BACKGROUND: Given an increasing proportion of non-English speaking residents in Ohio, we hypothesized that patients with limited English proficiency would have lower asthma care quality.
METHODS: We examined four asthma care quality measures by using electronic health records for 18,244 asthma patients aged 2–18 years from a regional health care center in Ohio during 2011–2015. Community-level income was assessed using U.S. Census data. Patients who required an interpreter were compared with patients who had not by using chi-square and t-tests. Multivariable analyses were conducted to assess for confounding by age, sex, race, or insurer.
RESULTS: An interpreter was required for 1,744 (10%) asthma patients. Most common languages interpreted were Spanish (936 [54%]) and Somali (523 [30%]). The majority of patients had Medicaid insurance (85% of interpreter-required patients versus 83%; P = 0.01), compared with 31% of all Ohio children. Average median household income was lower than the Ohio average ($40,740 versus $66,409). Pulmonary function testing was infrequent among both groups (7.8% of interpreter-required patients versus 5.8%; P = 0.02). Patients requiring an interpreter had a similar exacerbation rate (849/1,744 [49%] versus 8,051/16,500 [49%]; P = 0.93) and similar admission rate to intensive care (28/849 [3.3%] versus 230/8,051 [2.9%]; P = 0.47) but better frequency of recommended follow-up after exacerbation (503/849 [59%] versus 3,334/8,051 [41%]; P <.0001). Association of interpreter use with follow-up was attenuated after adjustment for race but remained significant (adjusted odds ratio 1.6; 95% confidence interval 1.3–1.9).
CONCLUSIONS: Limited English proficiency was not a barrier to asthma care quality among this low-income population. Pediatric patients might benefit from improved follow-up after asthma exacerbation, regardless of English proficiency.