1 Programming Languages (CS 550) Mini Language Interpreter Jeremy R. Johnson.
Access to Language Interpretation Services and its Impact ......the following: if language barriers...
Transcript of Access to Language Interpretation Services and its Impact ......the following: if language barriers...
April 2018
Access to Language Interpretation Services and its Impact on Clinical and Patient Outcomes: A Scoping ReviewNazeefah Laher, Anjum Sultana, Anjana Aery, & Nishi Kumar
Wellesley Institute works in research and policy to improve health and health equity in the GTA through action on the social determinants of health.
By: Nazeefah Laher, Anjum Sultana, Anjana Aery, & Nishi Kumar
Report© Wellesley Institute 2018
Copies of this report can be downloaded from www.wellesleyinstitute.com.
Statement on Acknowledgement of Traditional LandWe would like to acknowledge this sacred land on which the Wellesley Institute operates. It has been a site of human activity for 15,000 years. This land is the territory of the Huron-Wendat and Petun First Nations, the Seneca, and most recently, the Mississaugas of the Credit River. The territory was the subject of the Dish With One Spoon Wampum Belt Covenant, an agreement between the Iroquois Confederacy and Confederacy of the Ojibwe and allied nations to peaceably share and care for the resources around the Great Lakes.
Today, the meeting place of Toronto is still the home to many Indigenous people from across Turtle Island and we are grateful to have the opportunity to work in the community, on this territory.
Revised by the Elders Circle (Council of Aboriginal Initiatives) on November 6, 2014
10 Alcorn Ave, Suite 300Toronto, ON, Canada M4V [email protected]
TABLE OF CONTENTS
Introduction .................................................................................................................................................1
METHODS ....................................................................................................................................................2
Search Strategy and Study Selection .....................................................................................................2
Data Extraction and Synthesis ..............................................................................................................3
Terms and Definitions ...........................................................................................................................4
RESULTS .......................................................................................................................................................5
Quality Appraisal ...................................................................................................................................5
Description of Studies ...........................................................................................................................5
Theme 1: Access to and Mode of Interpretation ..................................................................................6
Theme 2: Clinical Outcomes of Interest ...............................................................................................8
Theme 3: Patient Outcomes ................................................................................................................10
Discussion ..................................................................................................................................................11
Interpretation of Findings...................................................................................................................11
Conclusion .................................................................................................................................................15
Appendices .................................................................................................................................................16
Appendix A ...........................................................................................................................................16
Appendix B ...........................................................................................................................................17
Endnotes ....................................................................................................................................................31
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 1
IntroductionLanguage barriers are a significant challenge in ensuring equitable access to health care. 1,2,3,4
Within the Canadian context, language is often cited as an obstacle to health care services for
immigrant populations, in particular newcomers.5 Patients and families who do not speak an
official language face obstacles accessing health services,6,7 receiving physician and hospital
care, as well as participating in health promotion and prevention programs.8 Language
barriers can result in inappropriate medical testing,9 increase the risk of adverse medication
reactions,10 and pose a significant barrier to medical comprehension.10 It has also been
associated with increased risk of hospital admission,11 medication adherence,12,13 less optimal
palliative care,14 and disparities in diagnostic testing.15 Also language barriers appear to have
measurable impacts on patient satisfaction, specifically on communication with health
care providers16 and on the care received.17 This carries over to health care providers who
also experience dissatisfaction in their interactions with patients when there is a language
barrier.18
In Ontario, data suggests that the issue of language barriers may impact more and more
residents. Census data from 2016 shows an increasingly diverse linguistic landscape.19 Nearly
half of all Canadians with a mother tongue other than English or French live in Ontario20
and almost 15 percent of Ontarians and 25 percent of Torontonians speak a non-official
language at home.20 Furthermore, approximately 80 percent of Ontarians who have no
knowledge of English or French are concentrated in Toronto.21 This speaks to the growing
need for linguistic accommodations in Toronto and Ontario. While Census data22 says that
vast majority of Canadians speak one of the official languages, it is not clear exactly how many
of Canadians are fully fluent or how many have limited official language proficiency. A 2001
review23 of the research literature related to language access suggested that 1 in 10 Canadians
may need an interpreter in a health care setting. It’s not just new immigrants that experience
language barriers in health care settings. Some long-term immigrants who have been fluent
in English or French for most of their lives are losing their English skills due to the impact
of dementia.24 In the era of Patients First25, which provides an opportunity to ensure that
patients have the right care, in the right place, at the right time, we also need the necessary
supports in place so patients can make informed decisions about their health care.
Ontarians who are not proficient in, or unable to speak an official language (English or
French), face inequities in health care settings. Health Quality Ontario defines health
equity as the ability of all people “to reach their full potential [and] receive quality care that
is fair and appropriate for them – regardless of where they live, what their economic and
social status, language, culture, gender or religion [is].”26 It is important to consider the
health equity impacts of language barriers in health care in the context of an increasingly
multicultural, multiracial, and multilingual province such as Ontario.27, 28
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 2
Despite the growing body of work on the impact of language barriers on access to health care
services, and the growing linguistic diversity in Ontario, there has been limited uptake of
formalized language supports across Ontario’s health care system. In a review of strategies to
increase language accessibility for patients who have limited English proficiency, a number
of supports are identified such as bilingual providers, non-professional interpreters such as
family members and volunteers, translated written materials, computer-assisted translation,
and most common, language interpretation services.29 Some health care institutions in
Ontario offer in-person professional language interpretation services to patients, but in
practice, many use informal methods such as communicating through bilingual hospital staff
or the patients’ family members.30
The purpose of this scoping review is to examine the impact of language interpretation
services on patients’ health and clinical outcomes to better understand its effectiveness as an
intervention. We chose language interpretation services compared to other interventions to
address language accessibility because of the formalized nature of the intervention as well as
to provide relevancy to similar interventions within the Canadian context.31
Systematic reviews that have examined the efficacy of language interpretation services have
focused on specific settings such as in psychiatric services32, or excluded outcomes of interest,
for example relating to the clinical experience of accessing health care services such as length
of stay, and re-admission rates.33 In general, these systematic reviews found that trained
interpreters were more effective than untrained interpreters in producing positive patient
outcomes when it came to psychiatric assessment and diagnoses, patient understanding of
treatment plans, patient satisfaction, and errors of clinical significance. However, many of the
studies in these reviews were conducted nearly 10 years ago and do not include more recent
research studies. Moreover, there has been limited exploration of the effectiveness of these
services across all potential modes of interpretation services such as in-person, phone, video
among others.
METHODS
Search Strategy and Study Selection
This scoping review was conducted using the Arksey & O’Malley methodology.34 We focused
on peer-reviewed academic literature and followed these steps: 1) identified our research
question; 2) selected our databases; 3) developed our search strategy and searched for
relevant studies; 4) used inclusion and exclusion criteria to select relevant studies; 5) charted
the data; 6) collated and summarized the results.
After identifying our research question (“What is the link between access to interpretation
services in health care and patient outcomes?”), we developed a search strategy with support
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 3
from a librarian at the University of Toronto. We adapted this search strategy to effectively
search our five selected scholarly databases (Medline, Scopus, PubMed, PsychInfo, and
Embase) (Appendix B). We selected these databases because of their focus on health and
social sciences. We selected studies based on the following inclusion criteria: articles had
to be peer-reviewed, in English, published in the last 17 years (2000 onwards), focused on
the provision of interpretation services in health care settings, and have a patient or clinical
outcome. This project focused on the needs of people who had barriers with spoken language
as well as the use of formal interpretation. As such, interventions that exclusively focused
on informal interpretation or those that did not address spoken language barriers were
out of scope for our project. Subsequently, we excluded research that exclusively focused
on non-professional or informal interpretation (such as by volunteers, family members
or by healthcare providers), and studies that focused on interpretation for American Sign
Language, or assessments of aides and tools for addressing communication disorders.
Articles that met the inclusion criteria were extracted and we collated key information on
relevant factors including: study design, country/region, type of service provided, how service
need was identified, type of interpretation provided, interventions, outcomes of interest,
study population, clinical care setting, and key findings.
Data Extraction and Synthesis
Our initial search of the five selected databases yielded 9,961 articles. A total of 3,691 articles
were excluded due to duplication. The remaining 6,270 articles were screened by titles, then
abstracts, and then full text screening, leaving a total of 30 articles that met all inclusion
criteria.
Medline: 2,249 Embase: 2,034CINAHL: 2,835
PsychInfo: 1,620Scopus: 1,223
Title Screened: n = 6,270
Abstract Screening: n = 1,845
Full Text Screening: n = 114
Full Text Screening: n = 114
Duplicates Removed: n = 3,691
Excluded: n = 4,425
Excluded: n = 1,731
Excluded: n = 84
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 4
At every stage of the screening process, each article was screened by two of the four
researchers and all four researchers resolved conflicts during the screening together.
Abstract titles were screened to identify if the study was relevant to language interpretation.
We then created a data extraction form to screen abstracts. The screening form identified
the following: if language barriers are addressed, if the intervention involved a trained
interpreter, and if clinical or patient outcomes are assessed. We used this extraction form
again for the full text screening. During this screening process we chose to exclude qualitative
studies, as we were primarily interested in measurable health or clinical outcomes. Data
extraction was divided amongst all four researchers. Throughout the screening and extraction
process, researchers met frequently to ensure consistency was maintained throughout the
process. A total of 30 articles were included for review.
Research team members then independently reviewed the results and identified themes
based on our outcomes of interest. These included but are not limited to: number of
clinically significant errors, admission and readmission rates, length of stay and length of
appointment, preventive care, chronic disease management, mental health assessments,
quality of care, medical adherence, service utilization and health care usage. The research
team then discussed and built consensus on key themes which were summarized and
included in the table in Appendix B.
As a point of reference, the table below includes frequently used terminology with an
accompanying definition.
Terms and Definitions
Term Definition
Language Interpretation Services An intervention that can increase language accessibility of the health care system.
Trained Interpreters Trained interpreters have received some form of training, whether formal in a classroom or on the job from the health care institution or organization that they are working at.
Untrained Interpreters Untrained interpreters are a broad term to refer to any person who engages in interpretation who has not been formally trained, whether in a classroom setting or on the job. In this scoping review, we refer to ad-hoc interpreters (individuals who conduct interpretation services without any clear training) as untrained interpreters.
In-person interpreters In-person interpreters are interpreters who are physically present during the health encounter a patient has with their health care provider.
Remote interpretation A modality of interpreting that is conducted at a distance, usually by telephone or video. Remote interpretation can either be consecutive or simultaneous.
Consecutive Interpretation In consecutive interpretation the interpreter listens to a unit of speech in the source language and then conveys that message into the target language. This mode is more often used in health care
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 5
Simultaenous Interpretation Simultaneous interpretation is not necessarily interpreting word to word, it is the mode in which the interpreter interprets the message into the target language at almost the same time as the original message is being said.There are studies included in this review that use “remote simultaneous medical interpretation,” referring to simultaneous interpretation using a telephone or video conferencing.
Language Concordant Providers Health care providers who are able to speak the same language as their patients.
LEP (Limited English Proficiency) Patients who do not speak English or are not proficient in English.
ESP (English Speaking Patients) Patients comfortable speaking English/choose to speak English in health care settings
Length of Stay Time spent in the hospital or in health care settings from intake to discharge
Length of Appointment Time spent during an appointment with a health care provider from the beginning to the end of the appointment
Clinical Outcomes For the purposes of this scoping review, we define clinical outcomes as issues related to institutional level factors impacting a patient’s experience within the health care system such as length of stay or medical errors for example.
Patient Outcomes For the purposes of this scoping review, we define patient outcomes as issues related to a patient’s uptake of services such as preventive services or the impact of LIS on access and quality of treatment services.
RESULTS
Quality Appraisal
After data extraction was completed, the researchers conducted a quality appraisal of the 30
articles included in the review using the Quality Assessment Tool for Quantitative Studies,
developed by the Effective Public Health Practice Project (EPHPP).35 One reviewer completed
the quality appraisal per article. There were six strong articles, 16 articles that were of
moderate strength, and eight weak articles (Appendix B).
Description of Studies
Thirty articles were included in our scoping review (Appendix B). Of these, the majority of
the studies were cohort studies (14) and cross-sectional studies (9). The review included two
randomized control trials, one randomized clinical trial, one case control study, and three
pre-post observational studies. The majority of the studies (25) were from the United States.
There were also studies from Switzerland (1), the United Kingdom (1), and Australia (3).
Through a process of iterative thematic coding, we categorized the outcome data extracted
from the finalized list of screened articles into three main themes: Access to and Mode of
Interpretation; Clinical Outcomes; and Patient Outcomes.
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 6
For the first theme: Access to and Mode of Interpretation, we explored the effectiveness of
professionally trained interpreters compared to untrained interpreters, such as volunteers
and family members. We also considered differences between five different modes of
interpretation (in-person, telephone, video, bilingual providers, and remote simultaneous
interpretation services) as well as how frequency and consistency of interpretation services
affected outcomes.
The second theme focused on Clinical Outcomes, which in our scoping review refers to how
language interpretation services impacted institutional and organizational level outcomes.
This can include various outcomes associated with a health care encounter such as duration
of a clinic visit and re-admission rates.
Finally, the last theme focused on the impact of interpretation services on various types of
Patient Outcomes such as changes in diagnostic, treatment and management outcomes, as
well as uptake of preventive services.
Theme 1: Access to and Mode of Interpretation
Comparing Trained Interpreters vs. Untrained or No Interpreters
In our scoping review, 14 studies examined the effectiveness of trained interpreters compared
to untrained or no interpreters. Of the 14 articles, six36, 37, 38, 39, 40, 41 showed that trained
interpreters led to better clinical outcomes, three34, 35, 42 showed that trained interpreters led to
better patient outcomes, and five43,44, 45, 46, 47 showed a decrease in clinical errors with trained
interpreters.
One of the most substantial differences when comparing trained interpreters to untrained or
no interpreters was seen in differences in errors of clinical significance. Five studies,40,41,42,43,44
were able to demonstrate that the rates of errors were less frequent and less severe for trained
interpreters compared to untrained interpreters or no interpreters. Flores and colleagues
found that the proportion of errors was lower for professionally trained interpreters (12%)
compared to untrained interpreters (22%) and no interpreters (20%).42 There were higher rates
of omissions and incorrect interpretation errors for untrained interpreters (46.3%; 31.6%) and
no interpreters (54.2%; 35.9%) compared to trained interpreters (41.9%; 13.6%), respectively.42
This was also seen by Napoles’ research team who found the odds of a moderately or highly
clinically significant error was lower for in-person trained interpreters compared to untrained
interpreters (OR = 0.25, p = 0.05).40 There was also a reduced likelihood of understanding of
health issues such as heart disease risk when family and friends were used as interpreters
compared to professional interpreters.41
The evidence from our scoping review indicates that having access to trained interpreters
improves clinical and patient outcomes in comparison to ad-hoc, informal, or no interpreters.
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 7
Comparing Different Modes of Interpretation
Seven studies36, 40, 48, 49, 50, 51, 52 evaluated different modes of interpretation. This included
both simultaneous interpretation and interpretation (table 1), delivered in-person, through
telephone, and through video conferencing. Some studies also used bilingual providers who
provided services in the patient’s language. The evidence on which mode was best differed
across studies and was dependent on multiple factors including the health care setting
context and type of outcome.
In another study,47 patients that had in-person interpreters were more likely to be seen
faster (65%) than those who had telephone interpreters (52%) or bilingual providers (42%).
Patients with in-person interpreters (8%) also had a lower frequency of complex medical
administration compared to their counterparts who received alternative support from
telephone interpreters (15%) or bilingual providers (15%).47
Length of encounter also varied depending on mode of interpretation. For example,
one study that looked at errors of clinical significance found that remote simultaneous
medical interpretation encounters were on average shorter and non-remote-simultaneous
medical encounters (which includes remote consecutive as well as in person simultaneous
and consecutive interpretation) were 12 times more likely to result in errors of clinical
significance.44 Remote simultaneous medical interpretation encounters were also associated
with greater rates of detection and treatment of depression, however it was not seen to be
statistically significant.45 The mode of interpretation may also have implications for patients’
understanding of diagnoses. Lion and colleagues found that parents were more likely to
correctly identify their child’s diagnosis if they were exposed to video interpretation (74.5%)
compared to telephone interpretation (59.8%).46
Impact of Frequency and Consistency of Interpreter Use
There were four studies 37,53,56,60 that commented on the impact of increased frequency of
interpreter use on clinical and patient outcomes.
