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Mathematica Policy Research, a nonpartisan research firm, provides a full range of research and data collection services, including program evaluation and policy research, survey design and data collection, research assessment and interpretation, and program performance/data management, to improve public well-being. Its clients include federal and state governments, foundations, and private-sector and international organizations. The employee-owned company, with offices in Princeton, N.J., Ann Arbor, Mich., Cambridge, Mass., Chicago, Ill., Oakland, Calif., and Washington, D.C., has conducted some of the most important studies of health care, international, disability, education, family support, employment, nutrition, and early childhood policies and programs.
Research has suggested a link between the use of professional interpreter services during emergency department (ED) visits and higher levels of patient and provider satisfaction with the care provided. However, evidence remains scant on whether the type of interpreter services used is actually causally linked to satisfaction ratings. Mathematica’s study addressed this evidence gap through a randomized controlled design, considered the most reliable and statistically valid approach for examining the question of causality. The study used random assignment to compare the reported satisfaction of patients and providers during 424 ED visits, roughly half of which included interpreter services from a professionally trained medical interpreter (the “treatment group”) and roughly half of which relied on the ED’s usual language services, that is, a telephone language line or ad hoc interpreter services (the “control group”). The study found that 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.
The inability of patients and health care providers to communicate in the same language can create serious barriers during medical encounters. Patients may be less likely to understand discharge instructions, adhere to recommended treatments, and return for follow-up visits. Similarly, providers may order more diagnostic tests and compromise patients’ access to quality care when language barriers are present. Using interpreters may alleviate these and other problems associated with language barriers in health care settings and is associated with greater patient/provider satisfaction with communication and care. However, the type of interpreter used can affect satisfaction levels and the perceived quality of care. Research has shown that use of trained interpreters is associated with higher satisfaction levels than other types of language services and may result in satisfaction levels equivalent to those of patients who are language concordant with their providers. This study used random assignment in two hospital emergency departments (EDs) to examine the satisfaction levels of patients and providers who used a professionally trained medical interpreter versus those who used the hospitals’ usual language services.
The study involved assigning eligible patients to treatment and control groups and collecting data from patients and providers about the encounters. Patient Participation. ED staff identified eligible patients at the time of registration or triage. All LEP, Spanish-speaking patients seen during the treatment and control time blocks were invited to participate in the study. Bilingual field interviewers were stationed near the ED reception area and obtained informed consent from 484 patients (262 treatments and 222 controls) out of 531 approached, for a participation rate of 91 percent. Because some patients were seen more than once during the study period, this brief includes only data for first-time visits by each patient (424 in total). Patient and Provider Surveys. In addition to collecting cost data through billing records, a survey was administered to patients, triage and discharge nurses, and attending physicians following the medical encounter. Patients completed the survey prior to discharge and providers completed their surveys immediately after treating the patient. The patient survey asked, “How satisfied were you with the way you and hospital staff were able to communicate?” The provider survey asked, “How satisfied are you that language issues were adequately addressed to assess and treat this patient’s condition?” This brief examines their responses to determine satisfaction levels with the communication process. Overall response rates were 95 percent for patients, 96 percent for triage nurses, 83 percent for discharge nurses, and 95 percent for doctors. Discharge nurses had lower response rates because many patients were still awaiting discharge when interviewers’ shifts ended for the day.
Access to Interpreters. A professional interpreter was available only during the treatment time blocks; however, because of high patient volume in the ED and interpreter scheduling, 17 patients seen during treatment time blocks used a professional interpreter for part of their ED visit and some other type of language service for another portion. For 12 of these patients, the other language service was a Spanish-speaking provider; therefore, there was no difference in satisfaction levels between patients who only used the professional interpreter and those seen in treatment time blocks who received language services in addition to those from the professional interpreter. Three patients seen during the treatment time blocks did not receive the services of the professional interpreter because the interpreter was with another patient at the time. Nine patients seen during the control time blocks reported receiving services from a professional interpreter; however, we assumed that these patients mistook some other hospital staff member for a trained interpreter. Another 84 patients in the control group did not receive any interpreter services. Overall, 22 patients (5 percent of the entire sample) turned in forms that were incomplete and did not specify the type of interpreter used.
Overall, Spanish-speaking patients seen during treatment time blocks were significantly more likely to be “very satisfied” with their ability to communicate with their providers. Similarly, medical staff were “very satisfied” that language issues had been adequately addressed to assess and treat patients. Because high levels of satisfaction increase the likelihood that a patient will return to the same ED, the study’s results may influence hospitals’ decisions about whether to hire interpreters. Future reports from this study will examine the value of providing language services by looking at the cost-effectiveness of professional interpreter services in ED visits. In addition to improving satisfaction, professional interpreters may improve other outcomes related to quality of care. Rigorous future research should examine the effects of interpreters on quality of care measures, both in this setting and in other health care settings and with other patient populations (for example, children, adolescents, and other language groups).
Via - Mathematica Policy Research