Results Summary

What was the research about?

Compared with fluent English speakers, patients who speak limited English often receive lower quality health care and have worse health. Offering patients a better way to talk about their health in their preferred language may improve health and quality of care.

In this study, the research team compared patients who received care before and after their clinics started using the Language Access Systems Improvement program, or LASI. Before LASI, patients scheduled an in-person interpreter before their clinic visit. Or they could use the phone to talk to an interpreter on demand. When treating patients who spoke limited English, bilingual clinicians spoke in Cantonese, Mandarin, or Spanish based on their own comfort level.

After LASI, patients and clinicians could request on-demand interpreters via video. Clinicians could also take a test to be certified to use a non-English language with patients.

The research team looked at patient-clinician communication and health outcomes for patients who spoke limited English.

What were the results?

During clinical visits where clinicians and patients didn’t speak the same language, after LASI, patients were more likely to

  • Use an interpreter
  • Discuss exercise
  • Remember discussing exercise and diet
  • Complete lab tests within 30 days

LASI didn’t change whether patients

  • Had a new prescription from their clinicians
  • Knew if clinicians prescribed a new medicine
  • Discussed diet during the visit
  • Completed lab tests within 100 days
  • Visited a referred specialist
  • Had better control of their blood pressure, heart disease, or diabetes

Who was in the study?

To look at patient-clinician communication, the study included 1,029 clinic visits with adults at least 40 years old. All received care at a primary care practice in San Francisco, California. Of these adults, 73 percent were Chinese, and 27 percent were Latino. The average age was 70, and 67 percent were women.

To look at health outcomes, the study included 2,123 adults. All had at least one chronic health problem. Of these adults, 59 percent were Chinese, and 41 percent were Latino. The average age was 64, and 57 percent were women.

What did the research team do?

The research team surveyed patients by phone to ask about patient-clinician communication one week after their clinic visit. The team also looked at health records before and after LASI.

Patients and caregivers gave input on the study.

What were the limits of the study?

This study took place in one practice in one city. Findings may differ in other places.

Future research could look at more ways to improve health and health care for patients who speak limited English.

How can people use the results?

Health systems can use the results when looking at ways to support patients who speak limited English.

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
$2,576,243
10.25302/02.2021.AD.140923627
Clinician Language Concordance and Interpreter Use: Impact of a Systems Intervention on Communication and Clinical Outcomes

Key Dates

April 2015
November 2020
2015
2020

Study Registration Information

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Last updated: January 25, 2023