One study50 found that when a patient had more frequent interpreted health care encounters,
there was a significant reduction in hospital admissions due to hyperkalemia, hypertension
and fluid overload. Specifically, the greatest reduction was seen for rates of hyperkalemia.
When a patient did not have any health care encounters interpreted, there was an average
of 10 hospital admissions for hyperkaliemia.50 However, when a patient had 5 interpreted
health care encounters, the number of hospital admissions for hyperkalemia dropped down
to 2.
In a study by Jimenez and colleagues, that measured the association between parental
language proficiency, interpreted care, and postsurgical pediatric pain management, it was
found that children of families who received less than 2 interpreted visits per day had higher
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 8
rates of post-analgesic pain score (1.6 ± 1.4 vs 0.7 ± 1.2; P = .004) compared to children with
more frequent interpretation.60
Researchers found that patient stroke rehabilitation patients who had more frequent
interpreter use had improved Functional Independence Scores.56 There was no evidence of
impact on other outcomes such as length of stay or discharge destination. The frequency
of interpreter use combined with the mode of interpreter use can also lead to a positive
impact. For example, one study found that patients who received 100% of their primary care
visits with language concordant providers (also known as bilingual providers) were the least
likely to have diabetes related emergency department visits compared to all other types of
interpretation which included in-person interpretation, and no interpretation.37
Theme 2: Clinical Outcomes of Interest
The impact of language interpretation services on clinical outcomes was observed in 17 of the
reviewed articles.
Length of Stay
For length of stay in hospital, evidence was mixed in hospital settings, and context specific,
with some studies finding that length of time increased when trained interpreters were
used while others finding it decreased the length of stay. Three studies54,55,56 reported that
interpretation increased length of stay, one study57 reported that interpretation decreased
length of stay, and one58, 59 reported no significant difference in length of stay.
Length of Appointment
Three studies36,47,57 provided evidence on the impact of interpretation on the length of an
appointment. In a study conducted by Fagan and colleagues, they showed that telephone
interpretation was associated with increased time spent with the provider (36.3 min vs.
28.0 min, P < 0.001), compared to patients not using an interpreter.36 In another study, 47 researchers looked specifically at the type of interpretation mode and the impact on
provider time and found patients who had in-person interpreters (116 min) had on average
significantly shorter throughput time compared to patients who had telephonic interpreters
(141 min) and bilingual providers (153 min). Researchers found that for every hour of
in-person interpretation (60 minutes), approximately 2 additional minutes were required
for an encounter with a bilingual provider and 9 additional minutes would be added for
an encounter using telephone interpretation. The third study57 found that limited English
proficiency (LEP) patients using a trained interpreter had longer appointments, such as
patients speaking Spanish (averaging 9.1 additional minutes of physician time) and Russian
(averaging 5.6 additional minutes of physician time) compared to English speaking patients
who did not use an interpreter.
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 9
Service Utilization
Clinical outcomes related to service utilization were also impacted by access to interpretation
services, demonstrated in four studies.33,35,38,60 Two of these studies studies33,57 found that
using professional interpreters led to a significant increase in referrals for primary, specialty,
and psychological care, and showed an uptake in the number of office visits. For general
medical referrals, access to both untrained interpreters and trained interpreters allowed
access to 48 percent and 42 percent of patients respectively, compared to 31 percent for
patients who did not use an interpreter.57 However, a study conducted by Sarver & Baker,
found no significant difference in appointment compliance rates for patients with and
without an interpreter.38 One study35 also found that English speaking patients had a
significantly greater volume of service use during an emergency department visit compared to
patients with limited English proficiency with and without an interpreter.35
Admission and Readmission Rates
In the four studies33,54,56,61 that examined admission and readmission rates in hospitals,
there was consistent evidence that showed that language interpretation services decreased
admission rates and re-admission rates. One5 found that upon giving patients access to
24-hour interpretation, 30-day readmission rates decreased by approximately 5% more during
the study period, compared to the 18 months before the intervention.9 Likewise, Lindholm
and colleagues56 found that patients who received interpretation at both admission and
discharge were less likely to be readmitted 30 days after discharge (14.9%) compared to those
only receiving interpretation at admission (16.9%), only at discharge (17.6%), or those who did
not receive interpretation at admission nor discharge (24.3%).
Medical Errors
There were three studies40,42,44 that evaluated how access to language interpretation services
decreased the likelihood of errors of clinical significance. Certain modes of interpretation
were less likely to produce errors in general as well as errors of clinical significance. For
example, one study44 found that remote simultaneous medical interpretation services were
less likely to produce errors of clinical significance. Non-remote simultaneous medical
interpretation was associated with a 12 times greater chance of potential medical errors
of moderate or greater clinical significance compared to remote simultaneous medical
interpretation. Non-remote in this case refers to in person simultaneous and consecutive
interpretation as well as remote consecutive interpretation. We also see that professional
interpreters (12%) are less likely to commit errors compared to ad hoc interpreters (22%) and
no interpreters (20%).42
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 10
Theme 3: Patient Outcomes
Our scoping review has found 11 studies that show the efficacy of language interpretation
services in the diagnosis, treatment, and management of various health conditions, as well as
uptake of preventive care.33, 34, 35, 37, 39, 41, 49, 55, 57, 59, 60
Diagnostic, Treatment and Management Outcomes
Four studies indicated the impact of interpretation services had on facilitating the diagnosis,
treatment and management of health conditions.39,55,57,60
Eytan and colleagues found that the use of interpreters was helpful in encouraging patients
to report traumatic events and psychological symptoms.57 The report of adverse events and
past exposure to situations like war, the violent death of a relative or a missing relative was
more frequently reported when trained interpreters (77%) were present compared to when
no interpreters (55%) or untrained interpreters (46%) were present.57 The use of trained
interpreters was also associated with increased referrals to medical care (42%) compared to
no interpreters (31%).57
The use of interpretation has also been seen to lead to higher rates of pain control, timely
response to patient pain, as well as help from staff compared to patients who did not always
receive interpretation.62 For stroke rehabilitation patients increased interpretation usage was
also associated with greater improvement in Functional Independence Measure efficiency
score, which is a significant measure for stroke rehabilitation.55 Patients with refugee status
who used interpreters (27%) were seen to have greater improvements in mental health
outcomes such as for scores on the Impact of Events Scale compared to refugees without
interpreters (14%).39
Preventive Health Services
Four studies in our scoping review examined the impact of language interpretation services
on the uptake of preventive health services.34,35,37,63
All studies that examined preventive health service use found that language interpretation
services increased uptake. Patients who had access to trained interpretation services were
more likely to have had rectal exams conducted compared to people that did not have access
to interpretation services (0.26 vs. 0.02; P =0.05; not shown).34 In another study60 it was found
that trained in-person medical interpreters increased the likelihood of mammograms (OR
= 1.85), clinical breast exams (OR = 3.03), and pap smears (OR = 2.34), compared to patients
that did not use any interpreters. Patients who had bilingual providers were also twice as
likely to have a clinical breast exam or a pap smear compared to patients who did not have
any interpreters.60 In another study, it was found that when patients received interpretation
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 11
services, they had higher rates of preventive services uptake for rectal exams and fecal occult
blood tests compared to their peers who did not receive any interpretation services.35
DiscussionThis is the only scoping review to our knowledge that has synthesized evidence on the
impact of language interpretation services on both the clinical and patient outcomes
across a range of health care settings. There is a significant body of evidence that trained
interpreters were consistently effective at producing better clinical and patient outcomes
for patients in comparison to patients who had access to only untrained interpreters or
no interpreters.33,34,40,41,42,49,57 This review also demonstrated that the issue of language
accessibility in health care was addressed through many different modes of interpretation. 40,45,46,47,48
Interpretation of Findings
Access to and Mode of Interpretation
Overall, the literature reports that trained interpreters are more effective than untrained
interpreters or no interpreters. The use of trained interpreters was associated with lower
rates of readmissions,56 fewer errors of clinical significance,42 and produced more favorable
outcomes for uptake of preventive services.35
While access to language interpretation appears to be beneficial with respect to clinical
outcomes and patient outcomes, it is not possible to definitively conclude which mode of
interpretation is most effective. The most effective mode of interpretation varies across
contexts and subgroups of patients depending on things such as the type of health problems
or acuity. There is no such thing as a one-size-fits-all approach in medical interpreting.
Telephone interpretation for example may not be the best approach to patients with dual
diagnosis, those who are hard on hearing clients, or children [new endnote]. This is because
the studies included in this review did not compare all available modes of interpretation
and it is difficult to evaluate the role of varying contexts. It was evident that context played an
important role in determining which mode to use, however demonstrating which mode is
best for each context is will require further research and exploration.44,64
Previous scoping and systematic reviews have not evaluated the impact of frequency and
consistency on language interpretation services. In our scoping review, we found evidence
suggesting that the frequency of interpreted health care encounters as well as the consistency
of access to language interpretation services seem to be a contributing factor to clinical and
patient outcomes.37 More research is required to better establish the relationship between
frequency of interpretation services and patient outcomes. However, the available evidence
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 12
suggests the value of having consistent access to interpretation services for patients with
limited proficiency.
Impact of Language Interpretation Services on Clinical Outcomes of Interest
This review found that the impact of language interpretation services on length of stay in
hospitals after length of stay was mixed. Length of stay is often used as a measure of health
care system efficiency and some studies suggest that trained interpreters can reduce length
of stay of patients by almost a day.54,56 While a shorter length of stay is often considered more
favorable, there is evidence to suggest more time is needed for appropriate high-quality
care.65,66,67 Therefore, even though studies showed both an increase and decrease in length
of stay with the use of an interpreter, more research is needed to understand whether an
increased length of stay is indicative of more appropriate and thorough care in health care
settings.
Studies suggest that length of appointment is longer when an interpreter is used, but how
much longer depends on the mode of interpretation.36,47,53 Increased length of appointment
can be due to many factors, such as more information being exchanged or extra time due
to the interpretation.36 Telephone interpretation appears to take more time than in-person
interpreters. This may be due to challenges when using the phone because there is an
inability to communicate through non-verbal means.47 In-person interpretation may be more
responsive to the needs of patients as there is a greater ability to convey and pick up on verbal
cues, body language and other interpersonal cues compared to telephone interpretation.
Additionally, a decrease in health care usage does not necessarily imply more appropriate
care.53 As Hampers and colleagues found, health care usage, or service utilization rates as
noted in their study, for patients receiving interpretation were similar to that of English
speaking patients. This study suggests that access to interpretation services removed a barrier
between the physician and the patient and brought patient service utilization closer to that
of English speaking patients.53 in many cases patients with language barriers are unable
to communicate with their health provider, and are thus are receiving fewer services than
English speaking patients.33 Professional interpreters open a line of communication between
patients and health care providers, thus allowing providers to have a more comprehensive
understanding of patients’ symptoms, pain, queries, and discomforts.57 In two studies33,57 this
led to increased referrals to psychological care and specialists, allowing patients to receive the
appropriate care.
Professional interpretation has been consistently shown to decrease hospital admission and
readmission rates. Patients with limited English proficiency have higher readmission rates
compared to English speaking patients, but one study showed that providing services from
trained interpreters significantly decreases the likelihood of being readmitted.68 The positive
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 13
impacts of interpretation throughout the care continuum contribute to this reduction in
admission and readmission rates. With improved health outcomes2, better communication
with health providers,57 and increased referrals to specialists57, patients are less likely to
experience adverse health implications that require admission and readmission to the
hospital.
Finally, the most definitive evidence that examined the impact of language interpretation
services on patient outcomes was related to the frequency of errors of clinical
significance.42,44,45 Trained interpreters were less likely to have clinically significant errors in
comparison to untrained interpreters or encounters with no interpreters. This is consistent
with previous systematic reviews that also found that patients with limited English
proficiency experience worse health care quality with untrained interpreters compared to
patients with trained interpreters.69,70 These studies also compared a range of interpreter
modes and two studies44,45 have found that remote simultaneous interpretation services were
the best at reducing the rate of medical errors of clinical significance
Impact of Language Interpretation Services on Health Outcomes of Interest
Language interpretation services were found to be effective in improving uptake of preventive
services.34,35,37,61
This was found for a range of services including mammograms, clinical breast exams, and
rectal exams. This is significant to note because there has been a substantial body of research
that has demonstrated disparities in breast and cervical cancer screening rates for racialized,
ethnic minority and immigrant women.69 Addressing language barriers has been noted to be
an important step towards addressing cancer-related inequities for racially and ethnically
diverse patients as well as immigrants and newcomers.70 Evidence suggesting that language
interpretation services can contribute to reducing inequities between LEP patients and
English speaking patients (ESP) indicates a potentially effective solution to addressing health
inequities.
Finally, the most definitive evidence that examined the impact of language interpretation
services on patient outcomes was related to the frequency of errors of clinical
significance.42,44,45
Trained interpreters were less likely to have clinically significant errors in comparison to
untrained interpreters or encounters with no interpreters. This is consistent with previous
systematic reviews that also found that patients with limited English proficiency experience
worse health care quality with untrained interpreters compared to patients with trained
interpreters.71,72 These studies also compared a range of interpreter modes and two studies44,45
have found that remote simultaneous interpretation services were the best at reducing the
rate of medical errors of clinical significance.
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 14
Limitations and Areas of Future Research
According to Grant and Booth73 , a scoping review is a “preliminary assessment of potential
size and scope of available research literature [and] aims to identify nature and extent of
research evidence.” A limitation to this methodology is the comprehensiveness of searching
is limited by time and scope. Due to the inclusion and exclusion criteria, this scoping review
was not exhaustive and did not include all studies related to language interpretation. Part
of the exclusion criteria was that it only included studies from 2000 onwards. This enabled
the study to focus on the most recent evidence when considering evaluations of language
interpretation services, making them as closely relevant to the current context as possible. It
is possible that there are studies prior to 2000 that may have value in understanding language
interpretation and its relationship to clinical and patient outcomes.
This scoping review also highlighted gaps in the literature and areas of future research. While
this review did include studies from Europe and Australia, a significant proportion of the
included studies were conducted in the United States and none of the studies included were
from Canada. There are aspects of the Canadian context that this study could not address
such as having a publicly financed health care system, the presence of two official languages,
and the high degree of linguistic diversity in certain regions such as the Greater Toronto Area
(GTA).74 The lack of Canadian academic literature on language interpretation points to a need
for more research on this topic in a Canadian context.
While we did not exclude research from non-hospital settings, nearly all studies were
from hospital settings. From our survey of the research literature, there is a gap in studies
investigating the use of language interpretation services in non-hospital settings. Language
interpretation services in hospital settings may not be generalizable to settings such as
smaller scale family practices which do not have the same level of resources. Family doctors
are often the first point of entry into a health care system and reducing language barriers in
such a setting would be warranted to ensure that a patient’s complete clinical history is able
to be taken and a positive relationship is able to be built.
Additionally, this review found limited data on the financial costs of providing interpretation
services. Some studies looked at costs of programs or service use, but none of the studies
conducted any sort of cost effectiveness analysis or cost benefit analysis. In the future,
as language interpretation services continue to expand, it may be helpful to understand
the resources required for implementation, particularly regarding different modes of
interpretation. However, this must be compared against arguably the most important
variable, clinical and patient outcomes and the ability of patients to achieve their full health
potential.
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 15
ConclusionEnsuring equitable access to health care is an important priority that benefits all Ontarians.
It improves the health of communities and addresses health disparities. Language barriers
have been noted to be a significant issue preventing access to health care services. This is
especially pronounced in a province as linguistically diverse as Ontario. Ontario’s health care
system should be accessible to its diverse communities. Therefore, it is important to better
understand the effectiveness of interventions that seek to address language barriers and
facilitate greater language accessibility of the health care system.
Access to language interpretation services can enhance the accessibility of Ontario’s health
care system. As this scoping review suggests, language interpretation services can have
a measurable impact on the clinical and patient outcomes. Ontario’s linguistic diversity
is likely to continue to grow, so it is important that health care institutions and providers
across the province consider how language needs in health care settings are addressed and
managed.
Language accessibility will also become increasingly relevant to the operations of our
health care systems. As such, it is important that resources and energy be directed towards
evaluating interventions that aim to address these concerns. Future work should look at
further evaluating the impact of language interpretation services and other interventions that
improve language accessibility in the health care system within the Canadian context and
within Ontario specifically.
This review has demonstrated the value of providing patients with services from trained
interpreters. As Ontario becomes increasingly linguistically diverse, language barriers will
continue to pose a challenge for health and health equity. Ontarians deserve the opportunity
to ensure not only that they have the right care at the right time, but also that they have
the necessary supports to make informed decisions about their health care. Investing in
interpretation services, and continuing to evaluate best practices, are important steps for
Ontario to improve patient care and health equity.
