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Studies Show Importance of Language Services on Reducing Disparities, Increasing Quality of Patient

By Lisa Cisneros

(Adapted from a Robert Wood Johnson Foundation and Hablamos Juntos news release) New studies just published in a special supplement to the Journal of General Internal Medicine examine the consequences of language barriers for patients who speak little, if any, English and the impact of the absence of language services in health care settings. Overall, the studies report that measurable disparities in quality of care result when patients and providers do not speak the same language. The supplement is sponsored by Hablamos Juntos, an initiative of the Robert Wood Johnson Foundation as part of its efforts to improve the quality of care for all Americans by addressing racial and ethnic disparities in health care. Nearly one in five people in the United States now speak a language other than English at home. And while many can comfortably speak English when needed, experts estimate some 20 million people in America - about one in every 15 people in the U.S. - speak and understand little, if any English. This means that health care providers are increasingly facing the challenge of how to communicate efficiently and effectively with patients who have limited English proficiency (LEP). Hablamos Juntos, administered by the UCSF Fresno Center for Medical Education and Research, seeks to develop practical and affordable solutions to increase the availability and quality of language services; interpretation, translation and signage. Alicia Fernandez, MD, associate professor of clinical medicine at UCSF, was co-editor of the supplement and senior author of one of the included studies. Along with Fernandez, Eliseo Pérez-Stable, MD, chief of the Division of General Internal Medicine at UCSF, co-authored an editorial, "Reducing Language Barriers and Racial/Ethnic Disparities in Health Care: An Investment in Our Future." Study: Hospitalized Patients Who Speak Little English Are Less Likely to Have Documentation of Informed Consent Prior to Invasive Procedures This study showed that, despite the availability of on-site professional interpreter services, hospitalized patients who do not speak English are less likely to have signed consent forms in their medical records. Researchers from the Department of Medicine at UCSF compared records of LEP and English-speaking patients for full documentation of informed consent - a legal and ethical requirement prior to invasive, non-emergency medical procedures. Full documentation includes a note documenting a consent discussion and a signed consent form. For LEP patients, it also requires some evidence of interpretation. Although the health care system has a long way to go in improving performance on informed consent for all patients, the results of this study showed that charts of English-speaking patients were nearly twice as likely as those of LEP patients to contain all elements of informed consent (53% vs. 28%). When examining the components of informed consent, charts of English-speaking and LEP patients were similar in the proportion documenting that a consent discussion took place, but charts of English-speaking patients were more likely to contain a signed consent form in any language (85% vs. 70%). The researchers conclude these findings suggest differences in practice, not documentation alone. "Informed consent is a fundamental tenet of the U.S. health care system," said lead researcher Yael Schenker, MD, a research fellow at UCSF. "While language barriers make obtaining informed consent more complex, it is still a legal and ethical requirement and is increasingly recognized as a key component of quality care and patient safety. Hospitals must work harder to break down the language barriers faced by LEP patients." Senior author Fernandez reported that "the hospital leadership has responded very appropriately to the study findings and the hospital has substantially revised its informed consent process to ensure that all patients are properly consented prior to invasive procedures." Former Surgeon General Speaks Out In a foreword to the supplement, Richard H. Carmona, MD, former Surgeon General of the United States and a 1979 graduate of the UCSF School of Medicine, discussed his family's experiences and the vital importance of culturally and linguistically appropriate health information. "Until my family found a local doctor who spoke Spanish and understood our culture, we often struggled to understand what we needed to do to prevent diseases or to recover from illness or injuries," said Carmona. "Language difficulties can create a wall of confusion and misunderstanding between health professionals and the people we are trying to serve, essentially becoming barriers to quality care. Our nation must increase its determination to serve diverse populations by providing culturally and linguistically appropriate care to our patients." Foundation Affirms Its Commitment to Issue In sponsoring the supplement, the Robert Wood Johnson Foundation reiterated its commitment to programs that bring more equality to the health care system. The Foundation leads national initiatives to improve the availability and quality of language services in hospitals and other health care settings. "The quality of health care for all Americans will not be improved without a concentrated effort to ensure that people with limited English-speaking proficiency have access to language services and assistance in clinical encounters within America's hospitals and health systems," said Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation. "I am hopeful that, with continued vigilance, we will identify solutions to address language barriers that affect the quality of patient care."
Language Barriers in Health Care Journal of General Internal Medicine 22 (supplement 2), November 2007 Table of Contents
The Impact of Language Barriers on Documentation of Informed Consent at a Hospital with On-site Interpreter Services Yael Schenker, Frances Wang, Sarah Jane Selig, Rita Ng and Alicia Fernandez Journal of General Internal Medicine 22 (supplement 2):294-299, November 2007 Abstract | Full Text | Full Text (PDF)
Reducing Language Barriers and Racial/Ethnic Disparities in Health Care: An Investment in Our Future Somnath Saha, Alicia Fernandez and Eliseo Pérez-Stable Journal of General Internal Medicine 22 (supplement 2):371-372, November 2007 Full Text | Full Text (PDF)
Related Links: Hablamos Juntos: Language Practice and Policy in Health Care UCSF Department of Medicine San Francisco General Hospital UCSF Fresno Center for Medical Education and Research