Compared with English speakers, patients with limited English proficiency (LEP) have worse healthcare quality. Full language concordance (i.e., the clinician is fully proficient in the patient’s language) and professional interpreters are important ways to reduce these disparities; however, both access to professional interpreters and determination of clinician language proficiency are challenging. To address these dual challenges, the University of California San Francisco (UCSF) has embarked on the Language Access Systems Improvement (LASI) initiative. LASI is made up of two complementary improvement programs: (1) certifying bilingual clinicians to use their non- English-language skills directly with patients, and (2) simultaneously increasing easy access to professional interpreters via videoconferencing in its ambulatory practices. We propose to investigate the impact of this initiative on communication and clinical outcomes for LEP patients.
In our first aim, we will recruit Chinese- and Spanish-speaking adult patients for a telephone interview within one week of a primary care visit to evaluate the impact of LASI on: (1) the proportion of professionally interpreted and language concordant visits; and (2) patients’ understanding of their medications, tests and referrals, and recommendations about health-related behaviors, such as diet and exercise. We will additionally audiotape primary care visits to evaluate and compare patient- centered communication for different modes of bridging the language barrier In our second aim, we will use data from the electronic medical record to evaluate the impact of LASI on clinical outcomes for Chinese- and Spanish-speaking adult patients with at least one chronic condition (hypertension, diabetes, or heart disease). Both aims will have an English-speaking comparison group. Our study design and outcomes were chosen in collaboration with the UCSF primary care practice’s Patient Advisory Council to ensure that the results will be useful and meaningful to patients.
This proposal leverages a unique opportunity of a natural experiment to evaluate a systems intervention in a real clinical setting. Together, the specific aims will provide new and important information about whether a systems intervention can increase appropriate means of communication during clinical care with LEP patients, and whether, in turn, that improvement will have a positive impact on communication and clinical outcomes that are important to patients. If proved effective, the results from this work will support implementation of similar language access initiatives in health systems across the country. These, in turn, will decrease disparities in health and health care for the growing population of aging LEP patients in the United States.
Training and Education Interventions
Low Health Literacy/Numeracy
Individuals with Multiple Chronic/co-morbid Conditions