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 16
Appendices
Appendix A
Search Strategies
Database Records Search Strategy Limits
Medline 2,249 [exp Patients/ OR (patient or patients).mp.] AND [exp Translating/ OR medical interpret*.mp. OR health interpret*.mp. OR cultural interpret*.mp. OR (translat* adj3 service*).mp. OR (interpret* adj3 service*).mp. OR (language* adj3 service*).mp. OR (interpreter or translator).mp. ]
Limit to [English language AND yr="2000 -Current" AND journal article]
Embase 2,034 [exp Patients/ OR (patients or patients).mp.] AND [exp Translating/ OR medical interpret*.mp. OR health interpret*.mp. OR cultural interpret*.mp. OR (translat* adj3 service*).mp. OR (interpret* adj3 service*).mp. OR (language* adj3 service*).mp. OR (interpreter or translator).mp.]
Limit to [English AND 13 to yr="2000 -Current"
CINAHL 2,835 [(MH "Patients") OR (TX patient OR patients)] AND [(MH "Translations") OR (MH "Interpreter Services") OR TX medical interpret* OR (TX health interpret* OR TX cultur* interpret*) OR (TX translat* N3 service*) OR (TX interpret* N3 service*) OR (TX language N3 service*) OR (TX interpreter OR translator)
Limit to [(Published Date: 20000101-20171231) AND English AND Journal Articles)
PsychInfo 1,620 [exp Patients/ OR (patient or patients).mp.] AND [medical interpret*.mp. OR health interpret*.mp. OR cultural interpret*.mp. OR (translat* adj3 service*).mp. OR (interpret* adj3 service*).mp. OR (language* adj3 service*).mp. OR (interpreter or translator).mp. OR (exp foreign language translation/ or exp foreign languages/ or exp interpreters/)]
Limit to [English language and journal article and yr="2000 -Current"]
Scopus 1,223 TITLE-ABS-KEY("Medical interpret*" OR "health interpret*" OR "language Pre/3 service" OR "translator" OR "interpreter" OR "interpret* Pre/3 service" OR "translat* Pre/3 service" OR "cultural interpret*") AND TITLE-ABS-KEY("Patient" OR "patients") AND TITLE-ABS-KEY("health" OR "health care" OR "health service" OR "healthcare")
Limit (PUBYEAR > 1999)
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 17
App
endi
x B
Sum
mar
y of
Fin
ding
s Ta
ble
Art
icle
Id
entif
icat
ion
Num
ber
Art
icle
Titl
eA
utho
r and
Ye
arSa
mpl
e In
form
atio
nTh
eme
1: A
cces
s to
and
Mod
es o
f In
terp
reta
tion
Com
pari
ng T
rain
ed In
terp
rete
rs
vs. U
ntra
ined
Inte
rpre
ters
vs.
No
Inte
rpre
ters
Freq
uenc
y of
Inte
rpre
tatio
n
Com
pari
ng D
iffer
ent M
odes
of
Inte
rpre
tatio
n
Them
e 2:
Clin
ical
Out
com
es
of In
tere
st
Leng
th o
f Sta
y
Leng
th o
f app
oint
men
t
Adm
issi
on/R
eadm
issi
on ra
tes
Serv
ice
utili
zatio
n
Med
ical
Err
ors
Them
e 3:
Hea
lth
Out
com
es
Prev
entio
n
Dia
gnos
tic
Qua
lity
App
rais
al
1D
etec
tion
of
Dep
ress
ion
with
Diff
eren
t In
terp
retin
g M
etho
ds
Am
ong
Chi
nese
an
d La
tino
Prim
ary
Car
e Pa
tient
s:
A R
ando
miz
ed
Con
trol
led
Tria
l
Leng
, C.F
., C
hang
rani
, J.,
Tsen
g, C
., &
G
any
F. (2
010)
.
Gro
up 1:
Gen
eral
LEP
ra
ndom
ized
to re
ceiv
e Re
mot
e Si
mul
tane
ous
Med
ical
Inte
rpre
ting
(RSM
I)
Gro
up 2
: Gen
eral
LEP
ra
ndom
ized
to re
ceiv
e us
ual a
nd c
usto
mar
y (U
&C
) in
terp
retin
g
Gro
up 3
: Lan
guag
e co
ncor
dant
pat
ient
s
Sett
ing:
New
Yor
k C
ity, U
SA
Stud
y D
esig
n: R
ando
miz
ed
Con
trol
Tria
l
Com
parin
g D
iffer
ent M
odes
of
Inte
rpre
tatio
n
RSM
I was
ass
ocia
ted
with
gre
ater
ra
tes
of d
etec
tion
and
trea
tmen
t of
dep
ress
ion,
how
ever
, the
resu
lts
wer
e no
t sta
tistic
ally
sig
nific
ant.
The
appa
rent
sup
erio
rity
of R
SMI m
ay
have
bee
n du
e to
pra
ctic
al is
sues
su
ch a
s tim
e an
d eff
icie
ncy.
RSM
I is
mor
e pr
ivat
e an
d si
mul
ates
a n
atur
al
conv
ersa
tion
betw
een
lang
uage
di
scor
dant
par
ticip
ants
; non
-ver
bal
cues
may
als
o be
mor
e ob
viou
s w
ithou
t a d
istr
actio
n by
third
per
son
in th
e ro
om
Stro
ng
2Eff
ect o
f Te
leph
one
vs V
ideo
In
terp
reta
tion
on
Pare
nt
Com
preh
ensi
on,
Com
mun
icat
ion,
an
d U
tiliz
atio
n
in th
e Pe
diat
ric
Emer
genc
y D
epar
tmen
t
A R
ando
miz
ed
Clin
ical
Tria
l
Lion
, K. C
, et a
l. (2
015)
.LE
P Yo
uth.
LEP
with
ano
ther
in
terp
rete
r mod
e. T
estin
g th
e eff
ect o
f tel
epho
ne
vs. v
ideo
inte
rpre
tatio
n on
com
mun
icat
ion
durin
g pe
diat
ric e
mer
genc
y ca
re.
Sett
ing:
Sea
ttle
, WA
, USA
Stud
y D
esig
n: R
ando
miz
ed
Clin
ical
Tria
l
Com
parin
g D
iffer
ent M
odes
of
Inte
rpre
tatio
n
Am
ong
208
pare
nts
who
com
plet
ed
the
surv
ey, t
hose
in th
e vi
deo
arm
w
ere
mor
e lik
ely
to n
ame
the
child
’s di
agno
sis
corr
ectly
than
thos
e in
th
e te
leph
one
arm
(P =
0.03
) and
le
ss li
kely
to re
port
freq
uent
laps
es
in in
terp
rete
r use
(P =
.04)
. No
diffe
renc
es w
ere
foun
d be
twee
n th
e vi
deo
and
tele
phon
e ar
ms
in p
aren
t-re
port
ed q
ualit
y of
com
mun
icat
ion
(P =
.43)
or i
nter
pret
atio
n (P
= .6
9).
Pare
nt-r
epor
ted
adhe
renc
e to
the
assi
gned
mod
ality
was
hig
her f
or
the
vide
o ar
m (P
= .0
04).
Use
of
vide
o in
terp
reta
tion
show
s pr
omis
e fo
r im
prov
ing
com
mun
icat
ion
and
patie
nt c
are
in th
is p
opul
atio
n.
Stro
ng
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 18
3Pr
ofes
sion
al
Lang
uage
In
terp
reta
tion
and
Inpa
tient
Len
gth
of S
tay
and
Read
mis
sion
Ra
tes
Lind
holm
, M.,
Har
grav
es J.
L.,
Ferg
uson
, W.
J., &
Ree
d, G
. (2
012)
.
Gen
eral
LEP
who
rece
ive
inte
rpre
tatio
n at
adm
issi
on/
disc
harg
e vs
. LEP
who
did
no
t
Sett
ing:
Mas
sach
uset
ts,
USA
Stud
y D
esig
n:
Retr
ospe
ctiv
e C
ohor
t
Leng
th o
f Sta
y
Patie
nts
who
did
not
rece
ive
inte
rpre
tatio
n du
ring
adm
issi
on +
dis
char
ge h
ad
a lo
nger
leng
th o
f sta
y (+
1.5
days
), co
mpa
red
to th
ose
who
had
inte
rpre
ters
dur
ing
adm
issi
on +
dis
char
ge
(p<0
.001
). In
terp
reta
tion
at d
isch
arge
onl
y w
as n
ot
sign
ifica
ntly
ass
ocia
ted
with
leng
th o
f sta
y, th
ough
in
terp
reta
tion
at a
dmis
sion
w
as.
Read
mis
sion
s
Patie
nts
rece
ivin
g in
terp
reta
tion
durin
g bo
th
adm
issi
on A
ND
dis
char
ge w
ere
less
like
ly to
be
read
mitt
ed
with
in 3
0 da
ys (1
4.9%
) co
mpa
red
to th
ose
rece
ivin
g it
at a
dmis
sion
(16.
9%),
disc
harg
e (1
7.6%
) or n
eith
er (2
4.3%
)(p
<0.0
01).
Patie
nts
who
got
in
terp
reta
tion
at a
dmis
sion
an
d/or
dis
char
ge w
ere
still
less
lik
ely
to b
e re
adm
itted
.
Stro
ng
4In
accu
rate
La
ngua
ge
Inte
rpre
tatio
n an
d Its
Clin
ical
Si
gnifi
canc
e in
the
Med
ical
En
coun
ters
of
Span
ish-
spea
king
La
tinos
Náp
oles
, A.
M.,
Sant
oyo-
Ols
son,
J.,
Karli
ner,
L.S.
, G
rego
rich,
S.
E., &
Per
ez-
Stab
le, E
. J.
(201
5).
Gen
eral
LEP
(n=3
2; fa
ce-
to-f
ace=
5; v
ideo
=27,
fa
mily
=5) v
s. L
EP w
ith
othe
r int
erpr
eter
mod
e (T
o co
mpa
re a
ccur
acy
of in
terp
reta
tion
usin
g in
-per
son,
vid
eo, o
r ad-
hoc
inte
rpre
ters
)
Sett
ing:
Cal
iforn
ia, U
SA
Stud
y D
esig
n: C
ross
-se
ctio
nal
Com
parin
g D
iffer
ent M
odes
of
Inte
rpre
tatio
n
The
odds
of a
mod
erat
ely
or h
ighl
y cl
inic
ally
sig
nific
ant e
rror
wer
e lo
wer
for f
ace-
to-f
ace
prof
essi
onal
in
terp
rete
rs th
an fo
r ad-
hoc
inte
rpre
ters
(OR=
0.25
, p=0
.05)
.
Stro
ng
5Kn
owle
dge
of
Hea
rt D
isea
se R
isk
Am
ong
Span
ish
Spea
kers
with
D
iabe
tes:
The
Role
of
Inte
rpre
ters
in
The
Med
ical
En
coun
ter
Wag
ner,
J.,
Abb
ott,
G.,
& L
acey
, K.
(200
5).
To in
vest
igat
e he
art d
isea
se
risk
know
ledg
e am
ong
Span
ish
spea
kers
with
di
abet
es a
nd e
xam
ine
whe
ther
use
of a
d-ho
c in
terp
rete
rs is
ass
ocia
ted
with
hea
rt d
isea
se
know
ledg
e. L
EP p
atie
nts
wer
e as
ked
to fi
ll ou
t a
surv
ey in
dica
ting
thei
r he
art d
isea
se k
now
ledg
e an
d w
heth
er th
ey u
se
ad-h
oc in
terp
reta
tion.
G
ener
al L
EP p
artic
ipan
ts
used
frie
nds/
fam
ily d
urin
g ap
poin
tmen
ts
Sett
ing:
Con
nect
icut
, USA
Stud
y D
esig
n: C
ross
-se
ctio
nal
Com
parin
g Tr
aine
d In
terp
rete
rs
vs. U
ntra
ined
Inte
rpre
ters
vs.
No
Inte
rpre
ters
Know
ledg
e of
hea
rt d
isea
se o
vera
ll w
as lo
w. T
hose
who
use
d fa
mily
or
frie
nds
had
low
er s
core
s (p
<001
) th
an th
ose
who
did
not
use
fam
ily
or fr
iend
s (1
8.8,
SD
=4.1,
p<0
.01)
. U
sing
frie
nds/
fam
ily in
stea
d of
a
prof
essi
onal
inte
rpre
ter i
s as
soci
ated
w
ith lo
wer
und
erst
andi
ng o
f hea
rt
dise
ase
risk.
Dia
gnos
tic
Know
ledg
e of
hea
rt
dise
ase
over
all w
as lo
w.
Regr
essi
on a
naly
sis
indi
cate
that
thos
e w
ho
wan
ted
but d
id n
ot h
ave
a pr
ofes
sion
al m
edic
al
inte
rpre
ter s
core
d lo
wer
(p
<0.0
1) th
an th
ose
who
did
not
wan
t an
inte
rpre
ter (
p<0.
01).
Stro
ng
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 19
6C
ompa
rison
of
Thr
ough
put
Tim
es fo
r Li
mite
d En
glis
h Pr
ofic
ienc
y
Patie
nt V
isits
in
the
Emer
genc
y D
epar
tmen
t Be
twee
n D
iffer
ent
Inte
rpre
ter
Mod
aliti
es
Gro
ver,
A.,
Dea
kyne
, S.
, Baj
aj, L
., Ro
osev
elt,
G.E
., (2
012)
.
Dat
a fr
om 11
96 fa
mili
es
wer
e an
alyz
ed. 1
st c
ohor
t co
nsis
ted
of L
EP fa
mili
es
pres
entin
g on
stu
dy
reen
rollm
ent d
ays
that
w
ere
seen
and
man
aged
by
a v
erifi
ed b
iling
ual
prov
ider
in th
e st
anda
rd
cour
se o
f ED
wor
kflo
w. I
f th
ey c
ould
not
be
seen
by
bilin
gual
pro
vide
r, th
ey
wer
e ra
ndom
ized
to e
ither
in
-per
son
or te
leph
onic
in
terp
rete
r.
Vario
us m
odal
ities
use
d –
in-p
erso
n in
terp
reta
tion,
re
mot
e te
leph
onic
in
terp
reta
tion,
and
bili
ngua
l pr
ovid
ers.
Sett
ing:
USA
Stud
y D
esig
n:
Retr
ospe
ctiv
e C
ohor
t
Com
parin
g D
iffer
ent M
odes
of
Inte
rpre
tatio
n M
ore
patie
nts
in th
e in
-per
son
coho
rt w
ere
seen
qui
ckly
co
mpa
red
to b
oth
tele
phon
ic a
nd
bilin
gual
coh
orts
.
Stat
istic
ally
sig
nific
ant d
ecre
ase
in
com
plex
med
icat
ion
adm
inis
trat
ion
in th
e in
-per
son
inte
rpre
ter g
roup
as
wel
l as
a lo
wer
adm
issi
on ra
te w
hen
com
pare
d to
the
tele
phon
ic a
nd
bilin
gual
inte
rpre
ter g
roup
.
Com
parin
g D
iffer
ent M
odes
of
Inte
rpre
tatio
n
The
in-p
erso
n co
hort
(116
min
) had
a
sign
ifica
ntly
sho
rter
tota
l thr
ough
put
time
than
tele
phon
ic (1
41 m
in) a
nd
bilin
gual
pro
vide
r (15
3 m
in) c
ohor
ts
(P <
0.00
1).
For e
very
hou
r of i
n-pe
rson
in
terp
reta
tion,
app
roxi
mat
ely
2 ad
ditio
nal m
inut
es w
ere
requ
ired
for a
bili
ngua
l vis
it an
d 9
addi
tiona
l m
inut
es w
ould
be
adde
d to
a
tele
phon
ic v
isit,
con
trol
ling
for
adm
issi
on ra
te, c
ompl
ex m
edic
atio
n ad
min
istr
atio
n, fa
st tr
ack
stat
us a
nd
invo
lvem
ent o
f tra
inee
s.
Leng
th o
f App
oint
men
t
The
mod
e of
inte
rpre
tatio
n im
pact
ed th
e le
ngth
of t
he
appo
intm
ent.
In-p
erso
n in
terp
reta
tion
had
a sh
orte
d le
ngth
of a
ppoi
ntm
ent
com
pare
d to
tele
phon
ic
inte
rpre
tatio
n an
d a
visi
t with
a
bilin
gual
pro
vide
r.
Stro
ng
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 20
7Tr
aine
d M
edic
al
Inte
rpre
ters
in
the
Emer
genc
y D
epar
tmen
t: Eff
ects
on
Serv
ices
, Su
bseq
uent
C
harg
es, a
nd
Follo
w-u
p
Bern
stei
n, J.
