While it is well documented in the literature that language interpretation services are essential to high-quality care for patients with Limited English Proficiency (LEP), no previous study has comprehensively summarized what is known regarding large-scale interventions to improve the care of LEP patients. The objective of the study is to systematically review the literature to describe evidence for interventions at the hospital or health system level to improve communication with, quality of care for, or health outcomes of LEP patients.
We defined the PICO question as follows: For (P) patients with Limited English Proficiency in any health care setting, (I) which interventions at the hospital (defined as 3 or more clinical services involved) or health system level, (C) compared to other interventions or none, will result in (O) improvement in quality of care, communication or health outcomes? In accordance with PRISMA guidelines, we searched the databases PubMed, CINAHL, EMBASE, and the Public Health Database (ProQuest) for relevant literature, with any publication date and no language restrictions. We included studies of any design provided they measured an outcome of an intervention to improve care for LEP patients. We excluded systematic reviews, interventions without measured outcomes, and epidemiologic descriptions of language access needs. Interrater reliability for reference inclusion was calculated on a subset of 10% of the initial search results using a probability adjusted and bias adjusted kappa (PABAK). The final included references were analyzed using a narrative approach. This review was registered with PROSPERO prior to the initiation of the search (Record number CRD42018093015)
The search yielded an initial 16,686 references. After deduplication, the references were screened by title and abstract, with 516 references included in a full-text review. The Interrater reliability was calculated at 0.98. After full-text review, 13 relevant articles were selected for inclusion in this review. Of these interventions, 4 included education of providers or interpreters, 5 involved policy change at the hospital or health-system level, 8 involved organizational or workflow change, and 4 included a technological intervention. The outcomes measured included 9 focused on improving communication, 7 on healthcare quality, 5 on increased access to care, and 2 measured pre-determined indicators of health. Included references ranged from 2001 to 2017 and showed the efficacy of professional interpreter services implementation, basic medical education of professional interpreters, routine collection of patient preferred medical language, telephonic and other remote interpretation services, and professional ladders for interpreters.
As our increasingly global society fosters cultural migration, effective interpreter services and other hospital and health-systems level interventions will need to be implemented to ensure high-quality, equitable health care for patients regardless of culture or language proficiency. Further research is necessary to guide hospitals and health systems on the most effective interventions.