Professional Abstract
Objective
To evaluate the effectiveness of interpreter access for patients and language certification for clinicians on improving patient-clinician communication and clinical outcomes among Chinese and Latino adults
Study Design
| Design Element |
Description |
| Design |
Quasi-experimental |
| Population |
Communication: 1,029 primary care visits among Chinese and Latino adults at least 40 years old with limited English proficiency
Clinical: 2,123 Chinese and Latino adults at least 18 years old with at least 1 chronic condition (hypertension, diabetes, or heart disease) |
Interventions/
Comparators |
- Communication: partially language concordant or language discordant pre-LASI versus post-LASI clinic visits among adults with limited English proficiency
- Clinical: pre-LASI versus post-LASI comparison between adults with limited English proficiency and those who are English proficient
|
| Outcomes |
Communication: interpreter utilization, frequency of new medication prescribed at the visit, patient awareness of new medication prescription, frequency of diet and exercise discussions, patient awareness of diet and exercise discussions, completion of ordered lab tests within 30 days and within 100 days, completion of referral appointments
Clinical: hypertension control, HbA1c control, anti-platelet or statin prescription
|
| Timeframe |
Communication: up to 1-week follow-up after clinic visits
Clinical: up to 2-year follow up |
Compared with fluent English speakers, patients who speak limited English often receive lower quality health care and often have worse health. This natural experiment examined whether the Language Access Systems Improvement (LASI) program improved patient-clinician communication and patients’ clinical outcomes. LASI included two initiatives in one health system in San Francisco: on-demand video medical interpretation services for patients and their clinicians and bilingual language certification for clinicians.
Before the LASI program, patients and their clinicians either scheduled an interpreter in advance for in-person services or could access telephone services on demand. When treating patients with limited English proficiency, bilingual clinicians spoke in Cantonese, Mandarin, or Spanish based on their self-reported ability. After LASI, patients and their clinicians could request on-demand interpreters via videoconferencing, and clinicians could take an oral proficiency test to be certified to use a non-English language with patients.
For communication outcomes, the study included 1,029 primary care visits. Of patients at these visits, 73% were Chinese, and 27% were Latino. The average age was 70, and 67% were female. Researchers surveyed patients by telephone and reviewed health records before and after LASI up to one week after patients’ clinical visits.
For clinical outcomes, the study included 2,123 Chinese and Latino adults with at least one chronic condition. Of these, 59% were Chinese, and 41% were Latino. The average age was 64, and 57% were female. Researchers reviewed patients’ health records before and after LASI to compare outcomes among Chinese and Latino adults who spoke limited English with those who were English proficient.
Patients and caregivers provided input on the study.
Results
Communication. Among partially language concordant or language discordant primary care visits with similar characteristics based on inverse probability weighted (IPW) propensity scores, the odds of professional interpreter use were higher post-LASI versus pre-LASI (IPW odds ratio [OR]=2.39; 95% confidence interval [CI]: 1.04, 5.48). Compared with pre-LASI, post-LASI patients were more likely to
- Have discussed exercise (IPW OR=2.04; 95% CI: 1.24, 3.36)
- Remember discussing exercise (IPW OR=5.02; 95% CI: 1.97, 12.8) and diet (IPW OR=5.94; 95% CI: 2.28, 15.5)
- Complete lab tests within 30 days (adjusted hazard ratio [aHR]=1.25; 95% CI: 1.0, 1.6)
Patients seeking care before and after LASI did not differ significantly in other communication outcomes.
Clinical. Compared with English-speaking patients, those who spoke limited English did not differ significantly in blood pressure control, HbA1C control, and statin or anti-platelet use pre- versus post-LASI.
Limitations
The study took place in one health system. Findings may differ in other locations.
Conclusions and Relevance
LASI was associated with increased professional interpreter use and increased patient awareness of diet and exercise discussions but not with improvements in clinical outcomes.
Future Research Needs
Future research could examine additional ways to improve clinical outcomes for patients with limited English proficiency.
