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QuestionQuestion · 6
An unknown we want to make known — addressable by studies, experiments, or prototypes.
- Q-0001How does language support (language ‘concordance’) affect healthcare outcomes?
- Q-0002What are the effects of language concordance on the quality and cost of medical treatment?
- Q-0003How to optimize delivery of language concordance services in healthcare?
- Q-0004What is the distribution of language discordance needs in American healthcare settings?
- Q-0005How does the absence of language support (language ‘discordance’) affect healthcare outcomes?
- Q-0006How does language concordance affect medication adherence for patients with limited English proficiency
ClaimClaim · 52
An atomic, generalized assertion about the world that (proposes to) answer a research question.
- C-000155% of malpractice cases come from miscommunication between patients and caregivers
- C-0002Doctors spend an extra 10 to 30 minutes to initiate every interpreting session when they have to chase down a tablet on wheels, vs. using directly from the mobile phone in their pocket
- C-0003For most large HDNs, the cumulative costs of language discordance adds up to 10s of millions of dollars of wasted provider time a year
- C-0004Interpreting services increase diagnosis accuracy for patients with limited english proficiency
- C-0005Patients with limited english proficiency receive less accurate diagnoses
- C-0006Interpreting services reduce recurrence rates for patients with limited english proficiency
- C-0007Patients with limited english proficiency have shorter hospital stays when interpreting services are used
- C-0008Patients with limited english proficiency have higher likelihood of recurrences
- C-0009When accessing interpreting directly on their own, as opposed to waiting for a caregiver, patients with limited english proficiency demonstrate an increased sense of empowerment
- C-0010When accessing interpreting directly on their own, as opposed to waiting for a caregiver, patients with limited english proficiency have less frequent “no shows”
- C-0011When interpreting is used, patients with limited english proficiency are 40% more likely to adhere to their treatment
- C-0012When interpreting is used, patients with limited english proficiency are 40% more likely to trust their physician
- C-0013Patient-provider language concordance more than preferred language accounts for medication adherence differences among LEP patients
- C-0014LEP patients can achieve medication adherence comparable to or better than English-speaking patients when care is language-concordant
- C-0015LEP patients use remote medication refill systems less than English-proficient patients, risking wider adherence disparities
- C-0016Language-concordant automated telephone self-management is a valid scalable way to assess medication adherence in linguistically diverse populations
- C-0017Language accessibility and concordance, not LEP status itself, is the operative lever for medication-adherence disparities
- C-0018Providing verbal medication information can mitigate LEP patients lower medication-related self-efficacy
- C-0019LEP patients have lower medication-related self-efficacy than English-proficient patients, a modifiable adherence risk
- C-0020Patients with limited english proficiency can achieve equal or better clinical outcomes than English-proficient patients when they receive care at facilities with robust support services
- C-0021Limited english proficiency is not necessarily associated with worse treatment adherence
- C-0022A medical Spanish curriculum for resident physicians increases language-concordant encounters and reduces reliance on interpreter phones
- C-0023Bilingual-provider language concordance is associated with greater patient satisfaction and adherence among Spanish-speaking LEP ED patients
- C-0024Culturally integrated, language-concordant diabetes nutrition education improves dietary adherence for LEP Chinese American patients and is feasible within usual clinic services
- C-0025A Spanish-language adaptation of an HIV mHealth app achieves good usability and acceptability for Latinx PWH while surfacing engagement barriers for iterative design
- C-0026Integrating early-warning-score monitoring and interpreters into the rapid response system reduces post-activation mortality for patients with limited english proficiency
