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    patients who use professional interpreters are _______ satisfied with the overall health care visit as patients who use qualified bilingual providers.

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    Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature

    To determine if professional medical interpreters have a positive impact on clinical care for limited English proficiency (LEP) patients.A systematic literature search, limited to the English language, in PubMed and PsycINFO for publications between 1966 ...

    Health Serv Res. 2007 Apr; 42(2): 727–754.

    doi: 10.1111/j.1475-6773.2006.00629.x

    PMCID: PMC1955368 PMID: 17362215

    Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature

    Leah S Karliner, Elizabeth A Jacobs, Alice Hm Chen, and Sunita Mutha

    Author information Copyright and License information Disclaimer

    This article has been cited by other articles in PMC.

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    Abstract

    Objective

    To determine if professional medical interpreters have a positive impact on clinical care for limited English proficiency (LEP) patients.

    Data Sources

    A systematic literature search, limited to the English language, in PubMed and PsycINFO for publications between 1966 and September 2005, and a search of the Cochrane Library.

    Study Design

    Any peer-reviewed article which compared at least two language groups, and contained data about professional medical interpreters and addressed communication (errors and comprehension), utilization, clinical outcomes, or satisfaction were included. Of 3,698 references, 28 were found by multiple reviewers to meet inclusion criteria and, of these, 21 assessed professional interpreters separately from ad hoc interpreters. Data were abstracted from each article by two reviewers. Data were collected on the study design, size, comparison groups, analytic technique, interpreter training, and method of determining the participants' need for an interpreter. Each study was evaluated for the effect of interpreter use on four clinical topics that were most likely to either impact or reflect disparities in health and health care.

    Principal Findings

    In all four areas examined, use of professional interpreters is associated with improved clinical care more than is use of ad hoc interpreters, and professional interpreters appear to raise the quality of clinical care for LEP patients to approach or equal that for patients without language barriers.

    Conclusions

    Published studies report positive benefits of professional interpreters on communication (errors and comprehension), utilization, clinical outcomes and satisfaction with care.

    Keywords: Language barriers, health disparities, quality of care, physician–patient communication

    According to the 2000 Census, 47 million people in the United States speak a language other than English at home (Shin and Bruno 2003). Half of these individuals report that they speak English less than “very well.” These individuals are considered to have limited English proficiency (LEP). That is, they are not able to speak, read, write, or understand the English language at a level that permits them to interact effectively with health care providers (OCR 2002). This language barrier puts the health of many LEP individuals, and that of their communities at risk by affecting their ability to access care and communicate with their providers.

    It is well established that language barriers contribute to health disparities for LEP patients (Jacobs et al. 2003). These patients have less access to a usual source of care, and lower rates of physician visits and preventive services (Fox and Stein 1991; Kirkman-Liff and Mondragon 1991; Woloshin et al. 1997; Fiscella et al. 2002). Even when they do have access to care, LEP patients often have poorer adherence to treatment and follow-up for chronic illnesses, decreased comprehension of their diagnoses and treatment after emergency department (ED) visits, decreased satisfaction with care, and increased medication complications. (Manson 1988; Crane 1997; Carasquillo et al. 1999; Gandhi et al. 2000) In contrast, language concordance between patients and physicians increases patient satisfaction, patient-reported health status, and adherence with medication and follow-up visits (Manson 1988; Perez-Stable, Napoles-Springer, and Miramontes 1997; Freeman et al. 2002).

    Given that over 100 languages are commonly spoken in the United States, (Shin and Bruno 2003) it is often not possible to provide language concordant health care. In one study of the use of medical interpreters in urban primary care practices, physicians reported encountering 20 different languages (Karliner, Perez-Stable, and Gildengorin 2004). Although some LEP patients are fortunate enough to be seen in settings where physician and office staff speak their primary language, this language concordance can readily disappear once these patients present for laboratory testing, emergency care, or are admitted to the hospital. Therefore, the majority of providers must use other means to communicate with their LEP patients and, if they receive federal financial assistance, are required to do so by Title VI of the Civil Rights Act of 1964 (OCR 2002). Most often this means is a third person, an interpreter, who can range from a highly trained professional medical interpreter to any available bilingual person (NCIHC 2001).

