Article

Improving the Provision of Language Services at an Academic Medical Center: Ensuring High-Quality Health Communication for Limited-English-Proficient Patients

Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48105, USA.
Academic medicine: journal of the Association of American Medical Colleges (Impact Factor: 2.93). 12/2009; 84(12):1693-7. DOI: 10.1097/ACM.0b013e3181bf4659
Source: PubMed

ABSTRACT

To evaluate and improve the provision of language services at an academic medicine center caring for a diverse population including many limited-English-proficient (LEP) patients.
The authors performed a prospective observational study between November 2006 and December 2008 evaluating the provision of language services at the University of Michigan Health System. The primary performance measures were (1) screening patients for their preferred language for health care, (2) assessing the proportion of LEP patients receiving language services from a qualified language services provider, and (3) assessing whether there were any disparities in diabetes care for LEP patients compared with English-speaking patients.
The proportion of patients screened for preferred language increased from 59% to 96% with targeted inventions, such as training staff to capture preferred language for health care and correcting prior inaccurate primary language data entry. The proportion of LEP outpatients with a qualified language services provider increased from 19% to 83% through the use of staff and contract interpreters, over-the-phone interpreting and bilingual providers. There were no systematic differences in diabetes quality performance measures between LEP and English-proficient patients.
Academic medical centers should measure their provision of language services and compare quality and safety data (e.g., performance measures and adverse events) between LEP and English-speaking patients to identify disparities in care. Leadership support and ongoing training are needed to ensure language-specific services are embedded into clinical care to meet the needs of our diverse patient populations.

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    ABSTRACT: To explore clinicians' perceptions of the communication difficulties experienced with Limited English Proficiency (LEP) patients and the clinical risks these difficulties pose in hospitals, as well as patterns of interpreter use among these clinicians. Senior health professionals in the two District Health Boards (DHBs) in the Wellington Area (about 900) of New Zealand were sent an electronic survey. Twenty clinicians were interviewed about their experience in 22 consultations with LEP patients, and an equal number with English proficient patients. Descriptive statistics were calculated, and 95% confidence intervals and formal statistical tests. 141 responses were received to the survey. There was a high level of awareness of how to access interpreters (84%) and lesser awareness of DHB interpreter policy (65%). Most respondents felt that communication difficulties with LEP patients have a significant effect on care at least sometimes, but there is a wide variation in reported actual use of interpreters, with only 14% always using an interpreter. In the actual consultations studied, no professional interpreters were used despite clinician acknowledgement of increased clinical risk. Even when clinicians are aware of policy, of how to obtain interpreters, and of the increased clinical risk in the situation, this does not necessarily lead to high levels of interpreter use with LEP patients.
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