- C-0027Certified dual-role nurse interpreters improve the hospital experience of Spanish-speaking LEP patients by brokering communication
- C-0028Professional interpretation at admission and discharge shortens length of stay for LEP inpatients
- C-0029Professional interpretation at admission or discharge lowers 30-day readmission for LEP inpatients
- C-0030Hospitalized patients with limited English proficiency receive less numeric pain assessment and fewer opioids than English-speaking patients
- C-0031Language discordance (LEP status) is not consistently associated with longer hospital length of stay
- C-0032Providing professional interpreter access does not raise hospital cost and can yield net savings
- C-0033Language discordance (LEP status) is not associated with higher acute-care utilization (ED visits or hospital admission)
- C-0034Interpreter services are systematically under-provided relative to need for LEP patients
- C-0035Discretionary criticality triage by clinicians rations interpreter use and suppresses routine concordant communication
- C-0036Translated written materials are under-provided and constrained to common languages and simple documents
- C-0037A professional-development career ladder raises medical interpreter certification and assessed competence
- C-0038Medical interpreters function as active co-constructors of meaning rather than neutral conduits
- C-0039In-person interpreting supports higher communication quality than telephone or video interpreting
- C-0040Language concordance improves the quality of clinical communication relative to discordance
- C-0041Language discordance is associated with reduced treatment adherence
- C-0042Language-concordant care improves patient satisfaction compared with interpreter-mediated or discordant care
- C-0043Language-concordant care increases patient engagement and active participation in the clinical encounter
- C-0044Language discordance increases the time and effort providers must spend delivering care
- C-0045Interpreter access barriers push clinicians toward ad hoc workarounds and truncated communication
- C-0046Investing in dedicated interpreter capacity and bilingual-provider skills reduces provider burden and improves care coordination
- C-0047Professional interpreter use improves the quality of psychiatric care for LEP patients while evaluation in a nonprimary language degrades it
- C-0048LEP status, especially with inconsistent professional interpreter use, is a risk factor for poorer perioperative care and outcomes
- C-0049For hospitalized LEP children, professional interpreters of any mode outperform ad hoc or no interpreter, and mode matters less than using a professional at all
- C-0050A multi-component quality-improvement bundle raises appropriate interpreter use and documentation for LEP patients
- C-0051Interpreter need (language discordance) is associated with discharge to a rehabilitation facility rather than home
- C-0052Interpreter need (language discordance) is not significantly associated with postoperative complication rates
EvidenceEvidence · 117
A specific empirical observation from a particular study.
- E-0001odds of 30-day readmission for the LEP compared with EP group was lower during the intervention period when professional interpreter services via telephone were available, but was roughly equivalent during pre-and post-intervention periods
- E-0002There was no significant association between access to professional interpreter services via telephone and length of stay for LEP patients
- E-0003Among 4,436 patients with DPN symptoms, difficulty speaking English was independently associated with not having a DPN diagnosis
- E-0004In the last 30 days of life, patients with LEP had higher odds of readmission (12% vs 8%; aOR 1.64, 95% CI 1.30-2.07; p < 0.001)
- E-0005In the last 30 days of life, patients with LEP had higher odds of ED visits (33% vs 20%; aOR 1.41, 95% CI 1.26-1.72; p < 0.001)
- E-0006The 119 estimated averted readmissions for LEP patients was associated with estimated monthly hospital expenditure savings of 161,404.
- E-0007There was no significant difference in readmission within one year between EP and LEP patients after bariatric surgery (adjusted OR = 0.94, 95% CI 0.56-1.55; p = 0.50).
