Interpreters: Telephonic, In-Person Interpretation and Bilingual Providers

CONTEXT: Language barriers affect health care interactions. Large, randomized studies of the relative efficacy of interpreter modalities have not been conducted. OBJECTIVE: To compare the efficacy of telephonic and in-person medical interpretation to visits with verified bilingual physicians. METHODS: This was a prospective, randomized trial. The setting was an urban pediatric emergency department at which ∼20% of visits are by families with limited English proficiency. The participants were families who responded affirmatively when asked at triage if they would prefer to communicate in Spanish. Randomization of each visit was to (1) remote telephonic interpretation via a double handset in the examination room, (2) an in-person emergency department–dedicated medical interpreter, or (3) a verified bilingual physician. Interviews were conducted after each visit. The primary outcome was a blinded determination of concordance between the caregivers' description of their child's diagnosis with the physician's stated discharge diagnosis. Secondary outcomes were qualitative measures of effectiveness of communication and satisfaction. Verified bilingual providers were the gold standard for noninferiority comparisons. RESULTS: A total of 1201 families were enrolled: 407 were randomly assigned to telephonic interpretation and 377 to in-person interpretation, and 417 were interviewed by a bilingual physician. Concordance between the diagnosis in the medical record and diagnosis reported by the family was not different between the 3 groups (telephonic: 95.1%; in-person: 95.5%; bilingual: 95.4%). The in-person–interpreter cohort scored the quality and satisfaction with their visit worse than both the bilingual and telephonic cohorts (P < .001). Those in the bilingual-provider cohort were less satisfied with their language service than those in the in-person and telephonic cohorts (P < .001). Using the bilingual provider as a gold standard, noninferiority was demonstrated for both interpreter modalities (telephonic and in-person) for quality and satisfaction of the visit. CONCLUSIONS: Both telephonic and in-person interpretation resulted in similar concordance in understanding of discharge diagnosis compared with bilingual providers. In general, noninferiority was also seen on qualitative measures, although there was a trend favoring telephonic over in-person interpretation.

[1]  Dodi Meyer,et al.  Satisfaction with telephonic interpreters in pediatric care. , 2008, Journal of the National Medical Association.

[2]  R. Wiebe,et al.  A Comparison of the Influence of Hospital-Trained, Ad Hoc, and Telephone Interpreters on Perceived Satisfaction of Limited English-Proficient Parents Presenting to a Pediatric Emergency Department , 2004, Pediatric emergency care.

[3]  L. Hampers,et al.  The truth about language barriers: one residency program's experience. , 2003, Pediatrics.

[4]  L. Hampers,et al.  Professional interpreters and bilingual physicians in a pediatric emergency department: effect on resource utilization. , 2002, Archives of pediatrics & adolescent medicine.

[5]  Linda J. Lee,et al.  Effect of spanish interpretation method on patient satisfaction in an urban walk-in clinic , 2002, Journal of General Internal Medicine.

[6]  S. Krug,et al.  Teaching Spanish to pediatric emergency physicians: effects on patient satisfaction. , 2002, Archives of pediatrics & adolescent medicine.

[7]  D. Kuo,et al.  Satisfaction with methods of spanish interpretation in an ambulatory care clinic , 1999, Journal of General Internal Medicine.

[8]  T. Brennan,et al.  Impact of language barriers on patient satisfaction in an emergency department , 1999, Journal of General Internal Medicine.

[9]  G. Flores,et al.  Access barriers to health care for Latino children. , 1998, Archives of pediatrics & adolescent medicine.

[10]  D W Baker,et al.  Interpreter use and satisfaction with interpersonal aspects of care for Spanish-speaking patients. , 1998, Medical care.

[11]  H. Binns,et al.  Language Barriers and Resource Utilization in a Pediatric Emergency Department , 1998, Pediatrics.

[12]  D. Baker,et al.  Methodological problems in comparing English-speaking and Spanish-speaking patients' satisfaction with interpersonal aspects of care. , 1998, Medical care.

[13]  D W Baker,et al.  Use and effectiveness of interpreters in an emergency department. , 1996, JAMA.

[14]  K. Todd,et al.  Ethnicity as a risk factor for inadequate emergency department analgesia. , 1993, JAMA.

[15]  Aaron Manson,et al.  Language Concordance as a Determinant of Patient Compliance and Emergency Room Use in Patients with Asthma , 1988, Medical care.

[16]  Mph Dr. David W. Baker MD,et al.  Effect of language barriers on follow-up appointments after an emergency department visit , 2007, Journal of General Internal Medicine.

[17]  B. Zuckerman,et al.  Errors in medical interpretation and their potential clinical consequences in pediatric encounters. , 2003, Pediatrics.

[18]  J A Crane,et al.  Patient comprehension of doctor-patient communication on discharge from the emergency department. , 1997, The Journal of emergency medicine.