Jessica E Murphy1, David Washington2,3, Ziming Xuan4, Michael K Paasche-Orlow5, Mari-Lynn Drainoni6,7,8,9. 1. Section of General Internal Medicine, Warren Alpert Medical School of Brown University, 245 Chapman Street, Suite 300, Providence, RI, 02905, USA. jessica_murphy1@brown.edu. 2. Department of General Internal Medicine and Pediatrics, Texas Gulf Coast Medical System, 250 Blossom Street, Suite 400, Webster, TX, 77598, USA. 3. Department of General Internal Medicine and Pediatrics, Bay Area Regional Medical Center, 200 Blossom Street, Webster, TX, 77598, USA. 4. Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, 02118, USA. 5. Section of General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Ave, Boston, MA, 02118, USA. 6. Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA. 7. Section of Infectious Diseases, Boston University School of Medicine, 72 E. Concord Street, Boston, MA, 02118, USA. 8. Center for Implementation and Improvement Sciences, Boston University School of Medicine, 72 E. Concord Street, Boston, MA, 02118, USA. 9. Center for Healthcare Organization and Implementation Research, ENRM VA Hospital, 200 Springs Rd, Building 70, Bedford, MA, 01730, USA.
Abstract
BACKGROUND: Medical interpreters improve care for patients with Limited English Proficiency but are underused. Protocols to improve interpreter use in primary care are needed. METHODS: Medical Assistants (MAs) screened patients for language needs and arranged for telephone interpreters during rooming in two pilot clinics (PCs). We interviewed MAs and providers and analyzed interviews using modified grounded theory, linking themes to the Promoting Action on Research Implementation in Health Services (PARiHS) framework categories of Context, Evidence, and Facilitation. Providers in PCs and four comparison clinics were surveyed. RESULTS: Context themes included issues with the telephone interpreter vendor; having established teams, roles and workflows; and difficulty incorporating time-sensitive tasks. Evidence themes included engagement in language screening; preferring in-person interpreters; improving the patient experience; and having mixed responses to the protocol. Facilitation themes included MAs needing more support. PC providers were more satisfied with care (OR = 12.7) and communication (OR = 7.6) than comparison clinic providers. CONCLUSIONS: The protocol may improve patient care and communication, but implementation was inconsistent. Language screening is a complex process and further research is needed to improve screening questions and procedures. Future interventions should capitalize on team members' drives to improve patient care and control costs but also need to consider the impacts of health system changes, and to consider the culture, training needs, roles, and relationships of team members.
BACKGROUND: Medical interpreters improve care for patients with Limited English Proficiency but are underused. Protocols to improve interpreter use in primary care are needed. METHODS: Medical Assistants (MAs) screened patients for language needs and arranged for telephone interpreters during rooming in two pilot clinics (PCs). We interviewed MAs and providers and analyzed interviews using modified grounded theory, linking themes to the Promoting Action on Research Implementation in Health Services (PARiHS) framework categories of Context, Evidence, and Facilitation. Providers in PCs and four comparison clinics were surveyed. RESULTS: Context themes included issues with the telephone interpreter vendor; having established teams, roles and workflows; and difficulty incorporating time-sensitive tasks. Evidence themes included engagement in language screening; preferring in-person interpreters; improving the patient experience; and having mixed responses to the protocol. Facilitation themes included MAs needing more support. PC providers were more satisfied with care (OR = 12.7) and communication (OR = 7.6) than comparison clinic providers. CONCLUSIONS: The protocol may improve patient care and communication, but implementation was inconsistent. Language screening is a complex process and further research is needed to improve screening questions and procedures. Future interventions should capitalize on team members' drives to improve patient care and control costs but also need to consider the impacts of health system changes, and to consider the culture, training needs, roles, and relationships of team members.
Entities:
Keywords:
Communication barriers; Cultural competency; English proficiency; Implementation; Interpreters; Language; Pilot projects
Authors: Kevin E O'Brien; Vineeth Chandramohan; Douglas A Nelson; Joseph R Fischer; Gary Stevens; John A Poremba Journal: J Gen Intern Med Date: 2003-04 Impact factor: 5.128