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Trained Interpreters Improve Patient and Provider Satisfaction, Says Study

Cheryl Clark, for HealthLeaders Media, March 1, 2010

Even as the Joint Commission introduced standards for medical interpreters, a new study reveals that the use of trained language specialists to assist physician-patient communication dramatically improves satisfaction in emergency room settings with non-English speaking patients.

According to Mathematica Policy Research, a non-partisan survey team, "The use of professional interpreter services dramatically increased satisfaction with patient-provider communication during the ED visit, not only for patients, but for all types of providers—including triage nurses, doctors, and discharge nurses."

Mathematica conducted the study with 424 Spanish speaking, limited English proficiency patients in two central New Jersey hospitals between October 2008 and April 2009.

Patients were assigned to one of two groups. The control group received "usual" language services in the ED, such as telephone language line and ad hoc interpreter services provided by bilingual staff and family members. The treatment group utilized professionally trained medical interpreters, along with the usual language services.

The improvement in satisfaction was not limited to patients and providers, said Ann Bagchi, a Mathematica senior researcher who led the study. "These professional interpreters may also improve other outcomes related to quality of care."

According to the Mathematica report, 96% of patients responded they were "very satisfied" with patient-provider communication in the treatment group compared with 23% in the control group. Likewise, 94% of doctors said they "very satisfied" when trained interpreters were used, compared with 19% when usual language services were provided.

Language and cultural barriers between patients and providers are an increasing concern, as evidenced by the decision last year by the Joint Commission to release new standards for patient provider communication, effective Jan. 1, 2011. Several interpreter certification programs are now in development to accredit and/or train would be interpreters to work in healthcare settings.

The idea is that medical interpreters should have proficiency standards much like those required of court reporters, sign language interpreters, and others who convey essential information. All too often, many hospital officials have acknowledged, children are being used to interpret medical care issues on behalf of their parents.

Instructions for taking medication, conversations with family members, and information on diagnoses and prognosis may get muddled when interpreters are not properly trained or sensitive to cultural fears and values.

Failure to effectively communicate can also drum up health costs, for example, if a patient has already undergone a test but is unable to convey that. Likewise, the inability of a provider to relay the importance of a follow-up visit, or compliance with a medication regimen, can result in avoidable progression of disease or hospitalization.

The Mathematica survey concluded that because high levels of satisfaction increase the likelihood that a patient will return to the same emergency department, the study's results "may influence hospitals' decisions about whether to hire interpreters."

The authors suggested that quality of care may also improve with better, more accurate communication between providers and patients, and recommended rigorous future research in both acute care and other health settings to examine the impact on patient outcomes.

The Robert Wood Johnson Foundation funded the study.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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