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Interpreter services, language concordance, and health care quality

Experiences of Asian Americans with limited English proficiency

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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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Author information

Authors and Affiliations

  1. Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Alexander R. Green MD, MPH

  2. Division of General Medicine and Primary Care and the Center for Health Policy Research, University of California Irvine College of Medicine, Irvine, CA, USA

    Quyen Ngo-Metzger MD, MPH

  3. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Anna T. R. Legedza ScD, Russell S. Phillips MD & Lisa I. Iezzoni MD, MSc

  4. Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Michael P. Massagli PhD

Authors
  1. Alexander R. Green MD, MPH
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  2. Quyen Ngo-Metzger MD, MPH
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  3. Anna T. R. Legedza ScD
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  4. Michael P. Massagli PhD
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  5. Russell S. Phillips MD
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  6. Lisa I. Iezzoni MD, MSc
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Corresponding author

Correspondence to Alexander R. Green MD, MPH.

Additional information

The authors have no conflicts of interest to declare.

This study was funded by the Agency for Health care Research and Quality, Grant no. RQ R01-HS10316 and the Commonwealth Fund, Grant no. 20020110. Dr. Green received support from a National Research Service Award, Grant no. T32 HP11001-15. Dr. Phillips is supported by a Mid-Career Investigator Award no. K24 AT00589-03 from the National Institutes of Health.

Role of Sponsor: The funding organizations took no part in the design and conduct of the study, collection, management, analysis, and interpretation of the data, or review or approval of the manuscript.

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Green, A.R., Ngo-Metzger, Q., Legedza, A.T.R. et al. Interpreter services, language concordance, and health care quality. J GEN INTERN MED 20, 1050–1056 (2005). https://doi.org/10.1111/j.1525-1497.2005.0223.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2005.0223.x

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