Transitions from hospital to community care: the role of patient–provider language concordance

Israel Journal of Health Policy Research

Efrat Shadmi²  Hanna Admi³  Nosaiba Rayan¹ 

[1] School of Public Health, Faculty of Social Welfare and Health Sciences, Haifa University, Mount Carmel 31905, Israel;The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, Haifa University, Mount Carmel 31905, Israel;Rambam Medical Campus: Nursing Division, Haifa 31096, Israel

关键词: Minority patients;    Quality of care;    Cultural differences;    Language concordance;    Transitional care;   

Others  :  1137546
DOI  :  10.1186/2045-4015-3-24

 received in 2014-02-24, accepted in 2014-06-26,  发布年份 2014

【 摘 要 】

Background

Cultural and language discordance between patients and providers constitutes a significant challenge to provision of quality healthcare. This study aims to evaluate minority patients’ discharge from hospital to community care, specifically examining the relationship between patient–provider language concordance and the quality of transitional care.

Methods

This was a multi-method prospective study of care transitions of 92 patients: native Hebrew, Russian or Arabic speakers, with a pre-discharge questionnaire and structured observations examining discharge preparation from a large Israeli teaching hospital. Two weeks post-discharge patients were surveyed by phone, on the transition from hospital to community care (the Care Transition Measure (CTM-15, 0–100 scale)) and on the primary-care post-discharge visit.

Results

Overall, ratings on the CTM indicated fair quality of the transition process (scores of 51.8 to 58.8). Patient–provider language concordance was present in 49% of minority patients’ discharge briefings. Language concordance was associated with higher CTM scores among minority groups (64.1 in language-concordant versus 49.8 in non-language-concordant discharges, P <0.001). Other aspects significantly associated with CTM scores: extent of discharge explanations (P <0.05), quality of discharge briefing (P <0.001), and post-discharge explanations by the primary care physician (P <0.01).

Conclusion

Language-concordant care, coupled with extensive discharge briefings and post-discharge explanations for ongoing care, are important contributors to the quality of care transitions of ethnic minority patients.