, Be
rnst
ein,
E.,
Dav
e, A
., H
ardt
, E.
, Jam
ess,
T.
, Lin
den,
J.,
Mitc
hell,
P.,
Ois
hi, T
., &
Saf
i, C
. (20
02).
The
stud
y w
as d
one
to
inve
stig
ate
the
impa
ct o
f an
Inte
rpre
ter S
ervi
ce o
n th
e in
tens
ity o
f Em
erge
ncy
Dep
artm
ent s
ervi
ces,
ut
iliza
tion,
and
cha
rges
.
In a
ll 26
573
ED
reco
rds
from
Jul
y to
Nov
embe
r 19
99, r
esul
ted
in a
dat
a se
t of 5
00 p
atie
nts
with
si
mila
r dem
ogra
phic
ch
arac
teris
tics,
chi
ef
com
plai
nt, a
cuity
, and
ad
mis
sion
rate
.
Thre
e gr
oups
– In
terp
rete
d Pa
tient
s (IP
s) n
= 6
3; N
on-
inte
rpre
ted
patie
nts
(NIP
)s
n =
374;
and
ESP
s n
= 63
)
Sett
ing:
Mas
sach
uset
ts,
USA
Stud
y D
esig
n: M
atch
ed
Coh
ort S
tudy
Com
parin
g Tr
aine
d In
terp
rete
rs
vs. U
ntra
ined
Inte
rpre
ters
vs.
No
Inte
rpre
ters
Non
-inte
rpre
ted
(NIP
s) p
atie
nts
who
did
not
spe
ak E
nglis
h ha
d th
e sh
orte
st E
D s
tay
(leng
th o
f sta
y).
Engl
ish
spea
king
pat
ient
s ha
d th
e lo
nges
t len
gth
of s
tay.
ESP
s st
ayed
in
ED a
n av
erag
e of
3 h
ours
long
er th
an
did
NIP
s
NIP
s ha
d lo
wes
t sub
sequ
ent c
linic
ut
iliza
tion.
The
thre
e gr
oups
diff
ered
in
the
30-d
ay p
erio
d fo
llow
ing
the
inde
x vi
sit.
IPs
rece
ived
mor
e pr
imar
y ca
re a
nd s
peci
alty
clin
ic re
ferr
als
than
did
eith
er N
IPs
or E
SPs.
ESPs
rece
ived
a s
igni
fican
tly g
reat
er
inte
nsity
and
vol
ume
of s
ervi
ces
than
di
d ei
ther
IPs
or N
IPs
durin
g th
eir
inde
x ED
vis
it.
Inte
rpre
ted
patie
nts
(IPs)
had
low
est
retu
rn E
D v
isits
. IPs
wer
e m
ore
likel
y th
an N
IPs
to d
emon
stra
te fo
llow
up
clin
ic v
isits
and
less
like
ly th
an N
IPs
to re
turn
to th
e ED
.
NIP
s w
hose
acu
ity le
vel (
inte
nsity
of
illne
ss) d
id n
ot d
iffer
sta
tistic
ally
at
base
line
from
IPs
or A
sp’s,
rece
ived
th
e fe
wes
t tes
ts a
nd p
roce
dure
s,
wer
e le
ast l
ikel
y to
hav
e an
IV s
tart
ed
and
rece
ived
the
few
est m
edic
atio
ns
durin
g th
eir E
D s
tay.
Leng
th o
f Sta
y
Non
-inte
rpre
ted
(NIP
s) p
atie
nts
who
did
not
spe
ak E
nglis
h ha
d th
e sh
orte
st E
D s
tay
(leng
th o
f st
ay).
Engl
ish
spea
king
pat
ient
s ha
d th
e lo
nges
t len
gth
of s
tay.
ES
Ps s
taye
d in
ED
an
aver
age
of 3
hou
rs lo
nger
than
did
NIP
s
Serv
ice
Util
izat
ion
NIP
s ha
d lo
wes
t sub
sequ
ent
clin
ic u
tiliz
atio
n. T
he th
ree
grou
ps d
iffer
ed in
the
30-d
ay
perio
d fo
llow
ing
the
inde
x vi
sit.
IPs
rece
ived
mor
e pr
imar
y ca
re
and
spec
ialty
clin
ic re
ferr
als
than
did
eith
er N
IPs
or E
SPs.
ESPs
rece
ived
a s
igni
fican
tly
grea
ter i
nten
sity
and
vol
ume
of
serv
ices
than
did
eith
er IP
s or
N
IPs
durin
g th
eir i
ndex
ED
vis
it.
Read
mis
sion
s
Inte
rpre
ted
patie
nts
(IPs)
had
lo
wes
t ret
urn
ED v
isits
. IPs
w
ere
mor
e lik
ely
than
NIP
s to
de
mon
stra
te fo
llow
up
clin
ic
visi
ts a
nd le
ss li
kely
than
NIP
s to
retu
rn to
the
ED.
Dia
gnos
tic
Non
-inte
rpre
ted
(NIP
s)
patie
nts
who
did
not
sp
eak
Engl
ish
had
the
few
est t
ests
, IVs
and
m
edic
atio
ns
NIP
s w
hose
acu
ity le
vel
(inte
nsity
of i
llnes
s) d
id
not d
iffer
sta
tistic
ally
at
base
line
from
IPs
or A
sp’s,
re
ceiv
ed th
e fe
wes
t tes
ts
and
proc
edur
es, w
ere
leas
t lik
ely
to h
ave
an
IV s
tart
ed a
nd re
ceiv
ed
the
few
est m
edic
atio
ns
durin
g th
eir E
D s
tay.
Mod
erat
e
8D
oes
Inte
rpre
ter-
Med
iate
d C
BT
with
Tra
umat
ized
Refu
gee
Peop
le W
ork?
A
Com
paris
on o
f Pa
tient
Out
com
es
in E
ast L
ondo
n
D’A
rden
ne,
P.D.
, Rua
ro,
L., C
esta
ri, L
., Fa
khou
ry, W
., &
Prie
be, S
. (2
007)
.
3 gr
oups
of p
atie
nts
– re
fuge
es w
ho re
quire
d in
terp
rete
rs, r
efug
ees
who
di
d no
t req
uire
inte
rpre
ters
, En
glis
h sp
eaki
ng n
on-
refu
gees
. Pat
ient
s re
ferr
ed
to a
n Ea
st L
ondo
n m
enta
l he
alth
ser
vice
spe
cial
izin
g in
the
psyc
holo
gica
l tr
eatm
ent o
f pos
t-tr
aum
atic
st
ress
dis
orde
r bet
wee
n 20
00 to
200
4.
44 re
fuge
e pa
tient
s re
quiri
ng in
terp
rete
rs,
36 re
fuge
e pa
tient
s no
t re
quiri
ng in
terp
rete
rs, a
nd
48 n
on-r
efug
ee p
atie
nts.
Sett
ing:
Eas
t Lon
don,
UK
Stud
y D
esig
n:
Retr
ospe
ctiv
e St
udy
Com
parin
g Tr
aine
d In
terp
rete
rs
vs. U
ntra
ined
Inte
rpre
ters
vs.
No
Inte
rpre
ters
Refu
gees
with
inte
rpre
ters
hav
e pr
opor
tiona
lly m
ore
impr
ovem
ent
than
refu
gees
with
inte
rpre
ters
.
Dia
gnos
tic
All
grou
ps s
how
ed
sign
ifica
nt im
prov
emen
t in
the
Impa
ct o
f Eve
nts
Scal
e (IE
S) w
hich
as
sess
ed s
ever
ity o
f PT
SD s
ympt
oms,
as
wel
l as
the
Beck
Dep
ress
ion
Inve
ntor
y (B
DI).
Refu
gees
with
inte
rpre
ters
ha
ve p
ropo
rtio
nally
m
ore
impr
ovem
ent t
han
refu
gees
with
inte
rpre
ters
.
Mod
erat
e
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 21
9D
oes
Engl
ish
prof
icie
ncy
impa
ct o
n he
alth
outc
omes
fo
r inp
atie
nts
unde
rgoi
ng s
trok
e
reha
bilit
atio
n?
Dav
ies,
S.E
., D
odd,
K.J
., Tu
, A
., Zu
cchi
, E.,
Zen,
S.,
Hill
, K.
D. (2
016)
.
To d
eter
min
e w
heth
er
Engl
ish
prof
icie
ncy
and/
or fr
eque
ncy
of in
terp
rete
r us
e im
pact
s on
hea
lth
outc
omes
for i
n pa
tient
st
roke
reha
bilit
atio
n
Peop
le a
dmitt
ed
for i
npat
ient
str
oke
reha
bilit
atio
n
Hig
h En
glis
h pr
ofic
ienc
y gr
oup
of n
ativ
e or
nea
r na
tive
Engl
ish
prof
icie
ncy
(n=8
0); a
nd a
low
Eng
lish
prof
icie
ncy
grou
p co
mpr
ised
peo
ple
who
pr
efer
red
a la
ngua
ge o
ther
th
an E
nglis
h (n
=80)
.
Sett
ing:
Aus
tral
ia
Stud
y D
esig
n:
Retr
ospe
ctiv
e C
ase
Con
trol
St
udy
Freq
uenc
y of
Inte
rpre
tatio
n
Incr
ease
d in
terp
rete
r usa
ge
impr
oved
Fun
ctio
nal I
ndep
ende
nce
Mea
sure
(FIM
) effi
cien
cy s
core
but
di
d no
t sig
nific
antly
alte
r oth
er
outc
omes
Leng
th o
f Sta
y
No
sign
ifica
nt d
iffer
ence
s w
ere
foun
d be
twee
n th
e gr
oups
in
leng
th o
f sta
y.
Dia
gnos
tic
The
low
Eng
lish
prof
icie
ncy
grou
ps
show
ed g
reat
er
impr
ovem
ent i
n FI
M fr
om
adm
issi
on to
dis
char
ge
Incr
ease
d in
terp
rete
r us
age
impr
oved
FIM
eff
icie
ncy
but d
id n
ot
sign
ifica
ntly
alte
r oth
er
outc
omes
Sign
ifica
nt d
iffer
ence
s w
ere
foun
d fo
r FIM
eff
icie
ncy
and
FIM
m
otor
effi
cien
cy w
ith
low
est i
nter
pret
er u
sage
re
sulti
ng in
low
est
effic
ienc
y; h
owev
er n
o st
atis
tical
ly s
igni
fican
t di
ffere
nces
wer
e fo
und
betw
een
the
quar
tiles
of
the
perc
enta
ge o
f th
erap
y en
coun
ters
with
an
inte
rpre
ter f
or F
IM a
nd
leng
th o
f sta
y.
Mod
erat
e
10Im
pact
of
Inte
rpre
ter
Serv
ices
on
Del
iver
y of
Hea
lth
Car
e to
Lim
ited-
Engl
ish-
prof
icie
nt
Patie
nts
Jaco
bs, E
.A.,
Laud
erda
le,
D.S.
, Mel
tzer
, D.
, Sho
rey,
J.M
., Le
vins
on, W
., &
Thi
sted
, R.A
. (2
001)
.
4380
adu
lts c
ontin
uous
ly
enro
lled
in a
sta
ff m
odel
H
MO
for t
wo
year
s of
st
udy
who
eith
er u
sed
the
com
preh
ensi
ve in
terp
rete
r se
rvic
es (I
SG, N
=327
) or
wer
e ra
ndom
ly s
elec
ted
into
a 10
% c
ompa
rison
gr
oup
of a
ll ot
her e
ligib
le
adul
ts (C
G, N
= 4
053)
.
Maj
ority
of p
atie
nts
in th
e IS
G s
poke
Spa
nish
(n=2
57)
ISG
was
mor
e fe
mal
e (6
3%
vs. 5
7%, P
<0.
05),
olde
r (m
ean
age
– 46
+/-
14 y
ears
, P<
0.0
1) a
nd li
ved
in a
ZIP
co
de w
ith a
low
er m
edia
n in
com
e co
mpa
red
to C
G.
Sett
ing:
Mas
sach
uset
ts,
USA
Stud
y D
esig
n:
Retr
ospe
ctiv
e C
ohor
t Stu
dy
Com
parin
g Tr
aine
d In
terp
rete
rs
vs. U
ntra
ined
Inte
rpre
ters
vs.
No
Inte
rpre
ters
Clin
ical
ser
vice
use
incr
ease
d si
gnifi
cant
ly in
the
ISG
com
pare
d to
th
e C
G fo
r offi
ce v
isits
(1.8
vs.
0.7
0,
P<.0
1); p
resc
riptio
ns w
ritte
n 1.7
6 vs
. 0.
53, P
< 0
.01)
, and
pre
scrip
tions
fil
led
(2.3
3 vs
. 0.8
6; P
< 0
.01)
.
Serv
ice
Util
izat
ion
Ove
rall
ther
e w
as a
n in
crea
se in
clin
ical
ser
vice
fo
r bot
h gr
oups
in a
ll bu
t of
the
mea
sure
s, w
hich
w
as u
rgen
t car
e ca
lls. I
t in
crea
sed
in C
G b
ut n
ot in
IS
G. A
ll ot
hers
incr
ease
d fo
r bo
th g
roup
s: o
ffice
vis
its,
phon
e ca
lls, u
rgen
t car
e vi
sits
, pre
scrip
tions
writ
ten,
pr
escr
iptio
ns fi
lled.
For t
hree
mea
sure
s, th
ere
was
a s
igni
fican
t inc
reas
e fo
r pat
ient
s in
the
ISG
gro
up
com
pare
d to
the
CG
gro
up:
offic
e vi
sits
ISG
1.8
vs. C
G 0
.7; #
of
pre
scrip
tions
writ
ten
for t
he
ISG
was
1.76
vs.
0.5
3 fo
r CG
; pr
escr
iptio
ns fi
lled
for I
SG w
as
2.33
pre
scrip
tions
per
per
son
per y
ear o
ver t
he s
tudy
per
iod
com
pare
d to
0.8
6 fo
r CG
. Thi
s st
ayed
eve
n af
ter a
djus
ting
for
age,
gen
der,
inco
me.
Prev
entio
n
Ove
rall,
ther
e w
as
an in
crea
se in
bot
h gr
oups
for a
ll pr
even
tive
mea
sure
s.
The
incr
ease
of r
ecta
l ex
ams
of 0
.26
per
man
ove
r age
40
was
si
gnifi
cant
. Rec
tal e
xam
s in
crea
sed
sign
ifica
ntly
m
ore
for I
SG c
ompa
red
to C
G b
ut th
is w
as n
ot
sign
ifica
nt a
fter
adj
ustin
g fo
r age
, gen
der a
nd
med
ian
inco
me.
Mod
erat
e
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 22
11O
verc
omin
g La
ngua
ge B
arrie
rs
in H
ealth
Car
e:
Cos
ts a
nd
Bene
fits
of
Inte
rpre
ter
Serv
ices
Jaco
bs, E
.A.,
Shep
ard,
D.S
., Su
aya,
J.A
., &
Sto
ne, E
.L.
(200
4).
They
ass
esse
d th
e im
pact
of
inte
rpre
ter s
ervi
ces
on
the
cost
and
util
izat
ion
of h
ealth
car
e se
rvic
es
amon
g pa
tient
s w
ith li
mite
d En
glis
h pr
ofic
ienc
y. T
hey
mea
sure
d th
e ch
ange
in
del
iver
y co
st o
f car
e pr
ovid
ed to
pat
ient
s en
rolle
d in
a h
ealth
m
aint
enan
ce o
rgan
izat
ion
befo
re a
nd a
fter
inte
rpre
ter
serv
ices
wer
e ad
ded.
The
time
perio
d of
Jun
e 1,
1995
thro
ugh
to M
ay 3
1, 19
97. 3
80 p
atie
nts
in th
e in
th
e in
terp
rete
r gro
up a
nd
4119
in th
e co
mpa
rison
gr
oup.
Sett
ing:
Mas
sach
uset
ts,
USA
Stud
y D
esig
n:
Retr
ospe
ctiv
e C
ohor
t
Com
parin
g Tr
aine
d In
terp
rete
rs
vs. U
ntra
ined
Inte
rpre
ters
vs.
No
Inte
rpre
ters
Rela
tive
to th
e co
mpa
rison
gro
up,
the
inte
rpre
ter s
ervi
ce g
roup
sho
wed
si
gnifi
cant
ly g
reat
er in
crea
ses
per
pers
on p
er y
ear i
n th
e fo
llow
ing
serv
ices
: per
cent
age
of th
e re
com
men
ded
prev
entiv
e se
rvic
es
rece
ived
(7.3
% v
s 2.
