Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers expressed concern about the researchers using an existing patient advisory committee for their engagement activities, when it was unclear how many people on that committee had experience with limited English proficiency. The researchers explained that while they used the existing patient advisory committee while developing the project proposal, once the study began they established the Advisory Collaboration on Language Access to better represent the needs of patients with limited English proficiency.
  • The reviewers asked why the researchers excluded African Americans and other nonwhite patients as English-proficient controls in aim 2 of the project. The researchers said they only included the groups that they had previously specified in their protocol, including those with Chinese, Latino, and white ethnicity compared to non-English proficient Chinese and Spanish speakers. The researchers acknowledged that African Americans and other nonwhite, English- proficient groups are important subgroups to consider and may be included in future analyses.
  • The reviewers asked about the measure used to assess health literacy. They suggested that future research should try to integrate the health literacy levels of family and friends who were present at visits and acted as interpreters or care partners. The researchers said they assessed health literacy assessed based on the answer to a single question: “How confident are you filling out medical forms by yourself?” The researchers noted that this question had been validated as an assessment for health literacy in a study published in 2008. 
  • The reviewers asked about the use of video medical interpreting (VMI)—how  easy it was to work with, how VMI affected what patients and clinicians discussed, and whether technical problems with VMI interfered with rapport. The researchers responded that they did not have data on how often VMI technology malfunctioned during visits but said that the type of interpretation used did not significantly affect the patient-centeredness of visits. The researchers pointed out that in focus groups, patients and clinicians were largely happy with VMI.
  • The reviewers wondered about the difficulty of certifying a clinician’s language skills, given that providers seemed reluctant to be tested on their language proficiency. The researchers said they used direct observation to account for provider reluctance, but that the direct observation tool they developed will require further study to establish its reliability and validity. The researchers noted that the implementation of the Language Access Systems Improvement program increased the overall use of interpretation services in visits.

Conflict of Interest Disclosures

Project Information

Leah S. Karliner, MD, MAS
University of California San Francisco
Clinician Language Concordance and Interpreter Use: Impact of a Systems Intervention on Communication and Clinical Outcomes

Key Dates

April 2015
November 2020

Study Registration Information


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Last updated: March 4, 2022