Patient-initiated questions differed across the three language-concordance groups and were lowest for discordant-interpreter visits (7.63 vs 6.98 vs 4.43, p=0.002)

Description #

On one-way ANOVA, the mean number of patient-initiated questions per clinical visit differed significantly across the three language-concordance groups (p = 0.002): concordant-English families asked 7.63, LEP concordant-Spanish families 6.98, and LEP discordant-interpreter families 4.43 questions per visit (Table 2). The discordant-interpreter group asked markedly fewer questions than either concordant group.

"The average number of parent questions between groups was significantly different (p = 0.002). Concordant English asked 7.63, LEP concordant-Spanish 6.98 and LEP discordant-Spanish 4.43 questions per visit." (Jaramillo, 2016, p. 672)

Methods Context #

What? #ⓘ

The observable: the count of patient-initiated questions asked during the clinical encounter, tallied from audio recordings.

"four trained research assistants listened to the audio recording of the encounter and measured the number of patient-asked questions related to eliciting medical information and the length of the visit with the surgeon." (Jaramillo, 2016, p. 672)

How? #ⓘ

Prospective convenience-sample study; visits audio-recorded and questions counted by trained research assistants, then compared across the three concordance groups by one-way ANOVA. The concordant-Spanish arm received care via A-0013ArtifactA-0013Initial AI draftThe Hispanic Clinic for Pediatric SurgeryA dedicated language-concordant outpatient clinic model at Lucile Packard Children's Hospital (Stanford) in which Spanish-speaking LEP families of pediatric surgery patients are cared for directly by a fluent Spanish-spe….

"We conducted a prospective study from a convenience sample recruited from a General Pediatric Surgery Clinic in an academic setting between August 2013 and August 2014." (Jaramillo, 2016, p. 671)

Who? #ⓘ

156 families of pediatric surgery patients (ages 0–18) at a single academic children's hospital, split into concordant-English (57), LEP concordant-Spanish (52), and LEP discordant-interpreter (47).

"A total of 156 families were enrolled including 57 concordant-English, 52 LEP concordant-Spanish and 47 LEP discordant families." (Jaramillo, 2016, p. 672)

Other Notes #

Group means and the ANOVA p-value are reported in Table 2. This omnibus test establishes that the groups differ; the pairwise structure (concordant groups equal, both above discordant) is captured in Table 3.

Caveats #

• No surgical or clinical outcomes measured; question-asking and satisfaction are proxies for care quality The study did not quantify any surgical or clinical outcomes; its endpoints are process/experience proxies (audio-counted question-asking and self-reported satisfaction survey ratings). The inference that language concordance improves surgical care rests on the assumed link between patient participation/satisfaction and downstream outcomes reported in other studies, not on outcomes measured here. Findings should therefore be read as evidence about communication and access to information, not about hard surgical outcomes.
• Single urban academic institution with a small, demographically narrow Spanish-speaking pediatric surgery sample All participants were pediatric surgery patients at a single institution in urban Northern California, whose clinician and patient demographics may differ from other settings, and the small, single-hospital sample may not represent the diversity of the Spanish-speaking population. These features constrain external validity: the observed concordance effects may not generalize to other surgical subspecialties, geographic regions, LEP language groups, or health systems.
• Convenience sample with non-randomized assignment to concordant vs discordant care and baseline SES imbalance The study used a convenience sample and did not randomize Spanish-LEP patients to the concordant versus discordant group; group assignment followed clinic scheduling/availability, so there was no control over which families received concordant versus interpreter-mediated care. In addition, the English-speaking and Spanish-speaking groups differed significantly at baseline in education and income (though the two Spanish-speaking groups were demographically similar). These features raise the possibility of selection bias and residual confounding in the association between concordance and question-asking / satisfaction, even though the multivariable model adjusted for education, native language, and new-patient status.