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Journal of General Internal Medicine

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01-06-2015 | Original Research

Use of Interpreters by Physicians for Hospitalized Limited English Proficient Patients and Its Impact on Patient Outcomes

Authors: Lenny López, MD, MPH, Fátima Rodriguez, MD, MPH, Diego Huerta, BA, Jane Soukup, MSc, Leroi Hicks, MD, MPH

Published in: Journal of General Internal Medicine | Issue 6/2015

ABSTRACT

BACKGROUND

Few studies have examined the impact of inpatient interpreter use for limited English proficient (LEP) patients on length of stay (LOS), 30-day post discharge emergency department (ED) visits and 30-day hospital readmission rates for LEP patients.

METHODS

A retrospective cohort analysis was conducted of all hospitalized patients admitted to the general medicine service at a large academic center. For patients self-reported as LEP, use of interpreters during each episode of hospitalization was categorized as: 1) interpreter used by non-MD (i.e., nurse); 2) interpreter used by a non-Hospitalist MD; 3) interpreter used by Hospitalist; and 4) no interpreter used during hospitalization. We examined the association of English proficiency and interpreter use on outcomes utilizing Poisson and logistic regression models.

RESULTS

Of 4,224 patients, 564 (13 %) were LEP. Of these LEP patients, 65.8 % never had a documented interpreter visit, 16.8 % utilized an interpreter with a non-MD, 12.6 % utilized an interpreter with a non-Hospitalist MD and 4.8 % utilized an interpreter with a hospitalist present. In adjusted models, compared to English speakers, LEP patients with no interpreters had significantly shorter LOS. There were no differences in readmission rates and ED utilization between LEP and English-speaking patients. Compared to LEP patients with no interpreter use, those who had a physician use an interpreter had odds for a longer LOS, but there was no difference in odds of readmission or ED utilization.

CONCLUSION

Academic hospital clinician use of interpreters remains highly variable and physicians may selectively be using interpreters for the sickest patients.

United States Census Bureau. Language spoken at home by ability to speak English for the population 5 years and over. Available at: http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_11_1YR_B16001&prodType=table. Accessed January 13, 2015.

Bernstein R. U.S. Census Bureau projections show a slower growing, older, more diverse nation a half century from now. United States Census Bureau Newsroom [Internet]. 2012 December 12. Available at: https://www.census.gov/newsroom/releases/archives/population/cb12-243.html. Accessed January 13, 2015.

Wilson-Stronks A, Galvez E. Hospitals, language and culture: A snapshot of the nation. Exploring cultural and linguistic services in the nation’s hospitals: A report of findings. The Joint Commission and The California Endowment 2007.

Diamond LC, Schenker Y, Curry L, Bradley EH, Fernandez A. Getting by: underuse of interpreters by resident physicians. J Gen Intern Med. 2009;24(2):256–62. doi:10.1007/s11606-008-0875-7.CrossRefPubMedCentralPubMed

Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007;42(2):727–54. doi:10.1111/j.1475-6773.2006.00629.x.CrossRefPubMedCentralPubMed

Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62(3):255–99. doi:10.1177/1077558705275416.CrossRefPubMed

Flores G, Abreu M, Barone CP, Bachur R, Lin H. Errors of medical interpretation and their potential clinical consequences: a comparison of professional versus ad hoc versus no interpreters. Ann Emerg Med. 2012;60(5):545–53. doi:10.1016/j.annemergmed.2012.01.025.CrossRefPubMed

Cohen AL, Rivara F, Marcuse EK, McPhillips H, Davis R. Are language barriers associated with serious medical events in hospitalized pediatric patients? Pediatrics. 2005;116(3):575–9. doi:10.1542/peds. 2005-0521.CrossRefPubMed

Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in US hospitals: a pilot study. Int J Qual Health Care. 2007;19(2):60–7. doi:10.1093/intqhc/mzl069.CrossRefPubMed

10.

Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century 2001.

11.

Ramirez D, Engel KG, Tang TS. Language interpreter utilization in the emergency department setting: a clinical review. J Health Care Poor Underserved. 2008;19(2):352–62. doi:10.1353/hpu.0.0019.CrossRefPubMed

12.

Lindholm M, Hargraves JL, Ferguson WJ, Reed G. Professional language interpretation and inpatient length of stay and readmission rates. J Gen Intern Med. 2012;27(10):1294–9. doi:10.1007/s11606-012-2041-5.CrossRefPubMedCentralPubMed

13.

Grubbs V, Bibbins-Domingo K, Fernandez A, Chattopadhyay A, Bindman AB. Acute myocardial infarction length of stay and hospital mortality are not associated with language preference. J Gen Intern Med. 2008;23(2):190–4. doi:10.1007/s11606-007-0459-y.CrossRefPubMedCentralPubMed

14.

Jacobs EA, Sadowski LS, Rathouz PJ. The impact of an enhanced interpreter service intervention on hospital costs and patient satisfaction. J Gen Intern Med. 2007;22(Suppl 2):306–11. doi:10.1007/s11606-007-0357-3.CrossRefPubMedCentralPubMed

15.

John-Baptiste A, Naglie G, Tomlinson G, et al. The effect of English language proficiency on length of stay and in-hospital mortality. J Gen Intern Med. 2004;19(3):221–8. doi:10.1111/j.1525-1497.2004.21205.x.CrossRefPubMedCentralPubMed

16.

Karliner LS, Kim SE, Meltzer DO, Auerbach AD. Influence of language barriers on outcomes of hospital care for general medicine inpatients. J Hosp Med. 2010;5(5):276–82. doi:10.1002/jhm.658.CrossRefPubMed

17.

