U.S. Primary Care Practice Capabilities Linked to Language Services for Patients with Limited English Proficiency.

Abstract

Patients with limited English proficiency (LEP) experience more challenges with clinician communication than English-proficient patients. U.S. federal policies require the provision of language services, but little is known about language service availability in adult primary care practices nationally. To identify primary care physician practice capabilities associated with the routine availability of language services for patients with LEP. Nationally representative physician practice survey data from the National Survey of Healthcare Organizations and Systems were linked to IQVIA OneKey data and the American Community Survey (n = 1226). Multivariable logistic regression models were estimated to assess the association of practice characteristics with availability of language services. Whether a practice "always" provides professional language services. Fifty-four percent of U.S. primary care practices always provide language services. In adjusted analyses, practices participating in an ACO (odds ratio (OR) = 2.21, p < 0.01), owned by a healthcare system or hospital (OR = 6.0, p < 0.01), or with FQHC status (OR = 3.10, p < 0.01) were more likely to provide language services than non-ACO, non-FQHC, or independently owned practices. Practices with relatively high revenue from commercial health insurance (OR = 0.76, p < 0.01) were less likely to provide language services, whereas practices with relatively high Medicaid revenue (OR = 1.33, p < 0.01) were more likely. Even though it is required by law, almost half of U.S. primary care practices do not always provide language services to patients with LEP. Independently owned practices are less likely to offer language services than those owned by healthcare systems or hospitals, or practices with FQHC status, suggesting practice ownership can influence availability. ACO participation and a higher payer mix of Medicaid revenue are associated with language services availability, highlighting that policy reforms can support the routine provision of language services at the practice-level.