Faculty of Medicine (Seale, Reaume, McIsaac, Kendall, Sood, Tanuseputro), University of Ottawa; Institut du Savoir Montfort (Seale, Reaume, Prud'homme, Tanuseputro), Ottawa, Ont.; Department of Internal Medicine (Reaume), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Ottawa Hospital Research Institute (Batista, Roberts, Rhodes, McIsaac, Kendall, Sood, Tanuseputro); ICES uOttawa (Batista, Bader Eddeen, McIsaac, Kendall, Sood, Tanuseputro); Institut du Savoir Montfort (Batista); Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Bruyère Research Institute (Kendall, Tanuseputro), Ottawa, Ont.; Université de Moncton (Prud'homme), Moncton, NB.
Faculty of Medicine (Seale, Reaume, McIsaac, Kendall, Sood, Tanuseputro), University of Ottawa; Institut du Savoir Montfort (Seale, Reaume, Prud'homme, Tanuseputro), Ottawa, Ont.; Department of Internal Medicine (Reaume), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Ottawa Hospital Research Institute (Batista, Roberts, Rhodes, McIsaac, Kendall, Sood, Tanuseputro); ICES uOttawa (Batista, Bader Eddeen, McIsaac, Kendall, Sood, Tanuseputro); Institut du Savoir Montfort (Batista); Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Bruyère Research Institute (Kendall, Tanuseputro), Ottawa, Ont.; Université de Moncton (Prud'homme), Moncton, NB
CMAJ. 2022 Jul 11;194(26):E899-E908. doi: 10.1503/cmaj.212155.
When patients and physicians speak the same language, it may improve the quality and safety of care delivered. We sought to determine whether patient-physician language concordance is associated with in-hospital and postdischarge outcomes among home care recipients who were admitted to hospital.
We conducted a population-based study of a retrospective cohort of 189 690 home care recipients who were admitted to hospital in Ontario, Canada, between 2010 and 2018. We defined patient language (obtained from home care assessments) as English (Anglophone), French (Francophone) or other (allophone). We obtained physician language from the College of Physicians and Surgeons of Ontario. We defined hospital admissions as language concordant when patients received more than 50% of their care from physicians who spoke the patients' primary language. We identified in-hospital (adverse events, length of stay, death) and post-discharge outcomes (emergency department visits, readmissions, death within 30 days of discharge). We used regression analyses to estimate the adjusted rate of mean and the adjusted odds ratio (OR) of each outcome, stratified by patient language, to assess the impact of language-concordant care within each linguistic group.
Allophone patients who received language-concordant care had lower risk of adverse events (adjusted OR 0.25, 95% confidence interval [CI] 0.15-0.43) and in-hospital death (adjusted OR 0.44, 95% CI 0.29-0.66), as well as shorter stays in hospital (adjusted rate of mean 0.74, 95% CI 0.66-0.83) than allophone patients who received language-discordant care. Results were similar for Francophone patients, although the magnitude of the effect was smaller than for allophone patients. Language concordance or discordance of the hospital admission was not associated with significant differences in postdischarge outcomes.
Patients who received most of their care from physicians who spoke the patients' primary language had better in-hospital outcomes, suggesting that disparities across linguistic groups could be mitigated by providing patients with language-concordant care.
当患者和医生使用同一种语言时，可能会提高医疗服务的质量和安全性。我们旨在确定在因住院而接受家庭护理的患者中，医患语言一致是否与住院和出院后结局相关。
我们进行了一项基于人群的回顾性队列研究，纳入了 2010 年至 2018 年期间在加拿大安大略省因住院而接受家庭护理的 189690 例患者。我们将患者的语言（从家庭护理评估中获得）定义为英语（讲英语的）、法语（说法语的）或其他语言（讲其他语言的）。我们从安大略省医师学院获取医生的语言信息。当患者接受的护理超过 50%来自讲患者母语的医生时，我们将医院收治定义为语言一致。我们确定了住院期间（不良事件、住院时间、死亡）和出院后结局（急诊就诊、再入院、出院后 30 天内死亡）。我们使用回归分析来估计每个结局的调整平均率和调整比值比（OR），按患者语言分层，以评估每个语言群体内语言一致护理的影响。
接受语言一致护理的讲其他语言的患者发生不良事件的风险较低（调整 OR 0.25，95%置信区间 [CI] 0.15-0.43），院内死亡风险也较低（调整 OR 0.44，95% CI 0.29-0.66），住院时间也较短（调整平均率 0.74，95% CI 0.66-0.83），而接受语言不一致护理的讲其他语言的患者则没有这些获益。说法语的患者的结果类似，尽管影响的幅度小于讲其他语言的患者。医院收治时的语言一致或不一致与出院后结局无显著差异。
接受母语医生提供的大部分护理的患者具有更好的住院结局，这表明通过为患者提供语言一致的护理，可以减轻不同语言群体之间的差异。