7%; P
=0.0
33),
num
ber o
f offi
ce v
isits
mad
e (1
.74
vs 0
.71;
P=0
.014
), an
d nu
mbe
r of
pres
crip
tions
writ
ten
(1.7
0 vs
0.5
2;
P= 0
.001
) and
fille
d (2
.38
vs 0
.88;
P<
0.00
1).
ER v
isits
wer
e sa
me
for b
oth
grou
ps.
Serv
ice
Util
izat
ion
Com
pare
d w
ith E
nglis
h sp
eaki
ng p
atie
nts,
pat
ient
s w
ho u
sed
the
inte
rpre
ter
serv
ices
mad
e si
gnifi
cant
ly
mor
e off
ice
visi
ts.
Prev
entio
n (S
ervi
ces,
Pr
escr
iptio
ns a
nd P
rimar
y C
are)
Com
pare
d w
ith E
nglis
h sp
eaki
ng p
atie
nts,
pa
tient
s w
ho u
sed
the
inte
rpre
ter s
ervi
ces
rece
ived
sig
nific
antly
m
ore
reco
mm
ende
d pr
even
tive
serv
ices
and
ha
d m
ore
pres
crip
tions
w
ritte
n an
d fil
led.
Betw
een
year
1 an
d ye
ar
2 of
the
stud
y, p
reve
ntiv
e se
rvic
es, p
rimar
y ca
re a
nd
tota
l cos
ts in
crea
sed
for
both
gro
ups.
ER c
osts
incr
ease
d in
th
e co
mpa
rison
gro
up
and
decr
ease
d fo
r the
in
terp
reta
tion
grou
p.
Mod
erat
e
12Im
pact
of
Inte
rpre
tatio
n M
etho
d on
Clin
ic
Visi
t Len
gth
Faga
n, M
.J.,
Dia
z, J.
A.,
Rein
ert,
S.E.
, Sc
ianm
anna
, C
.N.,
& F
agan
, D.
M. (
2003
).
613
visi
ts –
72%
(n=4
41)
of th
e vi
sits
requ
ired
no
inte
rpre
ters
and
28%
(n
=172
) use
d so
me
form
of
inte
rpre
ter.
15%
of a
ll vi
sits
use
d a
patie
nt s
uppl
ied
inte
rpre
ter
(n=9
0); 8
% o
f all
visi
ts u
sed
a ho
spita
l int
erpr
eter
(n=5
1),
and
5% o
f all
visi
ts u
sed
a te
leph
one
inte
rpre
ter
(n=3
1).
Sett
ing:
Rho
de Is
land
, USA
Stud
y D
esig
n: C
ross
se
ctio
nal
Com
parin
g Tr
aine
d In
terp
rete
rs
vs. U
ntra
ined
Inte
rpre
ters
vs.
No
Inte
rpre
ters
Com
pare
d to
pat
ient
s no
t usi
ng
any
inte
rpre
ters
, pat
ient
s us
ing
a te
leph
one
inte
rpre
ter h
ad
sign
ifica
ntly
long
er m
ean
prov
ider
tim
es (3
6.3
min
utes
vs.
28.
0 m
in) a
nd
clin
ic ti
mes
(99.
9 m
inut
es v
s. 8
2.4
min
utes
)
Patie
nts
usin
g a
patie
nt s
uppl
ied
inte
rpre
ter h
ad s
igni
fican
tly lo
nger
m
ean
prov
ider
tim
es (3
4.4
min
vs.
28
.0) a
nd m
ean
clin
ic ti
mes
(92.
8 m
in v
s. 8
2.4
min
, P =
0.02
7) w
hen
com
pare
d to
pat
ient
s no
t req
uirin
g an
inte
rpre
ter.
In c
ontr
ast,
patie
nts
usin
g a
hosp
ital
inte
rpre
ter d
id n
ot h
ave
sign
ifica
ntly
di
ffere
nt m
ean
prov
ider
tim
es (2
6.9
min
vs.
28.
0 m
in, P
=.51
) or m
ean
clin
ic ti
mes
(91.0
min
vs
82.4
min
, P=
0.16
) tha
n pa
tient
s no
t req
uirin
g an
in
terp
rete
r.
Leng
th o
f App
oint
men
t
In th
e m
odel
, use
of t
elep
hone
in
terp
rete
r was
ass
ocia
ted
with
long
er m
ean
prov
ider
tim
e (8
.3 m
in, 9
5% C
I, 3.
94
to 12
.7.a
s w
as u
se o
f a p
atie
nt
supp
lied
inte
rpre
ter (
4.58
m
in, 9
5% C
I, 1.8
4 to
7.3
3). I
n co
ntra
st, h
ospi
tal i
nter
pret
er
use
was
not
ass
ocia
ted
with
si
gnifi
cant
ly lo
nger
mea
n pr
ovid
er ti
me.
Whe
n co
mpa
red
to p
atie
nts
not r
equi
ring
inte
rpre
ters
, pat
ient
s us
ing
som
e fo
rm o
f int
erpr
eter
had
lo
nger
mea
n pr
ovid
er ti
mes
(3
2.4
min
utes
vs.
28
min
utes
) an
d cl
inic
tim
es (9
3.6
min
vs.
82
.4 m
in).
Mod
erat
e
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 23
13Er
rors
of M
edic
al
Inte
rpre
tatio
n an
d Th
eir P
oten
tial
Clin
ical
Con
sequ
ence
s:
A C
ompa
rison
of
Pro
fess
iona
l Ve
rsus
Ad
Hoc
Vers
us N
o In
terp
rete
rs
Flor
es, G
., A
breu
, M.,
Baro
ne, C
.P.,
Bach
ur, R
., &
Li
n, H
. (20
12).
57 e
ncou
nter
s in
clud
ed
with
20
with
pro
fess
iona
l in
terp
rete
rs, 2
7 w
ith a
d ho
c in
terp
rete
rs, a
nd 10
with
no
inte
rpre
ters
.
Inte
rpre
ters
wer
e pr
esen
t du
ring
thes
e en
coun
ters
in
clud
ed p
rofe
ssio
nal
inte
rpre
ters
, 20
(35%
); ad
ho
c in
terp
rete
rs, 2
7 (4
7%);
and
no in
terp
rete
r, 10
(18%
).
Sett
ing:
Bos
ton,
MA
, USA
Stud
y D
esig
n: C
ross
Se
ctio
nal
Com
parin
g Tr
aine
d In
terp
rete
rs v
s.
Unt
rain
ed v
s. N
o In
terp
rete
rs
The
prop
ortio
n of
err
ors
was
si
gnifi
cant
ly lo
wer
for p
rofe
ssio
nal
(12%
) vs.
ad
hoc
(22%
) vs.
no
inte
rpre
ters
(20%
).
Com
pare
d w
ith p
rofe
ssio
nal
inte
rpre
ters
, ad
hoc
inte
rpre
ters
and
ha
ving
no
inte
rpre
ter r
esul
ted
in
sign
ifica
ntly
hig
her p
ropo
rtio
ns o
f om
issi
ons
and
fals
e flu
ency
err
ors,
w
hile
pro
fess
iona
l int
erpr
eter
s ha
d hi
gher
err
ors
in th
e le
ss fr
eque
nt
erro
r cat
egor
ies.
Med
ical
Err
ors
The
mos
t com
mon
err
or w
as
omis
sion
(47%
of a
ll er
rors
), fo
llow
ed b
y fa
lse
fluen
cy (2
6%),
addi
tion
(10%
), ed
itoria
lizin
g (9
%) a
nd s
ubst
itutio
n (9
%).
Am
ong
prof
essi
onal
in
terp
rete
rs, p
revi
ous
hour
s of
inte
rpre
ter t
rain
ing,
but
no
t yea
rs o
f exp
erie
nce
wer
e si
gnifi
cant
ly a
ssoc
iate
d w
ith
erro
r num
bers
, typ
es a
nd
pote
ntia
l con
sequ
ence
s.
Thos
e w
ith g
reat
er th
an o
r eq
ual t
o 10
0 ho
urs
of tr
aini
ng
com
mitt
ed s
igni
fican
tly
low
er p
ropo
rtio
ns o
f err
ors
of
pote
ntia
l con
sequ
ence
ove
rall
(2%
vs.
12%
) in
ever
y er
ror
cate
gory
Mod
erat
e
14Ex
plor
ing
the
Impa
ct
of L
angu
age
Serv
ices
on
Util
izat
ion
and
Clin
ical
O
utco
mes
for
Dia
betic
s
Hac
ker,
K.,
Cho
i, Y.
S.,
Treb
ino,
L.,
Hic
ks, L
.R.,
Frie
dman
, E.,
Blan
chfie
ld, B
., &
Gaz
elle
, G.S
. (2
012)
.
1425
LEP
pat
ient
s in
C
ambr
idge
Hea
lth A
llian
ce
Dia
bete
s Re
gist
ry.
Ther
e ar
e 7
sam
ple
grou
ps w
hich
are
bas
ed
on th
e am
ount
and
the
com
bina
tion
of la
ngua
ge
serv
ices
(lan
guag
e co
ncor
dant
pro
vide
rs,
form
al in
terp
reta
tion,
no
inte
rpre
ters
)
Sett
ing:
Cam
brid
ge, M
A,
USA
Stud
y D
esig
n:
Retr
ospe
ctiv
e C
ohor
t D
esig
n.
Freq
uenc
y of
Inte
rpre
tatio
n
In u
nadj
uste
d an
alys
es, p
atie
nts
who
rece
ived
a m
ixtu
re o
f lan
guag
e se
rvic
es (P
atie
nts
with
1–49
% o
f th
eir v
isits
with
form
al in
terp
retin
g se
rvic
es a
nd 1–
99%
of t
heir
visi
ts
with
lang
uage
-con
cord
ant p
rovi
ders
an
d Pa
tient
s w
ith 5
0–10
0% o
f the
ir vi
sits
with
form
al in
terp
retin
g se
rvic
es a
nd 1–
99%
of t
heir
visi
ts w
ith
lang
uage
- con
cord
ant p
rovi
ders
) w
ere
mor
e lik
ely
to h
ave
expe
rienc
ed
a ho
spita
lizat
ion
or E
D v
isit
rela
ted
to
diab
etes
(ove
r 19.
5%/2
3 an
d 19
.2%
/10
resp
ectiv
ely)
com
pare
d to
oth
er
grou
ps in
the
outc
ome
perio
d.
Prev
entio
n
Patie
nts
who
rece
ived
10
0% o
f the
ir pr
imar
y ca
re v
isits
with
lang
uage
co
ncor
dant
pro
vide
rs
wer
e le
ast l
ikel
y to
ha
ve d
iabe
tes
rela
ted
emer
genc
y de
part
men
t vi
sits
com
pare
d to
oth
er
grou
ps in
the
follo
win
g 6
mon
ths.
Patie
nts
who
rece
ived
10
0% o
f the
ir vi
sits
with
la
ngua
ge-c
onco
rdan
t pr
ovid
ers
wer
e le
ss li
kely
to
hav
e an
ED
vis
it re
late
d to
dia
bete
s or
poo
rly
cont
rolle
d di
abet
es
com
pare
d to
pat
ient
s re
ceiv
ing
no la
ngua
ge
serv
ices
.
Mod
erat
e
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 24
15Eff
ect o
f La
ngua
ge B
arrie
rs
on F
ollo
w-u
p A
ppoi
ntm
ents
A
fter
an
Emer
genc
y D
epar
tmen
t Vis
it
Sarv
er, J
. &
Bake
r D. W
. (2
000)
.
Thre
e gr
oups
. Gro
up 1
- Lan
guag
e co
ncor
dant
- n
ativ
e En
glis
h an
d Sp
anis
h sp
eake
rs w
ho
com
mun
icat
ed w
ithou
t the
ai
d of
an
inte
rpre
ter.
Gro
up
2 –
inte
rpre
ter w
as u
sed
– na
tive
Span
ish-
spea
kers
w
ho c
omm
unic
ated
with
th
eir p
rovi
der i
n Sp
anis
h.
Gro
up 3
– in
terp
rete
r ne
eded
but
not
use
d –
nativ
e Sp
anis
h-sp
eake
rs
who
sai
d an
inte
rpre
ter
was
not
use
d bu
t tho
ught
an
inte
rpre
ter s
houl
d ha
ve
been
use
d.
Sett
ing:
Tor
ranc
e, C
A, U
SA
Stud
y D
esig
n: C
ohor
t Stu
dy
Com
parin
g Tr
aine
d In
terp
rete
rs v
s.
Unt
rain
ed In
terp
rete
rs
The
prop
ortio
n of
pat
ient
s w
ho
rece
ived
a fo
llow
up
appo
intm
ent
was
83%
for t
hose
with
out
lang
uage
bar
riers
, 75%
for t
hose
w
ho c
omm
unic
ated
thro
ugh
an
inte
rpre
ter,
and
76%
for t
hose
w
ho s
aid
they
sho
uld
have
an
inte
rpre
ter b
ut d
id n
ot h
ave
one
(P
= 0.
05).
App
oint
men
t com
plia
nce
rate
s w
ere
sim
ilar f
or p
atie
nts
who
com
mun
icat
ed th
roug
h an
in
terp
rete
r, th
ose
who
sai
d an
in
terp
rete
r sho
uld
have
bee
n us
ed
but w
as n
ot, a
nd th
ose
with
out
lang
uage
bar
riers
(P =
0.7
8).
Serv
ice
Util
izat
ion
The
prop
ortio
n of
pat
ient
s w
ho re
ceiv
ed a
follo
w u
p ap
poin
tmen
t was
83%
for
thos
e w
ithou
t lan
guag
e ba
rrie
rs, 7
5% fo
r tho
se w
ho
com
mun
icat
ed th
roug
h an
inte
rpre
ter,
and
76%
for
thos
e w
ho s
aid
they
sho
uld
have
an
inte
rpre
ter b
ut d
id
not h
ave
one
(P =
0.0
5).
App
oint
men
t com
plia
nce
rate
s w
ere
sim
ilar f
or p
atie
nts
who
co
mm
unic
ated
thro
ugh
an
inte
rpre
ter,
thos
e w
ho s
aid
an
inte
rpre
ter s
houl
d ha
ve b
een
used
but
was
not
, and
thos
e w
ithou
t lan
guag
e ba
rrie
rs (P
=
0.78
).
Mod
erat
e
16D
oes
a Vi
deo-
Inte
rpre
ting
Net
wor
k
Impr
ove
Del
iver
y of
Car
e in
the
Emer
genc
y D
epar
tmen
t?
Jaco
bs, E
. A.,
Fu J
r, P.
C.,
&
Rath
ouz,
P. J
. (2
012)
.
LEP
Span
ish
spea
king
vs
non-
LEP.
ED o
f 2 n
etw
ork
hosp
itals
in
Cal
iforn
ia (H
ospi
tal A
, in
a ru
ral a
rea,
and
Hos
pita
l B,
in a
n ur
ban
area
in)
Sett
ing:
Cal
iforn
ia, U
SA
Stud
y D
esig
n: P
re-p
ost,
Obs
erva
tiona
l stu
dy
Leng
th o
f Sta
y
Mea
n ho
spita
l tim
e in
the
ED
for b
oth
lang
uage
gro
ups
at
both
hos
pita
ls w
ent d
own
in
the
post
-vid
eo-in
terp
retin
g ne
twor
k tim
e pe
riod
com
pare
d w
ith th
e pr
e-vi
deo-
inte
rpre
ting
netw
ork
time
perio
d, b
y 16
m
inut
es fo
r Eng
lish
spea
kers
an
d 31
min
utes
for S
pani
sh
spea
kers
at H
ospi
tal A
, and
by
34 a
nd 8
7 m
inut
es fo
r the
se
two
grou
ps, r
espe
ctiv
ely,
at
Hos
pita
l B. [
Not
sta
tistic
ally
si
gnifi
cant
]
Adm
issi
on R
ates
The
perc
enta
ge o
f ED
pat
ient
s ad
mitt
ed to
the
hosp
ital
wen
t dow
n in
the
post
-vid
eo-
netw
ork
time
perio
d fo
r bot
h la
ngua
ge g
roup
s at
Hos
pita
l A
and
was
ess
entia
lly u
ncha
nged
fo
r bot
h la
ngua
ge g
roup
s at
Hos
pita
l B. T
here
was
no
sign
ifica
nt d
iffer
ence
in th
e ch
ange
in a
dmis
sion
rate
s fo
r En
glis
h sp
eake
rs c
ompa
red
with
Spa
nish
spe
aker
s at
eith
er
stud
y ho
spita
l.