- E-0008Nepali-speaking LEP diabetes patients had the highest medication Adherence Ratio
- E-0009Language-group differences in medication adherence disappeared after controlling for patient-provider language concordance
- E-0010Interaction between preferred language and language concordance was non-significant for all medications and outcomes
- E-0011Maximum days of medication non-adherence were lower for Nepali- and Spanish-speakers than English-preference patients
- E-0012LEP patients had much lower odds of using any remote medication refill system than English-proficient patients
- E-0013The remote-refill disparity was driven by Internet refills while telephone refill use did not differ by LEP status
- E-0014Language-concordant ATSM assessed self-reported adherence as well as a structured interview when validated against pharmacy-claims CMG
- E-0015Optimal adherence by claims was lower among ATSM respondents reporting more missed days for blood pressure and cholesterol but not diabetes pills
- E-0016LEP patients had lower medication learning self-efficacy than English-proficient patients but equal taking self-efficacy
- E-0017Verbal medication information narrowed the LEP learning self-efficacy gap but had no effect for English-proficient patients
- E-0018Only 11 percent of LEP patients reported receiving written medication information in their preferred language
- E-0019Adults with LEP and diagnosed HIV were more virally suppressed than EP adults (77.5% vs 69.6%)
- E-0020Adults with LEP were more likely to be prescribed ART than EP adults (89.7% vs 83.5%) but ART adherence did not differ
- E-0021Adults with LEP were more likely than EP adults to receive care at RWHAP-funded facilities (79.0% vs 67.0%)
- E-0022Residents trained in a medical Spanish curriculum spoke Spanish with more LEP patients and used translator phones less
- E-0023Patients rated visit satisfaction and resident Spanish ability higher for curriculum-trained residents
- E-0024Among LEP patients who followed medical recommendations after a Spanish-spoken encounter, most were seen by curriculum-trained residents
- E-0025Dietary adherence (adapted Mediterranean diet score) significantly improved with culturally integrated nutrition counseling but worsened with usual DSME
- E-0026Culturally integrated nutrition counseling was feasible to deliver within an existing clinic and 100% of intervention participants rated the bilingual booklet as helping their learning
- E-0027Dietary self-efficacy, weight, and HbA1c trended better with integrative counseling but no clinical or attitudinal outcome reached significance
- E-0028Spanish-language HIV mHealth app ConexionesPositivas scored 75 on the System Usability Scale (good usability)
- E-0029CP users perceived positive impacts of the app on medication-adherence self-monitoring, mood-stress check-ins, and provider communication
- E-0030CP users identified engagement barriers (privacy, low literacy, lack of personal connection, repetitiveness) and requested more interactivity and personalization
- E-0031Post-RR activation mortality among LEP patients decreased from 7.42% to 6.09% with special cause variation after the intervention
- E-0032Process measures, length of stay, and escalation of care showed no special cause variation after the intervention
- E-0033Disease severity (DI score) at RR activation rose slightly post-intervention with special cause variation
- E-0034Dual-role nurses observed Spanish-speaking patients show visible relief and ease once an interpreter brokered communication
- E-0035Without qualified interpretation Spanish-speaking patients experienced miscommunication confusion and anger during hospital stays
- E-0036Concentrating Spanish-speaking patient assignments on dual-role nurses added time-consuming interpreting burden and frustration
- E-0037LEP inpatients without a professional interpreter on both admission and discharge had a 0.75-1.47 day longer length of stay
- E-0038Adjusted mean length of stay was 5.06 days with no interpreter vs 2.57 days with interpreters on both admission and discharge
- E-0039LEP inpatients with no interpreter on admission or discharge had a higher 30-day readmission rate (24.3% vs 14.9%)
- E-0040Only 39% of LEP inpatients received professional interpretation on both admission and discharge while 13.8% received none on either day
- E-0041Patients with LEP had the lowest adjusted odds of numeric pain ratings (OR 0.61, 95% CI 0.58-0.65)
- E-0042English-speaking patients received substantially more daily opioids (MMEs) than patients with LEP across all pain assessments
- E-0043Patients with LEP had the highest proportion receiving behavioral pain tools, suggesting interpreter underutilization
- E-0044Professional interpreter use with ancillary staff was less than 4%.
