Institut du Savoir Montfort, Ottawa, Ontario, Canada; ICES, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Institut du Savoir Montfort, Ottawa, Ontario, Canada; Hôpital Montfort, Sport Medicine Clinic, Ottawa, Ontario, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
J Am Med Dir Assoc. 2021 Oct;22(10):2147-2153.e3. doi: 10.1016/j.jamda.2020.12.007. Epub 2021 Jan 9.
This study compared quality indicators across linguistic groups and sought to determine whether disparities are influenced by resident-facility language discordance in long-term care.
Population-based retrospective cohort study using linked databases.
Retrospective cohort of newly admitted residents of long-term care facilities in Ontario, Canada, between 2010 and 2016 (N=47,727). Individual residents' information was obtained from the Resident Assessment Instrument Minimum Data Set (RAI-MDS) to determine resident's primary language, clinical characteristics, and health care indicators.
Main covariates of interest were primary language of the resident and predominant language of the long-term care facility, which was determined using the French designation status as defined in the French Language Services Act. Primary outcomes were a set of quality and safety indicators related to long-term care: worsening of depression, falls, moderate-severe pain, use of antipsychotic medication, and physical restraints. Multivariable logistic regression models were used to assess the impact of resident's primary language, facility language, and resident-facility language discordance on each quality indicator.
Overall, there were few differences between francophones and anglophones for quality and safety indicators. Francophones were more likely to report pain (10.9% vs 9.9%; P = .001) and be physically restrained (7.3% vs 5.2%; P < .001), whereas a greater proportion of anglophones experienced worsening of depressive symptoms (24.0% vs 22.9%; P = .001). However, quality indicators were generally worse for francophones in Non-Designated facilities, except for pain, which was more commonly reported by francophones in French-Designated facilities. Anglophones were more likely to be physically restrained in French-Designated facilities (6.7% vs 5.1%; P < .001).
For francophones, quality indicators tended to be worse in the presence of resident-facility language discordance. However, these findings did not persist after adjusting for individual- and facility-level characteristics, suggesting that the disparities observed at the population level cannot be attributed to linguistic factors alone.
本研究比较了不同语言群体的质量指标，并试图确定在长期护理中，居民-设施语言不匹配是否会影响差异。
使用关联数据库的基于人群的回顾性队列研究。
2010 年至 2016 年间加拿大安大略省新入住长期护理设施的回顾性队列居民（N=47727）。从居民评估工具最低数据集（RAI-MDS）中获取每个居民的信息，以确定居民的主要语言、临床特征和医疗保健指标。
主要感兴趣的协变量是居民的主要语言和长期护理设施的主要语言，这是使用《法语服务法》中定义的法语指定地位来确定的。主要结果是一组与长期护理相关的质量和安全指标：抑郁恶化、跌倒、中重度疼痛、使用抗精神病药物和身体约束。多变量逻辑回归模型用于评估居民的主要语言、设施语言和居民-设施语言不匹配对每个质量指标的影响。
总体而言，法语和英语居民在质量和安全指标方面差异不大。法语居民更有可能报告疼痛（10.9%比 9.9%；P=0.001）和被身体约束（7.3%比 5.2%；P<0.001），而更多的英语居民经历抑郁症状恶化（24.0%比 22.9%；P=0.001）。然而，在非指定设施中，法语居民的质量指标普遍较差，除了疼痛，在指定设施中，法语居民更常报告疼痛。在指定设施中，英语居民更有可能被身体约束（6.7%比 5.1%；P<0.001）。
对于法语居民来说，在居民-设施语言不匹配的情况下，质量指标往往更差。然而，在调整了个人和设施层面的特征后，这些发现并没有持续存在，这表明在人群层面观察到的差异不能仅仅归因于语言因素。