Mod
erat
e
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 25
17Po
stop
erat
ive
Pain
Man
agem
ent
in C
hild
ren,
Pa
rent
al E
nglis
h Pr
ofic
ienc
y,
and
Acce
ss to
In
terp
reta
tion
Jim
enez
, N.,
Jack
son,
D. L
., Zh
ou, C
., Ay
ala,
N
. C.,
& E
bel,
B.
E. (2
014)
.
Chi
ldre
n w
ith L
EP p
aren
ts
(n=2
37);
Chi
ldre
n w
ith
EP p
aren
ts (n
=237
). O
bjec
tive
was
to e
xam
ine
the
asso
ciat
ion
betw
een
pare
ntal
lang
uage
pr
ofic
ienc
y, in
terp
rete
d ca
re, a
nd p
osts
urgi
cal
pedi
atric
pai
n m
anag
emen
t
Sett
ing:
USA
Stud
y D
esig
n:
Retr
ospe
ctiv
e M
atch
ed
Coh
ort
Freq
uenc
y of
Inte
rpre
tatio
n
With
in th
e LE
P gr
oup,
chi
ldre
n w
ith ≥
2 in
terp
reta
tions
per
day
had
lo
wer
pai
n sc
ores
aft
er m
edic
atio
n ad
min
istr
atio
n (P
< .0
5) a
nd w
ere
mor
e lik
ely
to re
ceiv
e op
ioid
s at
pai
n le
vels
sim
ilar t
o th
ose
of E
P fa
mili
es.
Chi
ldre
n of
fam
ilies
who
rece
ived
le
ss th
an 2
inte
rpre
ted
visi
ts p
er d
ay
had
high
er m
ean
post
ana
lges
ic p
ain
scor
es (P
- 0.
04) r
elat
ive
to c
hild
ren
with
mor
e fr
eque
nt in
terp
reta
tion.
Mod
erat
e
18C
onve
nien
t Ac
cess
to
Prof
essi
onal
In
terp
rete
rs in
the
Hos
pita
l D
ecre
ases
Re
adm
issi
on
Rate
s an
d Es
timat
ed
Hos
pita
l Ex
pend
iture
s fo
r Pat
ient
s w
ith
Lim
ited
Engl
ish
Prof
icie
ncy
Karli
ner,
L. S
., Pe
rez-
Stab
le, E
. J.
, & G
rego
rich,
S.
E. (
2017
).
Patie
nts
aged
50+
yea
rs --
- re
ceiv
ing
the
inte
rven
tion:
th
e du
al-h
ands
et
inte
rpre
ter t
elep
hone
at
ever
y be
dsid
e (b
edsi
de
inte
rpre
ter i
nter
vent
ion)
.
Sett
ing:
USA
Stud
y D
esig
n: P
re-P
ost
Read
mis
sion
Rat
es
Obs
erve
d 30
-day
read
mis
sion
de
crea
sed
durin
g th
e in
terv
entio
n pe
riod
and
incr
ease
d ag
ain
post
in
terv
entio
n. T
he in
terv
entio
n w
as p
rogr
amm
ed to
al
low
24-
hour
acc
ess
to a
pr
ofes
sion
al (t
rain
ed a
nd
test
ed) m
edic
al in
terp
rete
r fo
r mor
e th
an 10
0 la
ngua
ges.
Th
e eff
ect o
f the
inte
rven
tion
on re
adm
issi
on ra
tes
was
si
gnifi
cant
ly m
odifi
ed b
y pa
tient
lang
uage
gro
up; t
hat
is, t
he e
ffect
of t
he s
tudy
pe
riods
on
read
mis
sion
rate
s si
gnifi
cant
ly d
iffer
ed a
cros
s th
e 2
lang
uage
gro
ups
(P =
0.
040
for t
est o
f int
erac
tion)
. Th
e od
ds o
f rea
dmis
sion
for
the
LEP
com
pare
d w
ith E
P gr
oup
was
low
er d
urin
g th
e in
terv
entio
n pe
riod;
whi
le it
w
as ro
ughl
y eq
uiva
lent
dur
ing
both
the
pre-
inte
rven
tion
and
post
inte
rven
tion
perio
ds
(Tab
le 4
).
Mod
erat
e
19U
se o
f In
terp
rete
rs b
y Ph
ysic
ians
for
Hos
pita
lized
Lim
ited
Engl
ish
Prof
icie
nt P
atie
nts
and
Its Im
pact
on P
atie
nt
Out
com
es
Lope
z, L
., Ro
drig
uez,
F.
, Hue
rta,
D.,
Souk
up, J
., &
H
icks
, L. (
2015
).
Gen
eral
LEP
vs.
Non
-LEP
. Fo
ur g
roup
s:
1): i
nter
pret
er u
sed
by n
on-
phys
icia
n (i.
e., n
urse
); 2)
inte
rpre
ter u
sed
by a
non
-H
ospi
talis
t phy
sici
an;
3) in
terp
rete
r use
d by
H
ospi
talis
t; an
d 4)
no
inte
rpre
ter u
sed
durin
g ho
spita
lizat
ion.
Sett
ing:
USA
Stud
y D
esig
n:
Retr
ospe
ctiv
e C
ohor
t A
naly
sis
Leng
th o
f Sta
y
Com
pare
d to
Eng
lish
spea
kers
, LEP
pat
ient
s w
ith n
o in
terp
rete
rs h
ad
sign
ifica
ntly
sho
rter
leng
th o
f st
ay. L
EP p
atie
nts
who
had
an
inte
rpre
ter a
nd a
phy
sici
an
pres
ent h
ad th
e lo
nges
t len
gth
of s
tay.
Mod
erat
e
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 26
20U
se o
f In
terp
rete
rs b
y Ph
ysic
ians
for
Hos
pita
lized
Lim
ited
Engl
ish
Prof
icie
nt P
atie
nts
and
Its Im
pact
on P
atie
nt
Out
com
es
Ham
pers
, L.C
., &
McN
ulty
, J.E
. (2
002)
.
LEP
child
ren.
LEP
with
pr
ofes
sion
al in
terp
rete
rs v
s.
LEP
with
bili
ngua
l pro
vide
r
Exam
ined
vis
its o
f chi
ldre
n (a
ges
2mon
ths
to 10
ye
ars)
with
a p
rese
ntin
g te
mpe
ratu
re o
f 38.
5C o
r hi
gher
or a
com
plai
nt o
f vo
miti
ng o
r dia
rrhe
a. In
17
0 ca
ses,
the
trea
ting
phys
icia
n w
as b
iling
ual.
In 2
39, a
pro
fess
iona
l in
terp
rete
r was
use
d.
In th
e re
mai
ning
141,
a pr
ofes
sion
al m
edic
al
inte
rpre
ter w
as u
nava
ilabl
e
Sett
ing:
Chi
cago
, IL,
USA
Stud
y D
esig
n: P
rosp
ectiv
e C
ohor
t
Com
parin
g Tr
aine
d In
terp
rete
rs v
s.
Unt
rain
ed In
terp
rete
rs
Dec
isio
n m
akin
g w
as m
ost c
autio
us
whe
n no
n-En
glis
h-sp
eaki
ng c
ases
w
ere
trea
ted
in th
e ab
senc
e of
bi
lingu
al p
hysi
cian
s or
pro
fess
iona
l in
terp
rete
rs.
Leng
th o
f Sta
y
Cas
es w
ith a
n in
terp
rete
r had
lo
nger
leng
th o
f sta
y vi
sits
(+16
m
inut
es; 9
5% C
I, 6.
2-26
min
s).
The
barr
ier c
ohor
t (no
n-En
glis
h) w
ithou
t a p
rofe
ssio
nal
inte
rpre
ter s
how
ed n
o di
ffere
nce
in le
ngth
of v
isit.
Whe
n a
barr
ier w
as p
rese
nt,
and
a pr
ofes
sion
al in
terp
rete
r w
as u
nava
ilabl
e, p
hysi
cian
s pe
rfor
med
mor
e ex
tens
ive
eval
uatio
ns (m
ore
freq
uent
an
d m
ore
expe
nsiv
e di
agno
stic
te
stin
g) a
nd tr
eate
d ch
ildre
n m
ore
cons
erva
tivel
y (m
ore
intr
aven
ous
hydr
atio
n an
d m
ore
freq
uent
hos
pita
l ad
mis
sion
s.
Serv
ice
Util
izat
ion
Com
pare
d w
ith th
e En
glis
h-sp
eaki
ng c
ohor
t, no
n-En
glis
h sp
eaki
ng c
ases
with
bili
ngua
l ph
ysic
ians
had
sim
ilar r
ates
of
reso
urce
util
izat
ion.
Cas
es
with
an
inte
rpre
ter w
ere
leas
t lik
ely
to b
e te
sted
(odd
s ra
tio
[OR]
, mor
e lik
ely
to a
dmitt
ed
(OR,
1.7;
95%
CI,
1.1-2
.8),
and
no m
ore
likel
y to
rece
ive
intr
aven
ous
fluid
s. T
he b
arrie
r co
hort
(non
-Eng
lish
with
out a
pr
ofes
sion
al in
terp
rete
r) h
ad a
hi
gher
inci
denc
e (O
R, 1.
5; 9
5%
CI,
1.04-
2.2)
for t
estin
g an
d w
as
mos
t lik
ely
to b
e ad
mitt
ed (O
R,
2.6;
95%
CI,
1.4-4
.5) a
nd to
re
ceiv
e in
trav
enou
s hy
drat
ion
(OR,
2.3
; 95%
CI,
1.2-4
.3).
Mod
erat
e
21Pa
tient
-Rep
orte
d Q
ualit
y of
Pai
n Tr
eatm
ent a
nd
Use
of In
terp
rete
rs
in S
pani
sh-
Spea
king
Pat
ient
s H
ospi
taliz
ed
for O
bste
tric
and
G
ynec
olog
ical
C
are
Jim
enez
, N.,
Mor
eno,
G.,
Leng
, M.,
Buch
wal
d, D
., &
Mor
ales
L. S
. (2
012)
.
LEP
wom
en w
ith a
n in
terp
rete
r vs.
LEP
with
out
an in
terp
rete
r
Sett
ing:
USA
Stud
y D
esig
n: C
ross
-Se
ctio
nal
Freq
uenc
y of
Inte
rpre
tatio
n
Patie
nts
who
did
not
alw
ays
rece
ive
inte
rpre
tatio
n re
port
ed
sign
ifica
ntly
low
er s
core
s in
all
3 su
rvey
item
s: le
ss li
kely
to h
ave
thei
r pa
in c
ontr
olle
d (O
R=0.
4, p
<0.0
5),
have
a ti
mel
y re
spon
se to
thei
r pa
in (O
R=0.
4, p
<0.0
5), a
nd le
ss
help
fuln
ess
from
sta
ff (O
R=0.
03,
p<0.
05).
Dia
gnos
tic
Patie
nts
who
did
no
t alw
ays
rece
ive
inte
rpre
tatio
n re
port
ed
sign
ifica
ntly
low
er s
core
s in
all
3 su
rvey
item
s:
less
like
ly to
hav
e th
eir
pain
con
trol
led
(OR=
0.4,
p<
0.05
), ha
ve a
tim
ely
resp
onse
to th
eir p
ain
(OR=
0.4,
p<0
.05)
, and
less
he
lpfu
lnes
s fr
om s
taff
(OR=
0.03
, p<0
.05)
.
Mod
erat
e
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 27
22In
terp
reta
tion
in
Con
sulta
tions
w
ith Im
mig
rant
Pa
tient
s
With
Can
cer:
How
Ac
cura
te Is
It?
Buto
w, P
. N. e
t al
. (20
11).
To c
ompa
re a
ccur
acy
of in
terp
reta
tion
usin
g pr
ofes
sion
al v
s. a
d-ho
c in
terp
rete
rs. L
EP p
atie
nts
with
new
can
cer d
iagn
oses
w
ere
reco
rded
dur
ing
thei
r firs
t tw
o on
colo
gy
cons
ulta
tions
aft
er
diag
nosi
s, w
ith a
d-ho
c/fa
mily
inte
rpre
ters
or
prof
essi
onal
inte
rpre
ters
. G
ener
al L
EP (n
=49
enco
unte
rs; s
ome
of w
hich
ha
ve m
ultip
le in
terp
rete
rs
pres
ent)
VS.
LEP
with
an
othe
r int
erpr
eter
mod
e
Sett
ing:
Aus
tral
ia
Stud
y D
esig
n: C
ross
-se
ctio
nal
Com
parin
g Tr
aine
d In
terp
rete
rs v
s.
Unt
rain
ed In
terp
rete
rs
Prof
essi
onal
inte
rpre
ters
(pho
ne
or fa
ce-t
o-fa
ce) w
ere
less
like
ly to
pr
esen
t non
-equ
ival
ent i
nter
pret
atio
n th
an fa
mily
mem
bers
(50%
vs.
65%
, p=
0.05
). H
owev
er, a
cros
s bo
th
grou
ps th
ere
was
no
sign
ifica
nt
diffe
renc
e in
the
rate
of n
egat
ive
non-
equi
vale
nt in
terp
reta
tion.
No
diffe
renc
es b
etw
een
tele
phon
e an
d fa
ce-t
o-fa
ce in
terp
reta
tion.
Mod
erat
e
23C
ompa
ring
In-P
erso
n, V
ideo
, an
d Te
leph
onic
M
edic
al
Inte
rpre
tatio
n
Loca
tis, C
., et
al
. (20
10).
Gen
eral
LEP
(n =
241
; fac
e-to
-fac
e=80
; pho
ne=8
0;
vide
o =8
1) v
s. L
EP w
ith
anot
her i
nter
pret
er m
ode
Sett
ing:
Sou
th C
arol
ina,
U
SA
Stud
y D
esig
n: R
ando
miz
ed
Con
trol
Tria
l
Com
parin
g In
terp
reta
tion
Mod
es
Wai
t tim
es a
re s
igni
fican
tly lo
nger
(2
.5 m
in, p
=0.0
1) fo
r vid
eo v
s.
in-p
erso
n in
terp
reta
tion.
Inte
rvie
w
times
are
sig
nific
antly
long
er (7
.4
min
, p=0
.01)
for i
n-pe
rson
com
pare
d to
pho
ne, n
ot s
igni
fican
tly lo
nger
(5.3
m
in, p
=0.1)
for i
n-pe
rson
com
pare
d to
vid
eo.
Wea
k
24C
ompa
ring
the
Use
of P
hysi
cian
Ti
me
and
Hea
lth
Car
e Re
sour
ces
Am
ong
Patie
nts
Spea
king
Eng
lish,
Sp
anis
h, a
nd
Russ
ian
Krav
itz, R
L.,
Hel
ms,
J.L.
, A
zari,
R.,
Ant
oniu
s, m
D.,
& M
elni
kow
, J.
(200
0).
Dis
tingu
ish
betw
een
patie
nts
usin
g “h
ealth
sy
stem
inte
rpre
ters
” (p
aid
inte
rpre
ters
or b
iling
ual
phys
icia
ns) a
nd th
ose
usin
g “p
erso
nal i
nter
pret
ers”
(f
riend
s or
fam
ily m
embe
rs)
Gen
eral
LEP
(18
+ ye
ars)
w
ho s
peak
Spa
nish
and
Ru
ssia
n (n
=62
Span
ish)
(n
=111
Rus
sia)
com
pare
d to
N
on -
LEP
(18+
yea
rs) (
n=11
2 En
glis
h)
Sett
ing:
Cal
iforn
ia, U
SA
Stud
y D
esig
n: P
rosp
ectiv
e O
bser
vatio
nal S
tudy
Leng
th o
f App
oint
men
t
Com
pare
d w
ith E
nglis
h-sp
eaki
ng
patie
nts,
Spa
nish
and
Rus
sian
sp
eake
rs w
ho u
sed
heal
th
syst
em in
terp
rete
rs
aver
aged
12.2
and
7.1
addi
tiona
l m
inut
es o
f phy
sici
an ti
me,
re
spec
tivel
y (P
=
0.28
for S
pani
sh s
peak
ers
and
P =
0.82
for R
ussi
an
spea
kers
). Fo
r Spa
nish
and
Ru
ssia
n sp
eake
rs u
sing
pe
rson
al in
terp
rete
rs, t
here
w
as n
o st
atis
tical
ly s
igni
fican
t di
ffere
nce
betw
een
them
and
En
glis
h-sp
eaki
ng p
atie
nts.
Wea
k
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 28
25N
o D
iffer
ence
in
Em
erge
ncy
Dep
artm
ent
leng
th o
f sta
y fo
r Pat
ient
s w
ith
Lim
ited
Prof
icie
ncy
in
Engl
ish
Wal
lbre
cht,
J.,
Hod
es-V
illam
ar,
L., W
eiss
, S. J
., &
Ern
st, A
. A.