    In their review and analysis of health plans and language assistance programs, (Brach, Fraser, and Paez 2005) recommend the use of professional interpreters to augment the use of bilingual clinicians and staff in order to improve the quality of care delivered and to decrease health disparities. A recent general review of the literature concludes that the quality of medical care is improved by either use of professional interpreters or via direct provision of care by bilingual health care providers (Flores 2005). These reviews are broad and inclusive; however, many of the studies from which they draw their conclusions combined the effects of different types of interpreters (ad hoc, trained, untrained) as well as that of language concordant clinicians without systematically distinguishing among them. Thus, we are still left with the question of the specific effect of professional interpreters on clinical care, and how their effect compares with that of ad hoc interpreters.

    Source : www.ncbi.nlm.nih.gov

    cultural competence in healthcare exam 1 Flashcards

    Study with Quizlet and memorize flashcards terms like language, language has an impact on the following areas of healthcare, language barriers and negative outcomes and more.

    cultural competence in healthcare exam 1

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    language

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    often is considered a key aspect of culture and is thought to have a greater role than ethnicity or socio-economic status in accounting for differences in health status, use of services, and satisfaction with the healthcare system among minority populations

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    language has an impact on the following areas of healthcare

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    ability to obtain care, participation in preventative and screening activities, perceived health status, extent to which health care providers are trusted, satisfaction of care, protection of client rights

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    Terms in this set (57)

    language

    often is considered a key aspect of culture and is thought to have a greater role than ethnicity or socio-economic status in accounting for differences in health status, use of services, and satisfaction with the healthcare system among minority populations

    language has an impact on the following areas of healthcare

    ability to obtain care, participation in preventative and screening activities, perceived health status, extent to which health care providers are trusted, satisfaction of care, protection of client rights

    language barriers and negative outcomes

    miscommunication, misdiagnosis, inappropriate client treatment, reduced comprehension and adherence to treatment, clinical inefficiency, malpractice injury, death

    two factors related to the underestimation of the need for an interpreter

    overconfidence, flase fluency

    remote interpreting, telephonic interpreting

    _____ refers to situations in which the interpreter in not in the presence of the speakers and the interpretation is usually done via a telephone ___ telephonic and other remote styles of interpretation, using telephone lines, speakerphones, and headsets, rely on technology to provide language support. The most popular service of this nature in Canada and the US is the language line, which offer multiple languages, 24 hour access, and interpreter who are trained and certified for the healthcare context

    untrained, 50%

    _____ volunteer interpreter services that are staffed by professional ad non-professional employees of the organization. The advantage of using the employees particularly professional staff is that they are easier to access, may be viewed as trustworthy by the clients, and will likely have know ledge of healthcare terminology. What is the error rate?

    Ad hoc interpreters(family/friends) 23-52% error

    ____ also know as informal interpreters, include family, friends, and community volunteer, While the may be convenient, there are many disadvantages to using the, including a greater risk for issues related to confidentiality, disclosure, and errors in interpretation. What is the error rate?

    factors affecting the quality of interpretation

    omission, substitution, editorializing, addition

    two important reasons healthcare providers need preparation for a more diverse population

    demographic changes, participation in insurance programs

    how will a patient explain his/her current health status?

    personal experience, expectation

    how would a health care provider explain cultural competency or cultural care versus other types of care to unlicensed assistive personal? ex nurse tech, nurse aide, patient care tech

    Holistic thinking attend to the total context of the patient's situation

    Describe the process of becoming culturally competent

    it is a time consuming difficult, frustrating, extremely interesting

    If a hospital admin was selecting interpreter for its Spanish- speaking demographic population, what action would be best serve working with health care patients?

    medical terminology, people who are qualified with different Spanish speaking dialects

    in providing interpreters and bilingual staff, what criterion skills should interpreters have to work with patients with limited English proficiency?

    proficient in healthcare language or terminology

    How should a healthcare provider respond if a patient asks a family member to interpret for the staff?

    family services shouldn't be used as interpreter (unless on request by the patient)

    -okay to use a family member until non family interpreter can be located

    _______within the delivered care, the provider understands and attends to the total context of the patient's situation and this is a complex combo of knowledge, attitudes, and skills

    total context of patients situation culturally competent

    ____ the provider applies the underlying background knowledge that must be possessed to provide a patient with the best possible health/ healthcare

    culturally appropriate

    Joint commission's road map/ checklist for hospitals

    admission, assessment, treatment, discharge, end of life

    Joint commission's five recommendations for cultural competence

    value diversity, assessing themselves, manage dynamics of difference, acquire and institutionalize cultural knowledge, adapt to diversity and cultural contexts of individuals and communities

    If a non-English speaking patient is admitted to Joint- Commission- accredited organization,what action should be taken to support the Joint Commission principle of effective communication?

    Source : quizlet.com

    Cultural Competence in Health Care: Is it important for people with chronic conditions?

