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Professionally trained medical interpreters

Health Factors: Quality of Care
Decision Makers: State Government Federal Government Healthcare Professionals & Advocates Public Health Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 20-49% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

Professionally trained medical interpreters provide interpretation services for patients with limited English proficiency (LEP) in outpatient and inpatient health care settings, and sometimes also serve informally as cultural liaisons or patient advocates. Interpreters are taught to interpret spoken words in the correct context via at least 40 hours of training, which often includes on-the-job training and courses in health care interpretation (CCHI). Language access services are mandated by Title VI of the Civil Rights Act for health care providers receiving federal funds, including Medicare and Medicaid. Professional interpreters may provide services in-person or remotely by telephone, often using a dual-handset interpreter telephone, or video conference (Juckett 2014). Availability of professional interpreters is limited in many settings, often due to budgetary limitations. The use of ad-hoc interpreters such as untrained family, friends, or non-interpreter staff remains common (Galvez 2007). 

Expected Beneficial Outcomes

Improved patient-provider communication
Increased patient satisfaction
Improved health outcomes

Evidence of Effectiveness

There is strong evidence that professionally trained medical interpreters improve patient-provider communication (Campbell-Wollscheid 2015, Flores 2005, Lee 2017) and increase satisfaction for patients with limited English proficiency (LEP), especially when services are provided in-person or over the telephone (Campbell-Wollscheid 2015, Karliner 2007, Flores 2005, Bagchi 2011, Giordano 2007). Additional evidence is needed to confirm effects on health outcomes (Flores 2005, Giordano 2007, Karliner 2017).

Professionally trained medical interpreters have been shown to make fewer clinically significant interpretation errors than untrained interpreters (Flores 2005, Karliner 2007, Flores 2012, Napoles 2015, Bauer 2010) and are associated with improved quality of care for LEP patients (Campbell-Wollscheid 2015, Flores 2005, Karliner 2007, Flores 2012, Rosenberg 2008). Interpreters with 100 or more hours of training are less likely to make errors than interpreters with fewer hours of training (Flores 2012).

LEP patients who receive interpretation services from professionally trained medical interpreters are more likely to have preventive screenings, fill prescriptions, and successfully manage conditions such as diabetes than patients with ad-hoc interpreters such as family, friends, or health care staff untrained in interpretation (Flores 2005). In two New Jersey emergency departments, patients and providers report higher levels of satisfaction and better communication with in-person trained interpreters than ad-hoc or telephone interpreters (Bagchi 2011). A Denver-based study in a pediatric emergency department, however, indicates higher patient satisfaction with professional telephone interpreters than in-person professional interpreters (Crossman 2010) and another study indicates parents of pediatric patients prefer professional telephone interpretation over ad-hoc interpreters or no interpretation (Cunningham 2008).

In-person professional interpretation may better support understanding of cultural nuances than interpretation via video-conference (Napoles 2010). However, remote, real-time video-conferencing with professional interpreters may reduce errors (Napoles 2015). Professional telephone interpretation is associated with reductions in interpreter-related delays in care (Lion 2015) and may increase the use of interpreters in acute care settings (Tuot 2012).

A Boston-based study suggests that patients may prefer family members or friends serving as ad-hoc interpreters rather than engaging professionally trained interpreters (Ginde 2010).

Implementation

United States

Professionally trained medical interpreters are available in many health care settings, especially in non-profit hospitals in large, diverse urban areas (Schiaffino 2014). Memorial Sloan Kettering Cancer Center, for example, offers a medical interpreting training program along with cultural responsiveness training (MSKCC-Medical interpreting). The University of Texas MD Anderson Cancer Center’s international center provides professional medical interpretation services in Arabic, French, Mandarin, Spanish, Russian, Turkish, Vietnamese, and American Sign Language (UTMDACC-International center). The University of California Davis Medical Center’s Department of Interpreting and Translation Services provides in-person, over-the-phone, and video conference interpretation in 18 languages as well as health care interpreter training courses (UCDMC-Interpreting).

Professional interpreters can be certified by the Certification Commission for Healthcare Interpreters or the National Board of Certification for Medical Interpreters (Juckett 2014). The Continuing Education Accreditation Program (CEAP) maintains a database of all professional medical interpretation programs certified by the Certification Commission for Healthcare Interpreters (CCHI) (CEAP-CCHI providers).

Wisconsin

The University of Wisconsin Health System (UW Health) is one Wisconsin-based entity that provides nationally-certified/credentialed medical interpreters for patients with limited English proficiency (LEP). UW Health Interpreter Services serves approximately 200 LEP patients a day through in-person, telephone, and videoconference interpretation in 20 different languages (UW Health-Interpreter services).

Implementation Resources

CCHI - Certification Commission for Healthcare Interpreters (CCHI). Eligibility Criteria. Accessed on March 20, 2017
Think cultural health - US Department of Health and Human Services (US DHHS), Office of Minority Health (OMH). Think cultural health: Guide to providing effective communication and language assistance services. Accessed on March 20, 2017

Citations - Description

CCHI - Certification Commission for Healthcare Interpreters (CCHI). Eligibility Criteria. Accessed on March 20, 2017
Galvez 2007 - Galvez E, Wilson-Stronks A. Hospitals, Language and Culture: A Snapshot of the Nation: Exploring Cultural and Linguistic Services in the Nation's Hospitals. The Joint Commission. The California Endowment. 2007. Accessed on April 24, 2017
Juckett 2014 - Juckett G, Unger K. Appropriate use of medical interpreters. American Family Physician. 2014;90(7):476–480. Accessed on March 20, 2017

