Patient–physician language concordance and quality and safety outcomes among frail home care recipients admitted to hospital in Ontario, Canada

Emily Seale; Michael Reaume; Ricardo Batista; Anan Bader Eddeen; Rhiannon Roberts; Emily Rhodes; Daniel I. McIsaac; Claire E. Kendall; Manish M. Sood; Denis Prud’homme; Peter Tanuseputro

doi:10.1503/cmaj.212155

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Figure 1:
Study flow diagram. Note: RAI-HC = Resident Assessment Instrument–Home Care, OHIP = Ontario Health Insurance Plan.
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Figure 2:
Adjusted in-hospital outcomes for Francophone and allophone recipients of home care. Language-discordant care is the reference in all analyses. Values to the left of the line of null effect denote lower risk of harm (i.e., record of 1 or more adverse events during hospital admission), shorter stays in hospital and lower risk of death among patients receiving language-concordant care; values to the right of the line of null effect denote higher risk of harm, longer stays in hospital and higher risk of death among patients receiving language-concordant care. Effect sizes adjusted for age at admission, sex, marital status, education, income quintile, geographic region, urban or rural residence, immigration status, Charlson Comorbidity Index, diagnostic risk score, activities of daily living (ADL) scale, instrumental ADL scale, cognitive performance scale and changes in health, end-stage disease, signs and symptoms (CHESS) score. Note: CI = confidence interval, OR = odds ratio.
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Figure 3:
Adjusted postdischarge (within 30 days of discharge) outcomes for Francophone and allophone recipients of home care. Language-discordant care is the reference in all analyses. Values to the left of the line of null effect denote lower risk of emergency department visits, hospital admissions and death among patients receiving language-concordant care; values to the right of the line of null effect denote higher risk of emergency department visits, hospital admissions and death among patients receiving language-concordant care. Effect sizes adjusted for age at admission, sex, marital status, education, income quintile, geographic region, urban or rural residence, immigration status, Charlson Comorbidity Index, diagnostic risk score, activities of daily living (ADL) scale, instrumental ADL scale, cognitive performance scale and changes in health, end-stage disease, signs and symptoms (CHESS) score. Note: CI = confidence interval, OR = odds ratio.

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Table 1:

Baseline characteristics of home care recipients

Characteristic	No. (%) of recipients^*
Characteristic	Anglophone n = 159 621	Francophone n = 5118	Allophone n = 24 951
Age at admission, yr, mean ± SD	76.9 ± 12.6	78.5 ± 10.7	80.6 ± 9.4
Sex
Female	87 857 (55.0)	2888 (56.4)	13 399 (53.7)
Male	71 764 (45.0)	2230 (43.6)	11 552 (46.3)
Marital status
Not married	86 797 (54.4)	2955 (57.7)	12 236 (49.0)
Married or common-law	69 199 (43.4)	2085 (40.7)	12 553 (50.3)
Other	3625 (2.3)	78 (1.5)	162 (0.6)
Education
Less than high school	34 346 (21.5)	2255 (44.1)	9669 (38.8)
High school	24 955 (15.6)	544 (10.6)	1744 (7.0)
Some postsecondary	20 784 (13.0)	462 (9.0)	1588 (6.4)
University graduate	14 775 (9.3)	317 (6.2)	1073 (4.3)
Missing or unknown	64 761 (40.6)	1540 (30.1)	10 877 (43.6)
Income quintile
1 (lowest)	40 484 (25.4)	1407 (27.5)	6367 (25.5)
2	34 511 (21.6)	1216 (23.8)	6114 (24.5)
3	30 358 (19.0)	1013 (19.8)	5091 (20.4)
4	27 607 (17.3)	803 (15.7)	4203 (16.8)
5 (highest)	26 161 (16.4)	656 (12.8)	3113 (12.5)
Missing	500 (0.3)	23 (0.4)	63 (0.3)
Ontario geographic region
Champlain	11 163 (7.0)	2528 (49.4)	895 (3.6)
North	13 740 (8.6)	1845 (36.0)	685 (2.7)
Other	134 718 (84.4)	745 (14.6)	23 371 (93.7)
Urban or rural residence
Urban	137 344 (86.0)	3676 (71.8)	24 488 (98.1)
Rural	22 129 (13.9)	1429 (27.9)	452 (1.8)
Missing	148 (0.1)	13 (0.3)	11 (0)
Immigrant^†
Yes	4044 (2.5)	55 (1.1)	6095 (24.4)
No	155 577 (97.5)	5063 (98.9)	18 856 (75.6)