(201
4).
Gen
eral
LEP
(124
LEP
pa
tient
s); N
on -
LEP
(ES)
: Fo
r eac
h ES
pat
ient
, one
LE
P pa
tient
with
the
sam
e ac
uity
and
sim
ilar a
ge w
as
sele
cted
. (12
1 ES
patie
nts)
Sett
ing:
New
Mex
ico,
USA
Stud
y D
esig
n: P
rosp
ectiv
e C
onve
nien
ce S
ampl
ing
Coh
ort S
tudy
Leng
th o
f Sta
y
The
use
of in
terp
rete
rs w
as
asso
ciat
ed w
ith a
sig
nific
ant
incr
ease
in le
ngth
of s
tay
(incr
ease
d le
ngth
of s
tay
of
237
min
utes
from
the
time
of
arriv
al to
tim
e of
dis
char
ge
or a
dmis
sion
requ
est)
. No
diffe
renc
e in
leng
th o
f sta
y be
twee
n ES
pat
ient
s an
d pa
tient
s w
ith L
EP. O
nly
53%
of
pat
ient
s w
ith L
EP w
ere
repo
rted
to h
ave
used
an
inte
rpre
ter d
urin
g th
eir E
D
visi
t.
Wea
k
26Th
e Im
pact
of
Med
ical
In
terp
reta
tion
Met
hod
on T
ime
and
Erro
rs
Gan
y, F
., Ka
pelu
szni
k,
L., P
raka
sh,
K., G
onza
lez,
J.
, Ort
a, L
.Y.,
Tsen
g, C
.H.,
&
Cha
ngra
ni, J
. (2
007)
.
4 sc
ripte
d cl
inic
al
enco
unte
rs
Mod
es o
f int
erpr
etat
ion:
Re
mot
e si
mul
tane
ous,
Re
mot
e co
nsec
utiv
e,
Prox
imat
e co
nsec
utiv
e,
Prox
imat
e ad
hoc
Sett
ing:
New
Yor
k, N
Y, U
SA
Stud
y D
esig
n: C
ross
Se
ctio
nal
Com
parin
g M
odes
of I
nter
pret
atio
n an
d Tr
aine
d vs
. Unt
rain
ed
Inte
rpre
ters
Rem
ote
sim
ulta
neou
s m
edic
al
inte
rpre
ting
(RSM
I) en
coun
ters
av
erag
ed 12
.72
vs. 1
8.24
min
utes
for
the
next
fast
est m
ode
(pro
xim
ate
ad
hoc)
(p=0
.002
). Th
ere
wer
e 12
tim
es
mor
e m
edic
al e
rror
s of
mod
erat
e or
gr
eate
r clin
ical
sig
nific
ance
am
ong
utte
ranc
e in
non
-RSM
I enc
ount
ers
com
pare
d to
RSM
I enc
ount
ers
(p=0
.000
2).
Med
ical
Err
ors
RSM
I pro
duce
d fe
wer
err
ors
than
the
othe
r mod
es, w
hich
ha
d er
ror r
ates
that
wer
e cl
uste
red
at th
e a
sign
ifica
ntly
hi
gher
rate
. RSM
I had
a m
ean
of 1.
139
lingu
istic
err
ors
per
utte
ranc
e an
d 0.
019
med
ical
er
rors
of m
oder
ate
or g
reat
er
clin
ical
sig
nific
ance
per
ut
tera
nce.
Non
–RS
MI i
nter
pret
ing
mod
aliti
es w
ere
asso
ciat
ed
with
12-fo
ld g
reat
er ra
te o
f po
tent
ial m
edic
al e
rror
s (o
f mod
erat
e or
gre
ater
si
gnifi
canc
e (p
er u
tter
ance
co
mpa
red
to R
SMI (
P=0.
0002
).
Wea
k
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 29
27Th
e Ro
le
of M
edic
al
Inte
rpre
tatio
n on
Bre
ast a
nd
Cer
vica
l Can
cer
Scre
enin
g A
mon
g A
sian
Am
eric
an
and
Paci
fic
Isla
nder
Wom
en
Dan
g, J.
, Lee
, J.
, Tra
n, J.
H.,
Kaga
wa-
Sing
er,
M.,
Foo,
M.A
., &
Ngu
yen,
T.N
. (2
010)
.
1,708
Asi
an A
mer
ican
and
Pa
cific
Isla
nder
wom
en in
N
orth
ern
and
Sout
hern
C
alifo
rnia
. Cam
bodi
ans
n =
344,
Lao
tians
n =
353
, To
ngan
s n
= 28
6.
Sett
ing:
Cal
iforn
ia, U
SA
Stud
y D
esig
n: C
ross
-se
ctio
nal
Com
parin
g Tr
aine
d vs
. Unt
rain
ed v
s.
No
Inte
rpre
ters
Peop
le p
refe
rred
to s
peak
to th
eir
doct
or o
r med
ical
pro
vide
r in
a no
n-En
glis
h la
ngua
ge –
bili
ngua
l sta
ff (9
4.3%
), m
edic
al in
terp
rete
r (93
.6%
) an
d fa
mily
/frie
nds
(88.
9%).
Prev
entio
n
Wom
en w
ho ty
pica
lly
used
a m
edic
al in
terp
rete
r ha
d a
grea
ter o
dd
of h
avin
g re
ceiv
ed a
m
amm
ogra
m (O
R =
1.85;
95
% c
onfid
ence
inte
rval
=
1.21,
2.83
), a
clin
ical
br
east
exa
m (O
R 3.
03,
95%
CI =
1.82,
5.0
3) a
nd
a Pa
p Sm
ear (
OR
=2.3
4;
95%
CI =
1.38
to 3
.97)
than
th
ose
who
did
not
use
an
inte
rpre
ter.
Patie
nts
who
had
bili
ngua
l st
aff w
ere
twic
e as
like
ly
to h
ave
a cl
inic
al b
reas
t ex
am (2
.23
OR)
and
a
pap
smea
r (2.
82 O
R)
com
pare
d to
pat
ient
s w
ho d
id n
ot u
se a
ny
type
of i
nter
pret
atio
n.
Thos
e w
ho u
sed
bilin
gual
st
aff m
embe
rs h
ad th
e hi
ghes
t rat
e of
Pap
Sm
ears
(85.
8%) c
ompa
red
with
the
othe
r gro
ups
(non
e, 6
5.1%
; fam
ily o
r fr
iend
s, 7
7.1%
; med
ical
in
terp
rete
rs, 8
1.8%
).
Did
not
find
gre
ater
odd
s of
rece
ivin
g br
east
or
cerv
ical
can
cer s
cree
ning
af
ter a
ccou
ntin
g fo
r oth
er
varia
bles
in th
e m
odel
.
Wea
k
28Q
ualit
y of
Re
prod
uctiv
e H
ealth
Ser
vice
s to
Lim
ited
Engl
ish
Prof
icie
nt (L
EP)
Patie
nts
De
Boca
negr
a,
H.T.
D.,
Rost
ovts
eva,
D.
, Cet
inka
ya,
M.,
Rund
el, C
. &
Lew
is, C
. (20
11).
Mod
es o
f Int
erpr
etat
ion
– st
aff in
terp
rete
rs, l
angu
age
disc
onco
rdan
t (LD
I);
bilin
gual
clin
icia
n, la
ngua
ge
conc
orda
nt (L
C)
831 c
lient
s fo
r 158
9 re
prod
uctiv
e he
alth
vis
its
of fe
mal
e an
d m
ale
LEP
clie
nts
whe
re th
eir p
rimar
y la
ngua
ge w
as S
pani
sh a
nd
in w
hich
the
serv
ices
wer
e pr
ovid
ed b
y a
clin
icia
n w
ho
spok
e th
eir l
angu
age
or
thro
ugh
a st
aff in
terp
rete
r.
Sett
ing:
Cal
iforn
ia, U
SA
Stud
y D
esig
n:
Retr
ospe
ctiv
e C
ohor
t (Pr
e-Po
st)
Com
parin
g D
iffer
ent M
odes
of
Inte
rpre
tatio
n LD
I vis
its w
ere
sign
ifica
ntly
less
like
ly th
an L
C
visi
ts to
con
tain
doc
umen
tatio
n of
the
prov
isio
n of
edu
catio
n an
d co
unse
lling
ser
vice
s an
d le
ss li
kely
to
hav
e do
cum
enta
tion
of s
exua
lly
tran
smitt
ed in
fect
ion
(STI
) ris
k as
sess
men
t am
ong
new
fem
ale
clie
nts.
Fem
ale
clie
nts
in L
DI a
nd L
C
visi
ts w
ere
equa
lly li
kely
to b
e te
sted
fo
r Chl
amyd
ia.
Am
ong
wom
en, L
C v
isits
wer
e si
gnifi
cant
ly m
ore
likel
y th
an L
DI
visi
ts to
hav
e do
cum
enta
tion
of S
TI
risk
asse
ssm
ent.
How
ever
, fem
ale
clie
nts
in L
DI a
nd L
C v
isits
wer
e ab
out e
qual
ly li
kely
to b
e te
sted
for
Chl
amyd
ia, b
oth
for w
omen
und
er
the
age
of 2
6 an
d fo
r wom
en a
ge 2
6 an
d ol
der.
Dia
gnos
tic
Less
freq
uent
do
cum
enta
tion
of
educ
atio
n an
d co
unse
lling
on
any
topi
c w
hen
usin
g an
inte
rpre
ter c
ompa
red
to th
at fo
r clie
nts
seen
by
a la
ngua
ge c
onco
rdan
t pr
ovid
er.
Prov
ider
s w
ere
sign
ifica
ntly
less
like
ly
to d
ocum
ent a
n ST
I as
sess
men
t win
an
LDI
visi
t tha
n in
an
LC v
isits
–
new
clie
nts
seen
in
LDI w
ere
sign
ifica
ntly
le
ss li
kely
to h
ave
docu
men
tatio
n of
a S
TI
asse
ssm
ent w
hile
ther
e w
as n
o di
ffere
nce
in ri
sk
asse
ssm
ent b
etw
een
LDI a
nd L
C v
isits
am
ong
esta
blis
hed
clie
nts.
Wea
k
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 30
29Sc
reen
ing
of
men
tal d
isor
ders
in as
ylum
-see
kers
fr
om K
osov
o
Eyta
n, A
., Bi
scho
ff, A
., Rr
uste
mi,
I.,
Dur
ieux
, S.,
Lout
an, L
., G
ilber
t, M
., &
Boi
ver,
P.
(200
2).
319
stru
ctur
ed in
terv
iew
s co
nduc
ted
by n
urse
s w
ith a
sylu
m s
eeke
rs in
Ko
sovo
dur
ing
a sy
stem
atic
m
edic
al s
cree
ning
at t
ime
of e
ntry
, con
sist
ing
of
ques
tions
abo
ut h
ealth
co
nditi
ons,
pas
t exp
osur
e to
trau
mat
ic e
vent
s, a
nd
post
-tra
umat
ic s
ympt
oms.
Sett
ing:
Gen
eva,
Sw
itzer
land
Stud
y D
esig
n: C
ross
-se
ctio
nal
Com
parin
g Tr
aine
d In
terp
rete
rs
vs. U
ntra
ined
Inte
rpre
ters
vs.
No
Inte
rpre
ters
Subj
ectiv
e ra
ting
of c
omm
unic
atio
n w
as p
oore
st w
hen
ther
e w
as n
o in
terp
rete
r pre
sent
, bet
ter w
hen
rela
tives
wer
e us
ed a
nd b
est w
hen
trai
ned
inte
rpre
ters
wer
e us
ed (t
rend
te
st, p
<0.
0001
).
Serv
ice
Util
izat
ion
The
use
of b
oth
type
of
inte
rpre
ters
(tra
ined
and
re
lativ
e) le
d to
incr
ease
d re
ferr
al to
med
ical
car
e (n
on-
inte
rpre
ter 3
1%, r
elat
ives
as
inte
rpre
ter 4
8%, t
rain
ed
inte
rpre
ter 4
2%, p
=0.0
3.
Incr
ease
d re
ferr
al to
ps
ycho
logi
cal c
are
with
the
use
of a
trai
ned
inte
rpre
ter
(no
inte
rpre
ter 4
%, r
elat
ives
as
inte
rpre
ter 3
% a
nd tr
aine
d in
terp
rete
r 15%
, p =
0.0
7)
Dia
gnos
tic –
Rep
ortin
g of
Sy
mpt
oms
The
use
of re
lativ
es a
nd
trai
ned
inte
rpre
ters
si
gnifi
cant
ly in
fluen
ced
the
prop
ortio
n of
per
sons
re
port
ing
trau
mat
ic
even
ts a
nd p
sych
olog
ical
sy
mpt
oms.
Wea
k
30H
ow a
cces
sibl
e ar
e in
terp
rete
r se
rvic
es to
di
alys
is p
atie
nts
of N
on-E
nglis
h Sp
eaki
ng?
Back
grou
nd?
Zim
budz
i, E.
, Th
omps
on,
S., &
Ter
rill B
. (2
010)
.
To d
eter
min
e th
e le
vel
of in
terp
rete
r util
izat
ion
by d
ialy
sis
patie
nts;
to
asse
ss h
ow th
e fr
eque
ncy
of in
terp
rete
r util
izat
ion
affec
ts p
atie
nt o
utco
mes
. G
ener
al L
EP b
roke
n do
wn
into
num
ber o
f tim
es a
n in
terp
rete
r has
bee
n us
ed
(0-5
+)
Sett
ing:
Vic
toria
, Aus
tral
ia
Stud
y D
esig
n:
Retr
ospe
ctiv
e C
ohor
t
Freq
uenc
y of
Inte
rpre
tatio
n
Saw
redu
ctio
ns in
hos
pita
l ad
mis
sion
s du
e to
hyp
erka
lem
ia,
hype
rten
sion
& fl
uid
over
load
co
rrel
ated
with
freq
uenc
y of
in
terp
rete
r use
. Tho
se w
ith 0
in
terp
rete
rs s
aw 10
adm
issi
ons
with
flu
id o
verlo
ad a
nd h
yper
kalie
mia
, do
wn
to 5
and
2 (r
espe
ctiv
ely)
whe
n pa
tient
had
5 in
terp
rete
d en
coun
ters
. H
yper
tens
ion
mov
ed fr
om 6
(no
inte
rpre
ter)
to 2
adm
issi
ons
(5
inte
rpre
ter e
ncou
nter
s). N
o st
atis
tical
si
gnifi
canc
e or
con
foun
ders
de
scrib
ed.
Wea
k
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 31
Endnotes 1 Toronto Public Health. (2011). The Global City: Newcomer Health in Toronto. Retrieved from: http://www.toronto.ca/
legdocs/mmis/2011/hl/bgrd/backgroundfile-42361.pdf
2 Bowen, S. (2015). The Impact of Language Barriers on Patient Safety and Quality of Care. Société Santé en Francais. Retrieved from: https://santefrancais.ca/wp-content/uploads/SSF-Bowen-S.-Language-Barriers-Study.pdf
3 Flores, G. (2006). Language barriers to health care in the United States. New England Journal of Medicine, 355: 229-231. Retrieved from: http://www.nejm.org/doi/full/10.1056/NEJMp058316
4 Sears, J., Khan, K., Ardern, C.I., & Tamim, H. (2013). Potential for patient-physician language discordance in Ontario. BMC Health Services Research, 13:535. Retrieved from: https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-13-535
5 Toronto Public Health. (2011). The Global City: Newcomer Health in Toronto. Retrieved from: http://www.toronto.ca/legdocs/mmis/2011/hl/bgrd/backgroundfile-42361.pdff
6 Bowen, S. (2001). Language Barriers in Access to Health Care. Health Canada. Retrieved from: https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/hcs-sss/alt_formats/hpb-dgps/pdf/pubs/2001-lang-acces/2001-lang-acces-eng.pdf
7 Jacobs, E., Chen, A.H.M., Karliner, L.s., Agger-Gupta, N., & Mutha, S. (2006). The Need for More Research on Language Barriers in Health Care: A Proposed Research Agenda. The Milbank Quarterly, 84(1), 111-133. Retrieved from: http://onlinelibrary.wiley.com/doi/10.1111/j.1468-0009.2006.00440.x/full
8 Naish, J., Brown, J., & Denton, B. (1994). Intercultural consultations: investigation of factors that deter non-English speaking women from attending their general practitioners for cervical screening. British Medical Journal, 309, 1126-1128.