Citations - Evidence

Bagchi 2011* - Bagchi AD, Dale S, Verbitsky-Savitz N, et al. Examining effectiveness of medical interpreters in emergency departments for Spanish-speaking patients with limited English proficiency: Results of a randomized controlled trial. Annals of Emergency Medicine. 2011;57(3):248–256.e4. Accessed on March 20, 2017
Bauer 2010 - Bauer AM, Alegría M. The impact of patient language proficiency and interpreter service use on the quality of psychiatric care: A systematic review. Psychiatric Services. 2010;61(8):765-773. Accessed on April 24, 2017
Campbell-Wollscheid 2015 - Wollscheid S, Munthe-Kaas HM, Hammerstrøm KT, Noonan E. Effect of interventions to facilitate communication between families or single young people with minority language background and public services: A systematic review. Campbell Systematic Reviews. 2015:7. Accessed on March 20, 2017
Crossman 2010* - Crossman KL, Wiener E, Roosevelt G, Bajaj L, Hampers LC. Interpreters: Telephonic, in-person interpretation and bilingual providers. Pediatrics. 2010;125(3):e631-e638. Accessed on April 24, 2017
Cunningham 2008* - Cunningham H, Cushman LF, Akuete-Penn C, Meyer DD. Satisfaction with telephonic interpreters in pediatric care. Journal of the National Medical Association. 2008;100(4):429-434. Accessed on April 24, 2017
Flores 2005* - Flores G. The impact of medical interpreter services on the quality of care: A systematic review. Medical Care Research and Review. 2005;62(3):255-299. Accessed on March 20, 2017
Flores 2012* - Flores G, Abreu M, Barone CP, Bachur R, Lin H. Errors of medical interpretation and their potential clinical consequences: A comparison of professional versus ad hoc versus no interpreters. Annals of Emergency Medicine. 2012;60(5):545–553. Accessed on March 20, 2017
Ginde 2010* - Ginde AA, Sullivan AF, Corel B, Caceres JA, Camargo CA. Reevaluation of the effect of mandatory interpreter legislation on use of professional interpreters for ED patients with language barriers. Patient Education and Counseling. 2010;81(2):204–206. Accessed on March 20, 2017
Giordano 2007* - Giordano S. Overview of the advantages and disadvantages of professional and child interpreters for limited English proficiency patients in general health care situations. Journal of Radiology Nursing. 2007;26(4):126–131. Accessed on March 20, 2017
Karliner 2007 - Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Services Research. 2007;42(2):727-54. Accessed on March 20, 2017
Karliner 2017* - Karliner LS, Pérez-Stable EJ, Gregorich SE. Convenient access to professional interpreters in the hospital decreases readmission rates and estimated hospital expenditures for patients with limited English proficiency. Medical Care. 2017;55(3):199-206. Accessed on April 24, 2017
Lee 2017* - Lee JS, Pérez-Stable EJ, Gregorich SE, et al. Increased access to professional interpreters in the hospital improves informed consent for patients with limited English proficiency. Journal of General Internal Medicine. 2017:1-8. Accessed on April 24, 2017
Lion 2015* - Lion KC, Ebel BE, Rafton S, et al. Evaluation of a quality improvement intervention to increase use of telephonic interpretation. Pediatrics. 2015;135(3):e709-e716. Accessed on April 24, 2017
Napoles 2010 - Nápoles AM, Santoyo-Olsson J, Karliner LS, et al. Clinician ratings of interpreter mediated visits in underserved primary care settings with ad hoc, in-person professional, and video conferencing modes. Journal of Health Care for the Poor and Underserved. 2010;21(1):301-317. Accessed on April 24, 2017
Napoles 2015 - Nápoles AM, Santoyo-Olsson J, Karliner LS, Gregorich SE, Pérez-Stable EJ. Inaccurate language interpretation and its clinical significance in the medical encounters of Spanish-speaking Latinos. Medical Care. 2015;53(11):940-947. Accessed on April 24, 2017
Rosenberg 2008* - Rosenberg E, Seller R, Leanza Y. Through interpreters’ eyes: Comparing roles of professional and family interpreters. Patient Education and Counseling. 2008;70(1):87–93. Accessed on March 20, 2017
Tuot 2012 - Tuot DS, Lopez M, Miller C, Karliner LS. Impact of an easy-access telephonic interpreter program in the acute care setting: An evaluation of a quality improvement intervention. The Joint Commission Journal on Quality and Patient Safety. 2012;38(2):81-88. Accessed on April 24, 2017

Citations - Implementation

CEAP-CCHI providers - Continuing Education Accreditation Program (CEAP). Certification Commission for Healthcare Interpreters (CCHI). Find a health care interpretation provider. Accessed on March 20, 2017
Juckett 2014 - Juckett G, Unger K. Appropriate use of medical interpreters. American Family Physician. 2014;90(7):476–480. Accessed on March 20, 2017
MSKCC-Medical interpreting - Memorial Sloan Kettering Cancer Center (MSKCC). Immigrant Health & Cancer Disparities Service. Medical interpreting training program. Accessed on March 20, 2017
Schiaffino 2014 - Schiaffino MK, Al-Amin M, Schumacher JR. Predictors of language service availability in U.S. hospitals. International Journal of Health Policy and Management. 2014;3(5):259–268. Accessed on March 20, 2017
UCDMC-Interpreting - University of California Davis Medical Center (UCDMC). Department of Interpreting and Translation Services. Accessed on March 20, 2017
UTMDACC-International center - The University of Texas MD Anderson Cancer Center (UTMDACC). International center. Certified medical interpreters. Accessed on March 20, 2017
UW Health-Interpreter services - University of Wisconsin Health System (UW Health). UW Hospital patient guide: Interpreter services. Accessed on April 24, 2017

Page Last Updated

April 25, 2017

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