Note: SD = standard deviation.
↵* Unless indicated otherwise.
↵† Residents who immigrated to Canada and were granted citizenship or permanent residency after 1985.

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Table 2:

Health characteristics and functional status of home care recipients

Characteristic	No. (%) of recipients^*
Characteristic	Anglophone n = 159 621	Francophone n = 5118	Allophone n = 24 951
No. of chronic conditions, mean ± SD	4.0 ± 1.6	4.1 ± 1.7	4.1 ± 1.7
Charlson Comorbidity Index, mean ± SD	1.9 ± 2.1	1.9 ± 2.0	2.0 ± 2.0
ADL scale
Independent	90 462 (56.7)	2947 (57.6)	10 632 (42.6)
Supervision required	20 079 (12.6)	650 (12.7)	3767 (15.1)
Limited impairment	24 911 (15.6)	827 (16.2)	5010 (20.1)
Extensive assistance required (1)^†	11 129 (7.0)	360 (7.0)	2298 (9.2)
Extensive assistance required (2)^†	7492 (4.7)	205 (4.0)	1740 (7.0)
Dependent	4673 (2.9)	119 (2.3)	1094 (4.4)
Total dependence	875 (0.5)	10 (0.2)	410 (1.6)
IADL scale
No difficulty in any IADL	6315 (4.0)	139 (2.7)	430 (1.7)
Some difficulty in 1 IADL	7996 (5.0)	216 (4.2)	597 (2.4)
Some difficulty in 2 IADLs	18 856 (11.8)	526 (10.3)	1693 (6.8)
Some difficulty in all IADLs	2612 (1.6)	92 (1.8)	393 (1.6)
Great difficulty in 1 IADL	32 369 (20.3)	1025 (20.0)	3629 (14.5)
Great difficulty in 2 IADLs	70 279 (44.0)	2283 (44.6)	11 656 (46.7)
Great difficulty in all IADLs	21 194 (13.3)	837 (16.4)	6553 (26.3)
Cognitive performance scale
Intact	61 395 (38.5)	1633 (31.9)	7200 (28.9)
Borderline intact	28 728 (18.0)	932 (18.2)	4547 (18.2)
Mild impairment	51 295 (32.1)	1825 (35.7)	8878 (35.6)
Moderate impairment	12 891 (8.1)	542 (10.6)	2582 (10.3)
Moderate severe impairment	1569 (1.0)	50 (1.0)	490 (2.0)
Severe impairment	3129 (2.0)	127 (2.5)	924 (3.7)
Very severe impairment	614 (0.4)	9 (0.2)	330 (1.3)
CHESS score
No health instability	23 527 (14.7)	660 (12.9)	3551 (14.2)
Minimal health instability	43 951 (27.5)	1216 (23.8)	7041 (28.2)
Low health instability	48 068 (30.1)	1564 (30.6)	7710 (30.9)
Moderate health instability	33 491 (21.0)	1243 (24.3)	4962 (19.9)
High health instability	9983 (6.3)	413 (8.1)	1601 (6.4)
Very high health instability	601 (0.4)	22 (0.4)	86 (0.3)

Note: ADL = activities of daily living, CHESS = changes in health, end-stage disease, signs and symptoms, IADL = instrumental activities of daily living, SD = standard deviation.
↵* Unless indicated otherwise.
↵† “Extensive assistance required (1)” denotes patients requiring extensive assistance with personal hygiene or locomotion use (but not eating or locomotion). “Extensive assistance required (2)” denotes patients requiring extensive assistance with eating or locomotion.