- E-0045LEP patients perceived inferior care and described concrete harms when interpretation was inadequate or absent
- E-0046No LEP psychiatric inpatients received a personality disorder diagnosis versus 19% of English-proficient patients
- E-0047Barriers to professional interpretation led LEP patients to delay care or proceed without assistance, limiting communication
- E-0048LEP patients reported providers overestimate their English comprehension and do not check for understanding
- E-0049LEP psychiatric inpatients received more consultant reviews (median 4 vs 3) but not after adjusting for length of stay
- E-0050LEP patients described interpreter unavailability causing delays that lengthen outpatient and emergency visits
- E-0051Median psychiatric inpatient length of stay was higher for LEP patients (12 vs 8 days) but not statistically significant
- E-0052For LEP patients medical interpreters actively completed communicative tasks beyond verbatim translation
- E-0053Three-quarters of surveyed children's hospitals (74%) reported translating discharge instructions
- E-0054Telephone-based interpreters faced challenges completing communicative tasks versus in-person interpreters due to lost information and lack of visual cues
- E-0055Operational complexity from mismatched discharge and translation time frames was the most cited barrier to translating discharge instructions
- E-0056Hospitals rely on interpreters to act as translators despite differing training, limited to short or simple documents
- E-0057Every institutional policy mentioning machine translation forbade using it alone, calling it inaccurate and unsafe
- E-0058Standardized translated document libraries and EHR templates are the main strategy but are limited to common languages and cannot be personalized
- E-0059No significant difference in length of stay after bariatric surgery between LEP and EP patients (adjusted IRR 0.94)
- E-0060LEP patients visited the ED less than EP patients within one year of bariatric surgery (adjusted OR 0.65)
- E-0061No significant difference in one-year readmission after bariatric surgery between LEP and EP patients (adjusted OR 0.94)
- E-0062Interpreters enacted active collaborator and co-constructor roles rather than neutral conduits
- E-0063Interpreter's unstated assumption created an unrepaired misinterpretation of who served as informal interpreter
- E-0064Provider's use of a colloquialism (blood thinner) created interpretation confusion rather than aiding comprehension
- E-0065Collaborative co-construction among interpreter, provider, and patient achieved mutual understanding (intersubjectivity)
- E-0066Interpreters experienced role dissonance between conduit training and the collaborative demands of actual encounters
- E-0067Audiologists were significantly less confident testing speech discrimination in non-English non-Spanish speakers than Spanish speakers (3.65 vs 2.35)
- E-0068Providers reported significantly greater effort treating non-English non-Spanish speakers than Spanish speakers
- E-0069Most clinicians reported inability to accurately assess hearing loss in LEP patients hindered treatment (93 percent)
- E-0070Interpretation resources were the most frequently cited ideal resource with in-person interpreters preferred (72 and 62 percent)
- E-0071Clinicians improvised on validated speech-perception testing or used non-speech evaluation for CI candidacy in LEP patients (59 and 52 percent)
- E-0072Adjusted ED length of stay was negligibly different (0.77%, ~1.2 min) between interpreter-requested and English-speaking pediatric patients
- E-0073Adjusted odds of 7-day ED readmission were only 3% higher and non-significant for interpreter-requested pediatric patients
- E-0074Adjusted odds of hospital admission or transfer were only 6% higher for interpreter-requested pediatric patients, a reversed trend from prior gaps
- E-0075Interpreters were requested for 12.1% of pediatric ED patients in 2016, up from ~2% in 2002
- E-0076Interpreter use was documented for only 62% of LEP cholecystectomy patients despite the Section 1557 mandate
- E-0077Only 31% of LEP cholecystectomy patients received language-concordant documentation
- E-0078Documented interpreter use was not significantly associated with LOS, ED revisits, readmission, or surgical follow-up after cholecystectomy
- E-0079Language-concordant documentation was not significantly associated with LOS, ED revisits, readmission, or surgical follow-up after cholecystectomy
