be associated with poorer health care access; poorer health status; poorer quality care, including less recommended care (e.g., preventive services) and more adverse health effects (e.g., drug complications); and higher rates of diagnostic testing (Flores, 2005). One review found that use of professional interpreters improved clinical care, especially processes of care, among patients with a language barrier compared to patients with language-concordant care (Karliner et al., 2007). Another review similarly found that professional interpreter services are associated with increased office visits and prescriptions being written and refilled, while patients with no interpreter or an ad hoc interpreter have more tests resulting in more test costs and a higher risk of hospitalization (Flores, 2005). This review also found that interpreter services improve care processes, although whether interpreter use is associated with increased duration of visits remains unclear (Flores, 2005).

Individual studies echo review findings of generally worse outcomes for patients with language barriers. One study reported that deaf American Sign Language (ASL) users concordant providers (i.e., providers who sign) were more likely to receive an influenza vaccination but not a colon or cholesterol screening compared to deaf ASL users reporting discordant providers (McKee et al., 2011). Regarding health outcomes, one study found that among patients on warfarin, LEP was associated with less time in therapeutic range, but had no differences in risk of spending time in danger range. There was also a significant interaction with use of a communication surrogate, such that both LEP and non-LEP patients who used a surrogate spent less time in therapeutic range and more time in danger range (Rodriguez et al., 2013). A study of Latino diabetes patients found that LEP Latinos with language-discordant physicians had greater odds of poor glycemic control compared to Latino English speakers, but there were no differences between LEP Latinos with language-concordant physicians and Latino English speakers (Fernandez et al., 2011). Another study found that having English as the primary language spoken was associated with significantly lower risk of in-hospital, 30-day, 90-day, and 1-year mortality among critically ill patients (Mendu et al., 2013).

Several studies examined language and patient experiences of care. Among studies examining Spanish language, one study found that Spanish language was associated with significantly lower CAHPS ratings of nurses, doctors, and hospitals (O’Malley et al., 2005) one found that English-speaking Hispanics reported greater satisfaction with provider communication compared to Spanish-speaking Hispanics (Villani and Mortensen, 2014), and one reported no significant differences in provider ratings by Spanish language (Ayanian et al., 2010). Among studies examining experiences of Asian-language-speaking patients, one study found that there were significantly fewer excellent and excellent or very good ratings of providers among Chinese-speaking lung and colorectal patients compared to whites (Ayanian et al., 2010), and another reported that among LEP Asian Americans (Chinese and Vietnamese immigrants) there were no differences in provider communication or overall satisfaction

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