Interpreter Services, Language Concordance, and Health Care Quality

Experiences of Asian Americans with Limited English Proficiency

Authors

  • Alexander R. Green MD, MPH,

    1. Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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  • Quyen Ngo-Metzger MD, MPH,

    1. Division of General Medicine and Primary Care and the Center for Health Policy Research, University of California Irvine College of Medicine, Irvine, CA, USA
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  • Anna T. R. Legedza ScD,

    1. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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  • Michael P. Massagli PhD,

    1. Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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  • Russell S. Phillips MD,

    1. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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  • Lisa I. Iezzoni MD, MSc

    1. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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  • The authors have no conflicts of interest to declare.

Address correspondence and reprint requests to Dr. Green: Institute for Health Policy, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114 (e-mail: argreen@partners.org).

Abstract

Background: Patients with limited English proficiency (LEP) have more difficulty communicating with health care providers and are less satisfied with their care than others. Both interpreter- and language-concordant clinicians may help overcome these problems but few studies have compared these approaches.

Objective: To compare self-reported communication and visit ratings for LEP Asian immigrants whose visits involve either a clinic interpreter or a clinician speaking their native language.

Design: Cross-sectional survey—response rate 74%.

Patients: Two thousand seven hundred and fifteen LEP Chinese and Vietnamese immigrant adults who received care at 11 community-based health centers across the U.S.

Measurements: Five self-reported communication measures and overall rating of care.

Results: Patients who used interpreters were more likely than language-concordant patients to report having questions about their care (30.1% vs 20.9%, P<.001) or about mental health (25.3% vs 18.2%, P=.005) they wanted to ask but did not. They did not differ significantly in their response to 3 other communication measures or their likelihood of rating the health care received as “excellent” or “very good” (51.7% vs 50.9%, P=.8). Patients who rated their interpreters highly (“excellent” or “very good”) were more likely to rate the health care they received highly (adjusted odds ratio 4.8, 95% confidence interval, 2.3 to 10.1).

Conclusions: Assessments of communication and health care quality for outpatient visits are similar for LEP Asian immigrants who use interpreters and those whose clinicians speak their language. However, interpreter use may compromise certain aspects of communication. The perceived quality of the interpreter is strongly associated with patients' assessments of quality of care overall.

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