- E-0080Interpreter or bilingual-provider access was offered to only 24% of postpartum couplets at admission and 14% for daily rounds
- E-0081Median wait for an in-person interpreter after clinician request was 17 minutes (range 0-75)
- E-0082Long unpredictable interpreter wait times led clinicians to get by with hand gestures broken Spanish and phone apps
- E-0083Clinicians triaged encounters as noncritical and withheld interpreters reserving them for consents
- E-0084Clinicians strongly preferred in-person interpreters over phone and video for engagement and continuity
- E-0085Bedside interpreter telephone access lowered LEP 30-day readmission during intervention (OR 0.64)
- E-0086Bedside interpreter telephone access had no significant effect on length of stay
- E-0087Averted LEP readmissions during intervention yielded estimated $161,404 monthly hospital savings
- E-0088Time constraints led ad hoc interpreters to pressure psychiatric patients into short answers, cutting off their narratives
- E-0089Ad hoc interpreters acted as gatekeepers, answering on patients' behalf and controlling what reached the clinician
- E-0090In cultural-broker role, ad hoc interpreters' own interpretations took precedence, risking dilution of the patient's explanatory model
- E-0091As clinician and ad hoc interpreter negotiated roles, the patient's voice was lost in interpreter-mediated psychiatric consultations
- E-0092Interpreter use was the strongest predictor of LOS after TSA, adding 0.88 days per patient
- E-0093Interpreter-cohort TSA patients were 454 percent more likely to be discharged to a rehabilitation facility
- E-0094No significant association between interpreter need and 30- or 90-day complication rates after TSA
- E-0095Interpreter career-ladder restructuring was followed by large reductions in service-delay, encounter-quality, and unable-to-provide complaints
- E-0096All interpreter staff became nationally certified and mean assessment scores rose after the career-ladder intervention
- E-0097Inpatient excellent-satisfaction ratings for understandable nurse explanations rose over seven points post-intervention
- E-0098Staff satisfaction with interpreter timeliness was lower in inpatient settings than in clinics and the ED
- E-0099Embedding interpreters in inpatient care teams expanded their role to proactive care coordination and problem-solving
- E-0100QI bundle raised appropriate interpreter use and documentation for Spanish-speaking LEP ED patients from 35.7% to 64.5%
- E-0101Improving interpreter use and documentation did not reduce the 48-hour ED return-visit rate for LEP patients (3.1%)
- E-0102The interpreter-use QI bundle did not significantly change balancing measures of ED length of stay (186 min) or VRI encounter time (16.5 min)
- E-0103No significant difference in length of stay between LEP patients who did and did not receive an interpreter after casemix adjustment
- E-0104No significant difference in hospital cost between LEP patients who did and did not receive an interpreter after casemix adjustment
- E-0105About half (54.4%) of admitted LEP patients requiring an interpreter received one
- E-0106Female LEP patients were more likely than males to receive an interpreter (65.1% vs 41.7%)
- E-0107LEP children wore hearing aids far less per day than English-proficient peers (1.30 vs 5.19 hr)
- E-0108Nearly half of LEP children wore hearing aids 15 min or less per day versus 10 percent of English-proficient children
- E-0109Direct-Spanish care raised primary-endpoint general satisfaction over interpreter services (4.45 vs 4.09) in an RCT
- E-0110Direct-Spanish care raised satisfaction with overall-care domains (technical quality, interpersonal manner, communication, time spent)
- E-0111Direct-Spanish care raised satisfaction with physician communication (disclosure, empathy, confidence, general)
- E-0112Direct-Spanish consultations had more physician history-verification and partnering utterances
- E-0113Patients in direct-Spanish consultations asked more questions and gave more unprompted speech
- E-0114Satisfaction benefit of direct-Spanish care attenuated to nonsignificance at later treatment timepoints
- E-0115Initial consultation length did not differ between direct-Spanish and interpreter-services arms (37 vs 33 min)
- E-0116No difference in ED length of stay between LEP and English-speaking patients
- E-0117Among LEP ED patients interpreter use was associated with significantly longer length of stay
MethodMethod · 0
SourceSource · 33
A published research source — a journal article, conference paper, or book.
