The challenges faced by patients with limited English proficiency (LEP) trying to navigate the American healthcare system are longstanding and well-known; notably, patients and healthcare providers unable to communicate due to a language barrier can lead to misunderstandings and a lower likelihood of treatment adherence and follow-up care.

The requirement to provide translation and interpreting in patients’ languages is legislated at different levels in the US. Among the most impactful regulations are Joint Commission standards, which apply to hospital programs, and ACA 1557, the nondiscrimination provision of the Affordable Care Act, enacted in 2010.

Along with those mandates has come the general consensus that language services improve LEP patients’ medical care and interactions with healthcare providers. This has been borne out in certain research. 

For instance, a February 2022 study of nearly 10,000 patients hospitalized with Covid-19 found that outcomes for LEP patients improved during the second wave of the pandemic, reportedly thanks to specific efforts to minimize language-based healthcare disparities. 

The healthcare industry’s interest in interpreting, particularly tech-enabled solutions, is only growing as the number of LEP patients in the US increases, and the US population as a whole ages.

Healthcare staffing company AMN Healthcare acquired video remote interpreting (VRI) provider Stratus Video in 2020 for USD 475m, a move that has already paid off, according to Q1 2022 financial results (both Subscriber Content). Of course, new companies have popped up in response to demand, such as on-demand healthcare interpreting platform Jeenie, which recently raised USD 9.3m in Series A funding.

But a new study has found that, compared to English-speaking patients, LEP patients were generally less satisfied with their experiences with healthcare providers — even with their preferred mode of interpreting available during appointments. 

The May 2022 paper, Interpreter Use and Patient Satisfaction in the Otolaryngology Outpatient Clinic, retrospectively analyzed surveys completed by 209 English-, Spanish- and Haitian Creole-speaking patients at an outpatient otolaryngology clinic in Boston, collected between 2018 and 2019. 

All LEP patients were offered the use of a professional interpreter, with telephonic interpreting (OPI) and VRI used only when in-person interpreters were unavailable. Sixty-five patients used interpreters, while nine patients opted to have a family member or friend interpret instead; however, even for those patients, professional interpreters were required for appointments during which surgical consent or critical medical decisions would be discussed.

Overall, LEP patients using interpreters reported lower visit satisfaction than English-speaking patients (average ratings of 7.66 versus 8.69) after controlling for other variables, including wait times. Haitian Creole speakers had slightly higher rates of satisfaction (8.29) compared to Spanish speakers (7.63). 

“Although patients who utilized interpreter services expressed significantly greater interpreter satisfaction with in-person interpreters or family members compared to telephone services, the overall survey satisfaction scores did not significantly differ between different types or modes of interpreter used,” the authors wrote. 

Nine patients out of 209 reported satisfaction ratings of less than 4.0 — and eight of those were LEP patients. Their surveys indicated negative perceptions of physician communication, despite quite positive reviews of their interpreters. 

According to the researchers, “This suggests that some communicational difficulties that result in dissatisfaction are independent of the quality or perceived quality of interpretation and may be more dependent on physician communication strategies.”



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