【 授权许可】

   
2014 Rayan et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Coleman EA: Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc 2003, 51:549-555.
• [2]Coleman EA, Parry C, Chalmers S, Min SJ: The care transitions intervention: results of a randomized controlled trial. Arch Intern Med 2006, 166:1822-1828.
• [3]Naylor MD, Bowles KH, McCauley KM, Maccoy MC, Maislin G, Pauly MV, Krakauer R: High-value transitional care: translation of research into practice. J Eval Clin Pract 2011. doi:10.1111/j.1365-2753.2011.01659.x
• [4]Preen DB, Bailey BE, Wright A, Kendall P, Phillips M, Hung J, Hendriks R, Mather A, Williams E: Effects of a multidisciplinary, post-discharge continuance of care intervention on quality of life, discharge satisfaction, and hospital length of stay: a randomized controlled trial. Int J Qual Health Care 2005, 17:43-51.
• [5]Steeman E, Moons P, Milisen K, De Bal N, De Geest S, De Froidmont C, Tellier V, Gosset C, Abraham I: Implementation of discharge management for geriatric patients at risk of readmission or institutionalization. Int J Qual Health Care 2006, 18:352-358.
• [6]Balicer R, Shadmi E, Israeli A: Interventions for reducing readmissions–are we barking up the right tree? Isr J Health Policy Res 2013, 2:2.
• [7]Jowsey T, Gillespie J, Aspin C: Effective communication is crucial to self-management: the experiences of immigrants to Australia living with diabetes. Chronic Illn 2011, 7:6-19.
• [8]Betancourt R: Cultural competence and medical education: many names, many perspectives, one goal. Acad Med 2006, 81:499-501.
• [9]Ruiz P: Cultural barriers to effective medical care among Hispanic-American patients. Annu Rev Med 1985, 36:63-71.
• [10]Betancourt R, Green R, Carrillo E, Ananeh-Firempong O: Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep 2003, 118:293.
• [11]Nguyen GT, Bowman MA: Culture, language, and health literacy: communicating about health with Asians and Pacific Islanders. Fam Med 2007, 39:208.
• [12]Ishikawa H, Yano E, Fujimori S, Kinoshita M, Yamanouchi T, Yoshikawa M, Yamazaki Y, Teramoto T: Patient health literacy and patient–physician information exchange during a visit. Fam Pract 2009, 26:517-523.
• [13]Cooper LA, Powe NR: Disparities in Patient Experiences, Health Care Processes, and Outcomes: the Role of Patient-Provider Racial, Ethnic, and Language Concordance. New York, NY: Commonwealth Fund; 2004.
• [14]Perez-Stable EJ, Napoles-Springer A, Miramontes JM: The effects of ethnicity and language on medical outcomes of patients with hypertension or diabetes. Med Care 1997, 35:1212-1219.
• [15]Grubbs V, Chen AH, Bindman AB, Vittinghoff E, Fernandez A: Effect of awareness of language law on language access in the health care setting. J Gen Intern Med 2006, 21:683-688.
• [16]Manson A: Language concordance as a determinant of patient compliance and emergency room use in patients with asthma. Med Care 1988, 26:1119-1128.
• [17]Wilson E, Chen AH, Grumbach K, Wang F, Fernandez A: Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med 2005, 20:800-806.
• [18]Meghani SH, Brooks JM, Gipson-Jones T, Waite R, Whitfield-Harris L, Deatrick JA: Patient-provider race-concordance: does it matter in improving minority patients’ health outcomes. Ethn Health 2009, 14:107-130.
• [19]Fernandez A, Schillinger D, Warton EM, Adler N, Moffet HH, Schenker Y, Salgado MV, Ahmed A, Karter AJ: Language barriers, physician-patient language concordance, and glycemic control among insured Latinos with diabetes: the diabetes study of Northern California ) DISTANCE). J Gen Intern Med 2011, 26:170-176.
• [20]Traylor A, Schmittdiel J, Uratsu C, Mangione CM, Subramanian U: Adherence to cardiovascular disease medications: does patient-provider race/ethnicity and language concordance matter? J Gen Intern Med 2010, 25:1172-1177.
• [21]Carrasquillo O, Orav EJ, Brennan TA, Burstin HR: Impact of language barriers on patient satisfaction in an emergency department. J Gen Intern Med 1999, 14:82-87.
• [22]OECD: OECD Reviews of Health Care Quality: Israel 2012 Raising Standards. OECD Publishing; 2012. [http://www.oecd.org/els/health-systems/ReviewofHealthCareQualityISRAEL_ExecutiveSummary.pdf webcite], (accessed 30.06.14)
• [23]Gross R, Rosen B, Shirom A: Reforming the Israeli health system: findings of a 3-year evaluation. Health Policy 2001, 56:1-20.