- S-0001Communication Barriers and the Clinical Recognition of Diabetic Peripheral Neuropathy in a Diverse Cohort of Adults: The DISTANCE Study
- S-0002Pain Assessment Disparities by Race, Ethnicity, and Language in Adult Hospitalized Patients
- S-0003End-of-life healthcare utilization and palliative care use among older adults with limited English proficiency
- S-0004The impact of English proficiency on outcomes after bariatric surgery
- S-0005Clinician Perspectives on the Management of Hearing Loss in Patients With Limited English Proficiency
- S-0006The active role of interpreters in medical discourse - An observational study in emergency medicine
- S-0007Patient Perspectives on the Need for and Barriers to Professional Medical Interpretation
- S-0008The effect of limited English proficiency and interpreter service use on clinical outcomes in psychiatric inpatient units
- S-0009Translating Discharge Instructions for Limited English-Proficient Families: Strategies and Barriers
- S-0010A conversation analysis of verbal interactions and social processes in interpreter-mediated primary care encounters
- S-0011A Reversed Trend: Care for Limited English Proficiency Patients in the Pediatric Emergency Department
- S-0012Pilot Cluster Randomized Controlled Trial of Integrative Nutritional Counseling Versus Standard Diabetes Self-Management Education for Chinese Americans with Type 2 Diabetes
- S-0013Pilot study of provider adherence to language services for surgical patients with limited English proficiency
- S-0014Evaluation of Patient Access to Spanish-Language-Concordant Care on a Postpartum Unit
- S-0015Understanding Medication Adherence in Patients with Limited English Proficiency
- S-0016Convenient Access to Professional Interpreters in the Hospital Decreases Readmission Rates and Estimated Hospital Expenditures for Patients With Limited English Proficiency
- S-0017When roles within interpreter-mediated psychiatric consultations speak louder than words
- S-0018Optimizing usability of a mobile health intervention for Spanish-speaking Latinx people with HIV through user-centered design: a post-implementation study
- S-0019Association Between Limited English Language Proficiency and Disparities in Length of Stay and Discharge Disposition After Total Shoulder Arthroplasty: A Retrospective Cohort Stud
- S-0020Dual-role nurse interpreter perceptions of language barriers and Spanish-speaking patients: A qualitative study
- S-0021A Quality Improvement Project to Reduce Rapid Response System Inequities for Patients with Limited English Proficiency at a Quaternary Academic Medical Center
- S-0022Professional language interpretation and inpatient length of stay and readmission rates
- S-0023Creating a Professional Ladder for Interpreters for Improvement of Care
- S-0024Improving Equity of Care for Patients with Limited English Proficiency Using Quality Improvement Methodology
- S-0025Disparities in the Use of Internet and Telephone Medication Refills among Linguistically Diverse Patients
- S-0026Factors associated with utilisation of health care interpreting services and the impact on length of stay and cost: A retrospective cohort analysis of audit dat
- S-0027Pediatric Hearing Aid Daily Wear Time Is Significantly Impacted by Clinician-Family Language Discordance
- S-0028Limited English proficiency among adults with HIV in the United States - Medical Monitoring Project, 2015-2018
- S-0029Language-concordant automated telephone queries to assess medication adherence in a diverse population: a cross-sectional analysis of convergent validity with pharmacy claims
- S-0030The Influence of Patient-Provider Language Concordance in Cancer Care: Results of the Hispanic Outcomes by Language Approach (HOLA) Randomized Trial
- S-0031Does Spanish instruction for emergency medicine resident physicians improve patient satisfaction in the emergency department and adherence to medical recommendations?
- S-0032Medication Related Self- efficacy among Linguistically Diverse Patients with Chronic Illnesses
- S-0033No difference in emergency department length of stay for patients with limited proficiency in English
ArtifactArtifact · 2
A concrete system (prototype, standard, intervention) that instantiates a pattern or method.