A. Z. Paredes1, J. Idrees1, E. W. Beal1, Q. Chen1, E. Cerier1, V. Okunrintemi1, G. Olsen1, S. Sun1, T. M. Pawlik1 1Ohio State University,General Surgery,Columbus, OH, USA
Introduction: The proportion of Hispanic and Asian persons in the United States is expected to increase over the next 50 years. In turn, the number of patients who speak a language other than English will also continue to increase. The effect of English proficiency on health care outcomes has been poorly studied, yet may be important. Therefore, we sought to define the impact of English proficiency on self-reported patient provider communication and shared decision-making.
Methods: The 2013-2014 Medical Expenditure Panel Survey database was utilized to identify respondents who spoke a language other than English and who had self-rated their proficiency in English. Patient provider communication (PPC) and Shared Decision Making (SDM) were characterized into three categories using a composite score that ranged from 4 to 12 (score 4-7: “poor," 8-11: “average,” and 12 “optimal”). The relationship between PPC, SDM and English proficiency was analyzed using regression analysis.
Results: 13,880 respondents spoke a language other than English and self-rated their English proficiency. Most respondents were white (n=10,281, 75%), age 18-39 years (n=6,677, 48%), male (n=7,275, 52%), middle income (n=4,125, 30%), born outside of the United States (n=9,125, 65%), and currently lived in the Western region of the United States (n=5,812, 42%). English proficiency was rated as “very well” (n=7,221, 52%), “well” (n=2,378, 17%), “not well” (n=2,820, 20%) or “not at all” (n=1,463, 10%). Among individuals who self-reported English proficiency as “not at all,” 81% had the medical interview conducted completely in the patient’s native language with or without the use of translator (“well” 38% vs. “not well” 72% p=<0.001). On multivariable analysis, compared with “very well,” patients who self-reported English proficiency as “well” (OR 1.21, CI 1.033–1.42) or “not well” (OR 1.21, CI 1.04–1.43) were more likely to report "poor" PPC (both p<0.02). Similarly, SDM was more commonly self reported as “poor” among patients who reported English proficiency as “not well” (OR 1.31, CI 1.04–1.65, p=0.02). Compared with patients with “very well” English proficiency, individuals who reported “not at all” English proficiency had comparable PPC (OR 1.0, CI 0.82–1.23) and SDM (OR 0.96, CI 0.72–1.28) scores (p>0.05, both). Of note, the majority of patients who reported “poor” PPC had self-reported their proficiency as “well” and therefore had their interview conducted in English (n=413, 72%).
Conclusion: Decreased English proficiency was associated with worse self-reported PPC and SDM. Among patients for whom English was a second language, PPC was “poor” even among patients who reported English proficiency as “well” when the interview was conducted in English. Attention to the patient language needs is critical to patient satisfaction.