Primary Care Engagement and Acute Care Utilization by Interpreter Use in an Urban Resident Clinic: A Retrospective Cohort Study

Abstract Background Patients who prefer a language other than English (LOE) experience well-documented differences in health care access and quality. How care delivery and utilization differ for those requiring professional interpreter services in resident continuity clinics is not well characterized. Objective To compare primary care delivery, preventive screening, chronic disease management, and utilization between patients who did and did not require interpreter services. Design Retrospective cohort study using electronic health record data, October 2022 to October 2024. Setting and Participants An urban internal medicine resident continuity clinic in St. Louis, MO, with in-person interpreter services; 14,457 adults, of whom 1058 had documented interpreter use (LOE; > 50 preferred languages) and 13,399 did not (English-proficient). Main Measures Demographics, area-based socioeconomic indicators, comorbidity burden, screening adherence, clinic attendance, emergency department (ED) visits, and hospitalizations. No primary outcome was pre-specified. Key Results LOE patients were older and more often uninsured or Medicaid-insured, yet resided in less-deprived, higher-income areas (median ADI national percentile 71 vs 85) and had lower comorbidity burden. Colorectal, breast, and cervical cancer screening did not differ. Among those with diabetes, glycemic control was worse (A1c < 7%: 49.3% vs 56.8%; difference − 7.5%, 95% CI − 12.9 to − 2.1), as were tetanus vaccination and HIV screening. They had lower no-show rates (14.0% vs 21.0%; difference − 7.1%, 95% CI − 7.9 to − 6.2), more completed visits (mean 4.6 vs 3.9; difference + 0.7, 95% CI 0.5 to 0.9), fewer ED visits (36.2% vs 56.3%; difference − 20.1%, 95% CI − 23.1 to − 17.1), and fewer hospitalizations (26.5% vs 37.3%; difference − 10.8%, 95% CI − 13.6 to − 8.0). Conclusions In this single clinic, LOE patients had greater primary care engagement and lower acute care utilization, with residual gaps in glycemic control and vaccination. These descriptive, hypothesis-generating findings may reflect who reaches care as well as language-access supports and warrant prospective study.