Association of Patient Language with Guideline-Concordant Care for Individuals with Chronic Kidney Disease (CKD) in Prim
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University of California, San Francisco, San Francisco, CA, USA; 2Kidney Health Research Collaborative, University of California, San Francisco, CA, USA; 3Cricket Health, Inc., San Francisco, CA, USA.
J Gen Intern Med DOI: 10.1007/s11606-019-05113-4 © Society of General Internal Medicine 2019
INTRODUCTION
Adequate primary care has the potential to reduce the high morbidity among persons with chronic kidney disease (CKD).1 However, major gaps in care are documented, and these gaps are larger among race/ethnic minority groups, compared with whites.2 Whether a patient’s level of English proficiency and language preference contributes to gaps in appropriate CKD care prior to kidney failure remains poorly understood.3 Persons with limited English proficiency (LEP) are less likely than English speakers to receive optimal care, independent of selfreported race/ethnicity.4 We evaluated the association of non-English language preference with guidelineconcordant CKD care among adults with low eGFR who had active primary care in a well-resourced clinic with easy access to multimodal medical interpretation.
METHODS
We used University of California, San Francisco (UCSF) electronic medical records (EMR) data to identify a cohort of persons with CKD in primary care as previously described.5 We defined CKD as two eGFR measurements between 15 and < 60 ml/min/1.73 m2 at least 3 months apart.6 This study was approved by the institutional review board at UCSF. Patients were considered non-English language preferring if the EMR documented preferred language was not English. We considered providers and patients to be language-concordant if records indicated that the provider spoke the non-English language preferred by the patient. Outcomes of interest were evidence-based processes of care from international guidelines:6 (1) testing for albuminuria, which is required for risk stratification; (2) testing for hemoglobin A1c for diabetics; (3) prescription of inhibitors of the renin-angiotensin system (ACEi/ARB) for patients with diabetes or hypertension; (4) prescription
of a statin for patients age > 50 years; (5) BP < 140/ 90 mmHg; and (6) hemoglobin A1c < 7 for patients with diabetes, during the study period. Covariates included patient demographics, comorbidities, insurance type, and number of primary care visits, as previously described.5 We compared characteristics by patient language preference (English vs. non-English) using chi-squared tests. We estimated the relative risk of each outcome for patients with non-English language preference compared with English-language preference using multivariable modified Poisson regression models with logarithm link, clustered on provider and adjusting for potential confounders. Finally, we stratified analyses by provider-patient language concordance.
RESULTS
Among 1726 persons with CKD, 17% preferred a language other than English. The most common language preferred was Cantonese (30%), followed by Spanish (14%), Russian (13%), Vietnamese (10%), Mandarin (8%), and Korean (7%). Compared w
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