Smedley BD, Stith AY, Nelson AR. editors (Institute of Medicine). Unequal treatment: confronting racial and ethnic disparities in health care (with CD). Washington, DC: National Academies Press; 2003.

18.

Nalichowski R, Keogh D, Chueh HC, Murphy SN. Calculating the benefits of a Research Patient Data Repository. AMIA Annual Symposium proceedings/AMIA Symposium. AMIA Symposium 2006:1044.

19.

The Official Website of the Executive Office of Health and Human Services. Interpreter services. Available at: http://www.mass.gov/eohhs/gov/departments/dph/programs/admin/health-equity/interpreter-services.html. Accessed January 13, 2015.

20.

Official Website of the City of Boston. Demographic report. Available at: http://www.cityofboston.gov/newbostonians/publications.asp. Accessed January 13, 2015.

21.

Schenker Y, Perez-Stable EJ, Nickleach D, Karliner LS. Patterns of interpreter use for hospitalized patients with limited English proficiency. J Gen Intern Med. 2011;26(7):712–7. doi:10.1007/s11606-010-1619-z.CrossRefPubMedCentralPubMed

22.

U.S. Department of Health and Human Services, Office of Minority Health. National standards for culturally and linguistically appropriate services in health care. Washington, DC; 2001.

23.

Ulmer C, McFadden B, Nerenz DR. editors (Institute of Medicine). Race, ethnicity, and language data: standardization for health care quality improvement. Washington, DC: National Academies Press; 2009.

24.

Equal Employment Opportunity Program (US). Title VI, Prohibition against national origin discrimination affecting limited english proficient persons. Final guidance. Fed Regist. 2004;69(7):1763–8.

25.

Ebden P, Carey OJ, Bhatt A, Harrison B. The bilingual consultation. Lancet. 1988;1(8581):347.CrossRefPubMed

26.

David RA, Rhee M. The impact of language as a barrier to effective health care in an underserved urban Hispanic community. Mt Sinai J Med. 1998;65(5–6):393–7.PubMed

27.

Launer J. Taking medical histories through interpreters: practice in a Nigerian outpatient department. Br Med J. 1978;2(6142):934–5.CrossRefPubMedCentralPubMed

28.

Diamond LC, Tuot DS, Karliner LS. The use of Spanish language skills by physicians and nurses: Policy implications for teaching and testing. J Gen Intern Med. 2012;27(1):117–23. doi:10.1007/s11606-011-1779-5.CrossRefPubMedCentralPubMed

29.

Fagan MJ, Diaz JA, Reinert SE, Sciamanna CN, Fagan DM. Impact of interpretation method on clinic visit length. J Gen Intern Med. 2003;18(8):634–8. doi:10.1046/j.1525-1497.2003.20701.x.CrossRefPubMedCentralPubMed

30.

Tocher TM, Larson EB. Do physicians spend more time with non-English-speaking patients? J Gen Intern Med. 1999;14(5):303–9.CrossRefPubMedCentralPubMed

31.

Shi L. Patient and hospital characteristics associated with average length of stay. Health Care Manag Rev. 1996;21(2):46–61.CrossRef

32.

Chen LM, Farwell WR, Jha AK. Primary care visit duration and quality: does good care take longer? Arch Intern Med. 2009;169(20):1866–72. doi:10.1001/archinternmed.2009.341.CrossRefPubMed

33.

Abbo ED, Zhang Q, Zelder M, Huang ES. The increasing number of clinical items addressed during the time of adult primary care visits. J Gen Intern Med. 2008;23(12):2058–65. doi:10.1007/s11606-008-0805-8.CrossRefPubMedCentralPubMed

34.

Gany F, Leng J, Shapiro E, et al. Patient satisfaction with different interpreting methods: a randomized controlled trial. J Gen Intern Med. 2007;22(Suppl 2):312–8. doi:10.1007/s11606-007-0360-8.CrossRefPubMedCentralPubMed

35.

Jacobs EA, Leos GS, Rathouz PJ, Fu P Jr. Shared networks of interpreter services, at relatively low cost, can help providers serve patients with limited english skills. Health Aff. 2011;30(10):1930–8. doi:10.1377/hlthaff.2011.0667.CrossRef

36.

Karliner LS, Mutha S. Achieving quality in health care through language access services: lessons from a California public hospital. Am J Med Qual. 2010;25(1):51–9. doi:10.1177/1062860609351237.CrossRefPubMed

37.

Napoles AM, Santoyo-Olsson J, Karliner LS, O’Brien H, Gregorich SE, Perez-Stable EJ. Clinician ratings of interpreter mediated visits in underserved primary care settings with ad hoc, in-person professional, and video conferencing modes. J Health Care Poor Underserved. 2010;21(1):301–17. doi:10.1353/hpu.0.0269.CrossRefPubMedCentralPubMed

38.

Howie-Esquivel J, Dracup K. Effect of gender, ethnicity, pulmonary disease, and symptom stability on rehospitalization in patients with heart failure. Am J Cardiol. 2007;100(7):1139–44. doi:10.1016/j.amjcard.2007.04.061.CrossRefPubMed

39.

Campbell SE, Seymour DG, Primrose WR, Project A. A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. Age Ageing. 2004;33(2):110–5. doi:10.1093/ageing/afh036.CrossRefPubMed

Title: Use of Interpreters by Physicians for Hospitalized Limited English Proficient Patients and Its Impact on Patient Outcomes
Authors: Lenny López, MD, MPH
Fátima Rodriguez, MD, MPH
Diego Huerta, BA
Jane Soukup, MSc
Leroi Hicks, MD, MPH
Publication date: 01-06-2015
Publisher: Springer US
Published in: Journal of General Internal Medicine / Issue 6/2015
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-015-3213-x

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BACKGROUND

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