9 Fortier, J.P., Strobel, C., Aguilera, E. (1998). Language barriers to health care: federal and state initiatives, 1990-1995. Journal of Health Care for the Poor and Underserved, 9(5), S81-S100.
10 Wilson, E., Chen, A.H., Grumbach, K., Wang, F., & Fernandez, A. (2005). Effects of limited English proficiency and physician language on health care comprehension. Journal of General Internal Medicine, 20(9), 800-806.
11 Lee, E.D., Rosenberg, C.R., Sixsmith, D.M., Pang, D., & Abularrage, J. (1998). Does a Physician-Patient Language Difference Increase the Probability of Hospital Admission? Academic Emergency Medicien, 5(1), 86-89.
12 Brown, A.F., Perez-Stable, E.J., Whitaker, E.E., Alexander, M., Gathe, J., & Washington, A.E. (1999). Ethnic differences in hormone replacement prescribing patterns. Journal of General Internal Medicine, 14, 663-669.
13 Gill, P., Scrivener, G., Lloyd, d., & Dowell, T. (1995). The effect of patient ethnicity on prescribing rates. Health Trends, 27, 111-114.
14 Chan, A., & Woodruff, R.K. (1999). Comparison of palliative care needs of English- and non-English-speaking patients. Journal of Palliative Care, 15, 26-30.
15 Hampers, L.C., Cha, S., Gutglass, D.J., Binns, H.J., & Krug, S.E. (1999). Language barriers and resource utilization in a pediatric emergency department. Pediatrics, 103, 1253-1256.
16 Morales, L. S., Cunningham, W. E., Brown, J. A., Liu, H., & Hays, R. D. (1999). Are Latinos less satisfied with communication by health care providers? Journal of general internal medicine, 14(7), 409-417.
17 Carrasquillo, O., Orav, E. J., Brennan, T. A., & Burstin, H. R. (1999). Impact of language barriers on patient satisfaction in an emergency department. Journal of General Internal Medicine, 14(2), 82-87.
18 Hornberger, J., Itakura, H., & Wilson, S. R. (1997). Bridging language and cultural barriers between physicians and patients. Public Health Reports, 112(5), 410.
19 Statistics Canada. (2017). An Increasingly Diverse Linguistics Landscape: Highlights from the 2016 Census. Retrieved from http://www.statcan.gc.ca/daily-quotidien/170802/dq170802b-eng.htm?HPA=1
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 32
20 Statistics Canada. (2017). Data Tables, 2016 Census: Mother Tongue (8), Knowledge of Official Languages (5), Language Spoken Most Often at Home (8), Other Language(s) Spoken Regularly at Home (9), Age (7) and Sex (3) for the Population Excluding Institutional Residents of Canada, Provinces and Territories, Census Divisions and Census Subdivisions, 2016 Census - 100% Data. Retrieved from http://www12.statcan.gc.ca/census-recensement/2016/dp-pd/dt-td/Rp-
21 Statistics Canada. (2017). Data tables, 2016 Census: Mother Tongue (8), Knowledge of Official Languages (5), Language Spoken Most Often at Home (8), Other Language(s) Spoken Regularly at Home (9), Age (7) and Sex (3) for the Population Excluding Institutional Residents of Canada, Provinces and Territories, Census Divisions and Census Subdivisions, 2016 Census – 100% Data. Retrieved from: http://www12.statcan.gc.ca/census-recensement/2016/dp-pd/dt-td/Rp-eng.cfm?LANG=E&APATH=3&DETAIL=0&DIM=0&FL=A&FREE=0&GC=0&GID=0&GK=0&GRP=1&PID=109668&PRID=10&PTYPE=109445&S=0&SHOWALL=0&SUB=0&Temporal=2016&THEME=118&V-ID=0&VNAMEE=&VNAMEF=
22 Statistics Canada. (2016). Mother Tongue (8), Knowledge of Official Languages (5), Language Spoken Most Often at Home (8), Other Language(s) Spoken Regularly at Home (9), Age (7) and Sex (3) for the Population Excluding Institutional Residents of Canada, Provinces and Territories, Census Divisions and Census Subdivisions, 2016 Census - 100% Data. Retrieved from http://www12.statcan.gc.ca/census-recensement/2016/dp-pd/dt-td/Rp
23 Bowen, S. (2001). Language Barriers in Access to Health Care. Health Canada. Retrieved from: https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/hcs-sss/alt_formats/hpb-dgps/pdf/pubs/2001-lang-acces/2001-lang-acces-eng.pdf
24 McMurtray, A., Saito, E., & Nakamoto, B. (2009). Language preference and development of dementia among bilingual individuals. Hawaii Medical Journal, 68(9), 223.
25 Ministry of Health and Long-Term Care. (2017). Patients First: Action Plan for Health Care. Retrieved from: http://www.health.gov.on.ca/en/ms/ecfa/healthy_change/
26 Health Quality Ontario. (2017). What is Health Quality – Health Equity and Quality. Retrieved from: Language barriers pose significant impediments to accessing health care services.
27 Statistics Canada. (2015). Linguistic Characteristics of Canadians. Retrieved from: http://www12.statcan.gc.ca/census-recensement/2011/as-sa/98-314-x/98-314-x2011001-eng.cfm#a2
28 City of Toronto. (2012). 2011 Census – Language – Backgrounder. Retrieved from: https://www1.toronto.ca/city_of_toronto/social_development_finance__administration/files/pdf/language_2011_backgrounder.pdf
29 Riddick, S. (1998). Improving Access to Limited English-Speaking Consumers: A Review of Strategies in Health Care Settings. Journal of Health Care for the Poor and Underserved, 9(1998), S40-S61.
30 Aery, A., Kumar, N., Laher, N., & Sultana, A. (2017). Interpreting Consent – A Rights Based Approach to Language Accessibility in Ontario’s health care system. Wellesley Institute. Retrieved from: http://www.wellesleyinstitute.com/publications/interpreting-consent-a-rights-based-approach-to-language-accessibility-in-ontarios-health-care-system/
31 O’Campo, P., Devotta, K., Dowbor, T., & Pedersen, C. (2014). Reducing the language accessibility gap – Language Services Toronto Program Evaluation Report. St. Michael’s Hospital. Retrieved from: http://stmichaelshospitalresearch.ca/wp-content/uploads/2016/12/LST_Program_Evaluation_Report_July31_one-up.pdf
32 Bauer, A.M., & Alegria, M. (2010). The Impact of Patient Language Proficiency and Interpreter Service Use on the Quality of Psychiatric Care: A Systematic Review. Psychiatric Serv, 61(8), 765-773.
33 Flores, G. (2005). The Impact of Medical Interpreter Services on the Quality of Health Care: A Systematic Review. Medical Care Research and Review, 62(3), 255-299.
34 Arksey, H., & O’Malley, L. (2007). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19-32. Retrieved from: http://www.tandfonline.com/doi/abs/10.1080/1364557032000119616
35 Effective Public Health Practice Project. (n.d.). Quality Assessment Tool for Quantitative Studies. Retrieved from:
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 33
http://www.ephpp.ca/tools.html
36 Bernstein, J., Bernstein, E., Dave, A., Hardt, E., James, T., Linden, J., ... & Safi, C. (2002). Trained medical interpreters in the emergency department: effects on services, subsequent charges, and follow-up. Journal of Immigrant Health, 4(4), 171-176.
37 Jacobs, E. A., Lauderdale, D. S., Meltzer, D., Shorey, J. M., Levinson, W., & Thisted, R. A. (2001). Impact of Interpreter Services on Delivery of Health Care to Limited–English proficient Patients. Journal of General Internal Medicine, 16(7), 468-474.
38 Jacobs, E. A., Shepard, D. S., Suaya, J. A., & Stone, E. L. (2004). Overcoming language barriers in health care: costs and benefits of interpreter services. American Journal of Public Health, 94(5), 866-869.
39 Fagan, M. J., Diaz, J. A., Reinert, S. E., Sciamanna, C. N., & Fagan, D. M. (2003). Impact of interpretation method on clinic visit length. Journal of General Internal Medicine, 18(8), 634-638.
40 Hacker, K., Choi, Y. S., Trebino, L., Hicks, L., Friedman, E., Blanchfield, B., & Gazelle, G. S. (2012). Exploring the impact of language services on utilization and clinical outcomes for diabetics. PloS One, 7(6), e38507.
41 Sarver, J., & Baker, D. W. (2000). Effect of language barriers on follow‐up appointments after an emergency department visit. Journal of General Internal Medicine, 15(4), 256-264.
42 d’Ardenne, P., Ruaro, L., Cestari, L., Fakhoury, W., & Priebe, S. (2007). Does interpreter-mediated CBT with traumatized refugee people work? A comparison of patient outcomes in East London. Behavioural and Cognitive Psychotherapy, 35(3), 293-301.
43 Nápoles, A. M., Santoyo-Olsson, J., Karliner, L. S., Gregorich, S. E., & Pérez-Stable, E. J. (2015). Inaccurate Language Interpretation and Its Clinical Significance in the Medical Encounters of Spanish-speaking Latinos. Medical Care, 53(11), 940-947.
44 Wagner, J., Abbott, G., & Lacey, K. (2005). Knowledge of heart disease risk among Spanish speakers with diabetes: the role of interpreters in the medical encounter. Ethnicity & Disease, 15(4), 679-684.
45 Flores, G., Abreu, M., Barone, C. P., Bachur, R., & Lin, H. (2012). Errors of medical interpretation and their potential clinical consequences: a comparison of professional versus ad hoc versus no interpreters. Annals of Emergency Medicine, 60(5), 545-553.
46 Butow, P.N., Goldstein, D., Bell, M.L., Sze, M., Aldridge, L.J., Abdo, S., Tanious, M., Dong, S., Iedema, R., Vardy, J., Ashgari, R., Hui, R., & Eisenbruch, M. (2011). Interpretation in Consultations with Immigrant Patients with Cancer: How Accurate Is It? Journal of Clinical Oncology, 29(20), 2801-2807.
47 Gany, F., Kapelusznik, L., Prakash, K., Gonzalez, J., Orta, L. Y., Tseng, C. H., & Changrani, J. (2007). The impact of medical interpretation method on time and errors. Journal of General Internal Medicine, 22(2), 319-323.
48 Leng, J. C., Changrani, J., Tseng, C. H., & Gany, F. (2010). Detection of depression with different interpreting methods among Chinese and Latino primary care patients: a randomized controlled trial. Journal of Immigrant and Minority health, 12(2), 234-241.
49 Lion, K. C., Brown, J. C., Ebel, B. E., Klein, E. J., Strelitz, B., Gutman, C. K., ... & Mangione-Smith, R. (2015). Effect of telephone vs video interpretation on parent comprehension, communication, and utilization in the pediatric emergency department: a randomized clinical trial. JAMA Pediatrics, 169(12), 1117-1125.
50 Grover, A., Deakyne, S., Bajaj, L., & Roosevelt, G. E. (2012). Comparison of throughput times for limited English proficiency patient visits in the emergency department between different interpreter modalities. Journal of Immigrant and Minority Health, 14(4), 602-607.
51 Locatis, C., Williamson, D., Gould-Kabler, C., Zane-Smith, L., Detzier, I., Roberson, J., Maisiak, R., & Ackerman, M. (2010). Comparing In-Person, Video, and Telephonic Medical Interpretation. J Gen Intern Med, 25(4), 345-50.
52 de Bocanegra, H. T., Rostovtseva, D., Cetinkaya, M., Rundel, C., & Lewis, C. (2011). Quality of reproductive health services to limited English proficient (LEP) patients. Journal of Health Care for the Poor and Underserved, 22(4), 1167-1178.
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 34
53 Zimbudzi, E., Thompson, S., & Terrill, B. (2010). How accessible are interpreter services to dialysis patients of Non-English-Speaking Background? Australasian Medical Journal, 1(3), 205-212.
54 Wallbrecht, J., Hodes-Villamar, L., Weiss, S. J., & Ernst, A. A. (2014). No difference in emergency department length of stay for patients with limited proficiency in English. Southern Medical Journal, 107(1), 1-5.
55 López, L., Rodriguez, F., Huerta, D., Soukup, J., & Hicks, L. (2015). Use of interpreters by physicians for hospitalized limited English proficient patients and its impact on patient outcomes. Journal of General Internal Medicine, 30(6), 783-789.
56 Hampers, L. C., & McNulty, J. E. (2002). Professional interpreters and bilingual physicians in a pediatric emergency department: effect on resource utilization. Archives of Pediatrics & Adolescent Medicine, 156(11), 1108-1113.
57 Jacobs, E. A., Fu, P. C., & Rathouz, P. J. (2012). Does a Video Interpreting Network Improve Delivery of Care in the Emergency Department? Health Services Research, 47(1pt2), 509-522.
58 Davies, S. E., Dodd, K. J., Tu, A., Zucchi, E., Zen, S., & Hill, K. D. (2016). Does English proficiency impact on health outcomes for inpatients undergoing stroke rehabilitation? Disability and Rehabilitation, 38(14), 1350-1358.
59 Lindholm, M., Hargraves, J. L., Ferguson, W. J., & Reed, G. (2012). Professional language interpretation and inpatient length of stay and readmission rates. Journal of General Internal Medicine, 27(10), 1294-1299.
60 Eytan, A., Bischoff, A., Rrustemi, I., Durieux, S., Loutan, L., Gilbert, M., & Bovier, P. A. (2002). Screening of mental disorders in asylum-seekers from Kosovo. Australian & New Zealand Journal of Psychiatry, 36(4), 499-503.
61 Karliner, L. S., Pérez-Stable, E. J., & Gregorich, S. E. (2017). Convenient access to professional interpreters in the hospital decreases readmission rates and estimated hospital expenditures for patients with limited English proficiency. Medical Care, 55(3), 199-206.
62 Jimenez, N., Jackson, D. L., Zhou, C., Ayala, N. C., & Ebel, B. E. (2014). Postoperative pain management in children, parental English proficiency, and access to interpretation. Hospital Pediatrics, 4(1), 23.
63 Dang, J., Lee, J., Tran, J. H., Kagawa-Singer, M., Foo, M. A., Nguyen, T. U. N., ... & Tanjasiri, S. P. (2010). The role of medical interpretation on breast and cervical cancer screening among Asian American and Pacific Islander women. Journal of Cancer Education, 25(2), 253-262
64 Price, E. L., Pérez-Stable, E. J., Nickleach, D., López, M., & Karliner, L. S. (2012). Interpreter perspectives of in-person, telephonic, and videoconferencing medical interpretation in clinical encounters. Patient education and counseling, 87(2), 226-232.
65 Chen, L.M., Farwell, W.R. & Jha, A.K. (2009). Primary care visit duration and quality: does good care take longer? Arch Intern Med, 169(20):1866–72. doi:10.1001/archinternmed.2009.341.
66 Abbo, E.D., Zhang, Q., Zelder, M., & Huang, E.S. (2008). The increasing number of clinical items addressed during the time of adult primary care visits. J Gen Intern Med, 23(12):2058–65. doi:10.1007/s11606-008-0805-8.
67 Lopez, L., Rodriquez, F., Huerta, D., Soukup, J. &Hicks, L. (2015). Use of Interpreters by Physicians for Hospitalized Limited English Proficient Patients and Its Impact on Patient Outcomes. Journal of General Internal Medicine, 30(6), 783-789.
68 Karliner, L.S., Kim, S.E., Meltzer, D.O., & Auerback, A.D. (2010). Influence of language barriers on outcomes of hospital care for general medicine inpatients. Journal of Hospital Medicine, 5(5), 276-282.
69 Flores, G. (2005). The Impact of Medical Interpreter Services on the Quality of Health Care: A Systematic Review. Medical Care Research and Review, 62(3), 255-299.
70 Bauer, A.M., & Alegria, M. (2010). The Impact of Patient Language Proficiency and Intrepreter Service Use on the Quality of Psychiatric Care: A Systematic Review. Psychiatric Serv, 61(8), 765-773.
71 Flores, G. (2005). The Impact of Medical Interpreter Services on the Quality of Health Care: A Systematic Review. Medical Care Research and Review, 62(3), 255-299.
LANGUAGE INTERPRETATION SERVICES SCOPING REVIEW - WELLESLEY INSTITUTE 35
72 Bauer, A.M., & Alegria, M. (2010). The Impact of Patient Language Proficiency and Intrepreter Service Use on the Quality of Psychiatric Care: A Systematic Review. Psychiatric Serv, 61(8), 765-773.
73 Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26(2), 91-108.
74 Madore, O. (1992). The Canadian and American Health Care Systems. Economics Division. Retrieved from: http://publications.gc.ca/Collection-R/LoPBdP/BP/bp300-e.htm