• [24]Baron-Epel O, Garty N, Green MS: Inequalities in use of health services among Jews and Arabs in Israel. Health Serv Res 2007, 42:1008-1019.
• [25]Brammli-Greenberg S, Rosen B, Gross R: Co-payments for Physician Visits: How Large is the Burden and Who Bears the Brunt?. Jerusalem: Myers – JDC - Brookdale Institute, The Smokler Centerfor Health Policy Research; 2006. Hebrew
• [26]Al Haj M, Leshem E: Immigrants from the Former Soviet Union in Israel: Ten Years Later: A Research Report. Haifa: Center for Multiculturalism and Educational Research, University of Haifa; 2000.
• [27]Baron-Epel O, Garty-Sandalon N, Green M: Patterns of utilization of healthcare services among immigrants to Israel from the former Soviet Union. Harefuah 2008, 147:282-286. Hebrew
• [28]Soskolne V, Auslander GK, Ben Shahar I: Help seeking and barriers to utilization of medical and social work services among ageing immigrants to Israel from the former Soviet Union. Health Soc Care Community 2006, 14:74-84.
• [29]Central Bureau of Statistics: Statistical Abstract of Israel 2009-No.60. 2009. http://www.cbs.gov.il webcite
• [30]Israeli Center for Disease Control: The Health Status of the Arab Population in Israel 2004. Tal Hashomer: Tel Aviv: Israel Center for Disease Control; 2005. Hebrew
• [31]Israel Ministry of Health: Health Inequalities and Whys to Cope with it. Jerusalem: Israel Ministry of Health; 2010. Hebrew
• [32]Israel Ministry of Health: Health Inequalities and Whys to Cope with it. Jerusalem: Israel Ministry of Health; 2012. Hebrew
• [33]Erdfelder E, Faul F, Buchner A: GPOWER: a general power analysis program. Behav Res Meth Ins C 1996, 28:1-11.
• [34]Shadmi E, Admi H, Ungar L, Naveh N, Muller MA, Kaffman M, Rayan N, Reis S: Cancer care at the hospital-community interface: perspectives of patients from different cultural and ethnic groups. Patient Educ Couns 2010, 79:106-111.
• [35]Coleman EA, Smith JD, Frank JC, Eilertsen TB, Thiare JN, Kramer AM: Development and testing of a measure designed to assess the quality of care transitions. Int J Integr Care 2002, 2:e02.
• [36]Ware JE, Kosinski M, Turner-Bowker D, Gandeck B: User’s Manual for the SF-12v2 Health Survey. Massachusetts: QualityMetric Incorporated Lincoln, Rhode Island and Health Assessment Lab Boston; 2007.
• [37]Coleman EA, Mahoney E, Parry C: Assessing the quality of preparation for posthospital care from the patient’s perspective: the care transitions measure. Med Care 2005, 43:246-255.
• [38]Shadmi E, Zisberg A, Coleman EA: Translation and validation of the care transition measure into Hebrew and Arabic. Int J Qual Health Care 2009, 21:97-102.
• [39]Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR: Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med 2003, 139:907-915.
• [40]Cooper-Patrick L, Gallo JJ, Gonzales JJ, Vu HT, Powe NR, Nelson C, Ford DE: Race, gender, and partnership in the patient-physician relationship. JAMA 1999, 282:583-589.
• [41]García JA, Paterniti DA, Romano PS, Kravitz RL: Patient preferences for physician characteristics in university-based primary care clinics. Ethn Dis 2003, 13:259-267.
• [42]Ministry of Health: Workforce Survey in the Israeli Health Care System for 2009. Jerusalem: Israel Ministry of Health; 2010. Hebrew
• [43]Snow V, Beck D, Budnitz T, Miller DC, Potter J, Wears RL, Weiss KB, Williams MV: Transitions of Care Consensus Policy Statement American College of Physicians-Society of General Internal Medicine-Society of Hospital Medicine-American Geriatrics Society-American College of Emergency Physicians-Society of Academic Emergency Medicine. J Gen Intern Med 2009, 24:971-976.
• [44]Gross R, Brammli-Greenberg S, Matzliach R: Public opinion on the level of service and performance of the health care system ten years after the introduction of national health insurance. Jerusalem: JDC-Brookdale Institute; 2007. (Hebrew)
• [45]Parry C, Mahoney E, Chalmers SA, Coleman EA: Assessing the quality of transitional care: further applications of the care transitions measure. Med Care 2008, 46:317-322.
• [46]Clark T, Sleath B, Rubin RH: Influence of ethnicity and language concordance on physician-patient agreement about recommended changes in patient health behavior. Patient Educ Couns 2004, 53:87-93.
• [47]Bischoff A, Hudelson P: Access to healthcare interpreter services: where are we and where do we need to go? Int J Environ Res Public Health 2010, 7:2838-2844.