    Visit profiles to view data profiles and issue briefs from the series Challenges for the 21st Century: Chronic and Disabling Conditions as well as data profiles on young retirees and older workers. The increasing diversity of the nation brings opportunities and challenges for health care providers, health care systems, and policy makers to create and […]

    Cultural Competence in Health Care: Is it important for people with chronic conditions?

    Visit profiles to view data profiles and issue briefs from the series Challenges for the 21st Century: Chronic and Disabling Conditions as well as data profiles on young retirees and older workers.

    The increasing diversity of the nation brings opportunities and challenges for health care providers, health care systems, and policy makers to create and deliver culturally competent services. Cultural competence is defined as the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.(1) A culturally competent health care system can help improve health outcomes and quality of care, and can contribute to the elimination of racial and ethnic health disparities. Examples of strategies to move the health care system towards these goals include providing relevant training on cultural competence and cross-cultural issues to health professionals and creating policies that reduce administrative and linguistic barriers to patient care.

    Racial and ethnic minorities are disproportionately burdened by chronic illness

    Racial and ethnic minorities have higher morbidity and mortality from chronic diseases. The consequences can range from greater financial burden to higher activity limitations.

    Among older adults, a higher proportion of African Americans and Latinos, compared to Whites, report that they have at least one of seven chronic conditions — asthma, cancer, heart disease, diabetes, high blood pressure, obesity, or anxiety/ depression.(2) These rank among the most costly medical conditions in America.(3)

    African Americans and American Indians/Alaska Natives are more likely to be limited in an activity (e.g., work, walking, bathing, or dressing) due to chronic conditions.(4)

    The population at risk for chronic conditions will become more diverse

    Although chronic illnesses or disabili- ties may occur at any age, the likelihood that a person will experience any activity limitation due to a chronic condition increases with age.(5) In 2000, 35 million people — more than 12 percent of the total population — were 65 years or older.(6) By 2050, it is expected that one in five Americans — 20 percent — will be elderly. The population will also become increasingly diverse (see Figure 2). By 2050, racial and ethnic minorities will comprise 35 percent of the over 65 pop-ulation.(7) As the population at risk of chronic conditions becomes increasingly diverse, more attention to linguistic and cultural barriers to care will be necessary.

    Access to health care differs by race and ethnicity

    Having a regular doctor or a usual source of care facilitates the process of obtaining health care when it is needed. People who do not have a regular doctor or health care provider are less likely to obtain preventive services, or diagnosis, treatment, and management of chronic conditions. Health insurance coverage is also an important determinant of access to health care. Higher proportions of minorities compared to Whites do not have a usual source of care and do not have health insurance (see Figures 3A and 3B).

    Language and communication barriers are problematic

    Of the more than 37 million adults in the U.S. who speak a language other than English, some 18 million people — 48 percent — report that they speak English less than “very well.”(8) Language and communication barriers can affect the amount and quality of health care received. For example, Spanish-speaking Latinos are less likely than Whites to visit a physician or mental health provider, or receive preventive care, such as a mammography exam or influenza vaccination.(9) Health service use may also be affected by the availability of interpreters. Among non-English speakers who needed an interpreter during a health care visit, less than half — 48 percent — report that they always or usually had one.(10)

    Language and communication problems may also lead to patient dissatisfaction, poor comprehension and adherence, and lower quality of care. Spanish-speaking Latinos are less satisfied with the care they receive and more likely to report overall problems with health care than are English speakers.(11) The type of interpretation service provided to patients is an important factor in the level of satisfaction. In a study comparing various methods of interpretation, patients who use professional interpreters are equally as satisfied with the overall health care visit as patients who use bilingual providers. Patients who use family interpreters or non-professional interpreters, such as nurses, clerks, and technicians are less satisfied with their visit.(12)

    Low literacy also affects access to health care

    The 1992 National Adult Literacy Survey found that 40 to 44 million Americans do not have the necessary literacy skills for daily functioning.(13) The elderly typically have lower levels of literacy, and have had less access to formal education than younger populations.(14) Older patients with chronic diseases may need to make multiple and complex decisions about the management of their conditions. Racial and ethnic minorities are also more likely to have lower levels of literacy, often due to cultural and language barriers and differing educational opportunities.(15) Low literacy may affect patients’ ability to read and understand instructions on prescription or medicine bottles, health educational materials, and insurance forms, for example. Those with low literacy skills use more health services, and the resulting costs are estimated to be $32 to $58 billion — 3 to 6 percent — in additional health care expenditures.(16)

    Source : hpi.georgetown.edu

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