Inpatient Care Experiences Differ by Preferred Language Within Racial/Ethnic Groups

Published in: Health Services Research, Volume 54, Issue S1, pages 263–274 (February 2019). doi: 10.1111/1475-6773.13105

by Denise D. Quigley, Marc N. Elliott, Katrin Hambarsoomian, Shondelle Wilson-Frederick, William Lehrman, Denis Agniel, Judy H. Ng, Elizabeth Goldstein, Laura Giordano, Steven C. Martino

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To describe differences in patient experiences of hospital care by preferred language within racial/ethnic groups.

Data Source

2014–2015 HCAHPS survey data.

Study Design

We compared six composite measures for seven languages (English, Spanish, Russian, Portuguese, Chinese, Vietnamese, and Other) within applicable subsets of five racial/ethnic groups (Hispanics, Asian/Pacific Islanders, American Indian/Alaska Natives, Blacks, and Whites). We measured patient-mix adjusted overall, between- and within-hospital differences in patient experience by language, using linear regression.

Data Collection Methods

Surveys from 5,480,308 patients discharged from 4517 hospitals 2014–2015.

Principal Findings

Within each racial/ethnic group, mean reported experiences for non-English-preferring patients were almost always worse than their English-preferring counterparts. Language differences were largest and most consistent for Care Coordination. Within-hospital differences by language were often larger than between-hospital differences and were largest for Care Coordination. Where between-hospital differences existed, non-English-preferring patients usually attended hospitals whose average patient experience scores for all patients were lower than the average scores for the hospitals of their English-preferring counterparts.


Efforts should be made to increase access to better hospitals for language minorities and improve care coordination and other facets of patient experience in hospitals with high proportions of non-English-preferring patients, focusing on cultural competence and language-appropriate services.

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