From Admission to Discharge: Patterns of Interpreter Use Among Resident Physicians

1. From Admission to Discharge: Patterns of Interpreter Use Among Resident Physicians Amy Shen1, BA; Jenna Kruger1,2, MPH; Judy Quan1,2, PhD; Alicia Fernandez1,2, MD 1UCSF School of Medicine, 2 Division of General Internal Medicine, University of California, San Francisco, CA BACKGROUND RESULTS DISCUSSION • Communication with hospitalized LEP patients relies on individual providers’ decisions to use professional interpreters. • Underuse of professional interpreters adversely affects quality of care to patients with limited English proficiency (LEP). • Residents report using different modes of communication with LEP patients depending on the clinical encounter. • Variation in professional interpreter use by type of clinical encounter and not clinical site or patient language underscores the importance of resident decision-making in determining whether LEP patients receive professional interpreter services. • Our findings confirm prior research which suggests there is considerable underuse of professional interpreters among resident physicians caring for LEP patients. • In addition, we found that residents perceive that their communication with hospitalized LEP patients to be worse compared to their communication with clinically similar English-speaking patients. • To improve provider interpreter training efforts, future studies with larger samples sizes are needed to determine how resident characteristics such as specialty, hours of training, and growing up speaking a non-English language at home predict resident physicians’ interpreter use when caring for LEP patients. Figure 1. Resident physicians’ percent use of professional interpretation during the hospital course of an LEP patient. % resident physicians AIM % professional interpreter use In our sample, 71% of residents reported using professional interpreters for less than 60% of hospital clinical encounters. Professional interpreter use was dichotomized with different percentage cut-offs for different logistic regression models. There were no consistently significant predictors of professional interpreter use, through physician specialty, hours of interpreter training and growing up speaking a non-English language were associated with interpreter use in some models. • To assess resident physicians’ patterns of communication with LEP patients by hospital encounter type. • To identify predictors of professional interpreter use. Figure 2. Resident physicians’ self-rated quality of communication with an LEP patient compared to an English-speaking patient. % resident physicians METHODS • Study Design • Cross-sectional survey. Resident physicians reported on interpreter use with their last hospitalized LEP patient with whom they experienced a language barrier. • Participants • Internal medicine, general surgery, and family medicine resident physicians from one academic medical institution who care for LEP patients across three hospitals. • Data Analysis • Descriptive statistics were performed to ascertain residents’ percent use of professional interpretation, perceived quality of communication, and patterns of interpreter use for six routine hospital encounters. Logistic regression models were used to determine the independent contribution of clinical site, patient characteristics, and physician characteristics to resident physician use of professional interpreters. Quality of communication In our sample, most residents (91%) reported that their quality of communication with hospitalized LEP patients was "slightly worse" (62%) or "much worse" (29%) compared to their communication with clinically similar English-speaking patients. Only patient language with adjusted odds ratio of 3.57 (95% Cl: 1.01, 12.67) was shown to be a significant, but borderline, predictor of much worse vs. other quality of communication rating in logistic regression models. Figure 3. Patterns of interpreter use among resident physicians for common hospital encounters. % use by resident physicians ACKNOWLEDGEMENTS • Partial support from R25MD006832 NIH-NIMHD. • Special thanks to UCSF internal medicine, family medicine, and general surgery residency programs for their support and participation in this study. Patterns of professional interpreter use substantially varied by type of clinical encounter, with more residents reporting getting by with ad-hoc interpreters, their own language skills or not talking to the patient due to time constraints during routine daily rounds and check-ins than during “high-stakes” planned encounters such as procedure consents or family meetings (45% and 41% vs. 9% and 16%, p-value<0.005). *The survey response rate was 73%. ++Total percentages may not add up to 100 due to rounding. +++Total numbers add up to > 80 because subjects could specify more than one non-English language spoken.