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

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.

Use of Interpreters by Physicians for Hospitalized Limited English Proficient Patients and Its Impact on Patient Outcomes

“…Similar to all prior inpatient studies we found a low use of interpreters by hospital clinicians. 5,6,21 Federal law, the Institute of Medicine (IOM), and hospital guidelines, including the Joint Commission standards, all recommend the routine use of professional interpreters during clinical encounters. 3,[22][23][24] It is possible that our low rate of interpreter use is due to the use of nonprofessional interpreters (i.e., family members or friends) and/or clinical encounters with bilingual physicians or other clinical staff and/or even LEP patients relying on their own limited English language abilities.…”

“…Several studies show that when LEP patients have access to an interpreter, they actually have increased utilization of services and have improved disease-specific process measures/testing and outcomes. 5 It is possible that the sicker LEP patients required more appropriate medical care or that sicker LEP patients lacked a regular source of medical care, therefore getting most of their workup as an inpatient. In addition, one study has shown that the LOS for LEP patients was longer for seven of 23 medical and surgical conditions.…”

“…3,4 The use of professional medical interpreters is associated with increased patient satisfaction, quality of care, and improved disease-specific process measures and outcomes. 5,6 The Institute of Medicine report Crossing the Quality Chasm states that the use of an interpreter is not only a quality, but also a patient safety imperative. [7][8][9][10] Most studies to date have focused on the impact of interpreters in the outpatient and emergency department (ED) settings.…”

Diabetic foot ulcer outcomes from a podiatry led tertiary service in Kuwait

“…The language barrier has been associated with poor patient comprehension because the patient may not understand the clinician’s requests, lack the health vocabulary to accurately report symptoms or may recount information in an illogical or fragmented manner [38]. The use of either medically trained or ad hoc translators can reduce the impact of these problems, but do not eliminate them [39]. …”

Clinicians' Obligations to Use Qualified Medical Interpreters When Caring for Patients with Limited English Proficiency

“…Health care professionals face potential civil liability when they fail to provide qualified interpreters, if such failure leads to a tort cause of action, such as lack of informed consent, breach of duty to warn, or improper medical care [15]. In contrast, the use of professional interpreters while providing medical care for patients with LEP improves comprehension, service utilization, clinical outcomes, and patient satisfaction [16].…”