Advertisement

Impact of English Proficiency on Care Experiences in a Pediatric Emergency Department

Published:September 05, 2014DOI:https://doi.org/10.1016/j.acap.2014.06.019

      Abstract

      Objective

      To compare emergency department care experiences of Spanish-speaking, limited-English-proficient (SSLEP) and English-proficient (EP) parents and to assess how SSLEP care experiences vary by parent-perceived interpretation accuracy.

      Methods

      The National Research Corporation Picker Institute's Family Experience Survey (FES) was administered from November 26, 2010, to July 17, 2011, to 478 EP and 152 SSLEP parents. Problem scores for 3 FES dimensions were calculated: information/education, partnership with clinicians, and access/coordination of care. Adjusted associations between language proficiency (SSLEP vs EP) and dimension problem scores were examined by multivariate Poisson regression. Unadjusted Poisson regression analysis was used to examine the association between perceived interpretation accuracy and FES problem scores for SSLEP parents who received interpretation.

      Results

      SSLEP parents had a higher risk of reporting problems with access/coordination of care compared to EP parents (risk ratio 1.6, 95% confidence interval 1.2, 2.1). There were no differences in reported care experiences related to information/education or partnership with clinicians. Among SSLEP parents who received professional interpretation, those reporting poor accuracy had a higher risk of also reporting problems with information/education (risk ratio 2.1, 95% confidence interval 1.2, 3.6).

      Conclusions

      In a pediatric emergency department with around-the-clock access to professional interpretation, SSLEP parents report poorer experiences than EP parents with access/coordination of care, including perceived wait times. Their experiences with provision of information/education and partnership with clinicians approximate those of EP parents. However, SSLEP parents who perceive poor interpretation accuracy report more problems understanding information provided about their child's illness and care.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Carrasquillo O.
        • Orav E.J.
        • Brennan T.A.
        • Burstin H.R.
        Impact of language barriers on patient satisfaction in an emergency department.
        J Gen Intern Med. 1999; 14: 82-87
        • Weech-Maldonado R.
        • Morales L.S.
        • Spritzer K.
        • et al.
        Racial and ethnic differences in parents’ assessments of pediatric care in Medicaid managed care.
        Health Serv Res. 2001; 36: 575-594
        • Morales L.S.
        • Cunningham W.E.
        • Brown J.A.
        • et al.
        Are Latinos less satisfied with communication by health care providers?.
        J Gen Intern Med. 1999; 14: 409-417
        • David R.A.
        • Rhee M.
        The impact of language as a barrier to effective health care in an underserved urban Hispanic community.
        Mt Sinai J Med. 1998; 65: 393-397
        • Ngo-Metzger Q.
        • Sorkin D.H.
        • Phillips R.S.
        • et al.
        Providing high-quality care for limited English proficient patients: the importance of language concordance and interpreter use.
        J Gen Intern Med. 2007; 22: 324-330
        • Baker D.W.
        • Parker R.M.
        • Williams M.V.
        • et al.
        Use and effectiveness of interpreters in an emergency department.
        JAMA. 1996; 275: 783-788
        • Baker D.W.
        • Hayes R.
        • Fortier J.P.
        Interpreter use and satisfaction with interpersonal aspects of care for Spanish-speaking patients.
        Med Care. 1998; 36: 1461-1470
        • Bagchi A.D.
        • 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.
        Ann Emerg Med. 2011; 57: 248-256.e241–244
        • Garcia E.A.
        • Roy L.C.
        • Okada P.J.
        • et al.
        A comparison of the influence of hospital-trained, ad hoc, and telephone interpreters on perceived satisfaction of limited English-proficient parents presenting to a pediatric emergency department.
        Pediatr Emerg Care. 2004; 20: 373-378
        • Gany F.
        • Leng J.
        • Shapiro E.
        • et al.
        Patient satisfaction with different interpreting methods: a randomized controlled trial.
        J Gen Intern Med. 2007; 22: 312-318
        • Mazor S.S.
        • Hampers L.C.
        • Chande V.T.
        • Krug S.E.
        Teaching Spanish to pediatric emergency physicians: effects on patient satisfaction.
        Arch Pediatr Adolesc Med. 2002; 156: 693-695
        • Cunningham H.
        • Cushman L.F.
        • Akuete-Penn C.
        • Meyer D.D.
        Satisfaction with telephonic interpreters in pediatric care.
        J Natl Med Assoc. 2008; 100: 429-434
        • Jacobs E.A.
        • Sadowski L.S.
        • Rathouz P.J.
        The impact of an enhanced interpreter service intervention on hospital costs and patient satisfaction.
        J Gen Intern Med. 2007; 22: 306-311
        • Kuo D.
        • Fagan M.J.
        Satisfaction with methods of Spanish interpretation in an ambulatory care clinic.
        J Gen Intern Med. 1999; 14: 547-550
        • Lee L.J.
        • Batal H.A.
        • Maselli J.H.
        • Kutner J.S.
        Effect of Spanish interpretation method on patient satisfaction in an urban walk-in clinic.
        J Gen Intern Med. 2002; 17: 641-645
        • Halfon N.
        • Inkelas M.
        • Mistry R.
        • Olson L.M.
        Satisfaction with health care for young children.
        Pediatrics. 2004; 113: 1965-1972
        • Flores G.
        • Olson L.
        • Tomany-Korman S.C.
        Racial and ethnic disparities in early childhood health and health care.
        Pediatrics. 2005; 115: e183-e193
        • Clemans-Cope L.
        • Kenney G.
        Low income parents’ reports of communication problems with health care providers: effects of language and insurance.
        Public Health Rep. 2007; 122: 206-216
        • Lion K.C.
        • Thompson D.A.
        • Cowden J.D.
        • et al.
        Clinical Spanish use and language proficiency testing among pediatric residents.
        Acad Med. 2013; 88: 1478-1484
        • Flores G.
        Language barriers to health care in the United States.
        N Engl J Med. 2006; 355: 229-231
        • Ginde A.A.
        • Clark S.
        • Camargo Jr., C.A.
        Language barriers among patients in Boston emergency departments: use of medical interpreters after passage of interpreter legislation.
        J Immigr Minor Health. 2009; 11: 527-530
        • Ginde A.A.
        • Sullivan A.F.
        • Corel B.
        • et al.
        Reevaluation of the effect of mandatory interpreter legislation on use of professional interpreters for ED patients with language barriers.
        Patient Educ Couns. 2010; 81: 204-206
      1. Shin HB. Language use in the United States, 2007. Available at: http://www.census.gov/hhes/socdemo/language/. Accessed November 28, 2011.

      2. ALTA Language Services. Clinician cultural and linguistic assessment (CCLA). Available at: http://www.altalang.com/language-testing/ccla.aspx. Accessed July 10, 2013.

      3. Family Experience Survey. Available at: http://www.nrcpicker.com/products-solutions. Accessed November 23, 2012.

        • Co J.P.
        • Ferris T.G.
        • Marino B.L.
        • et al.
        Are hospital characteristics associated with parental views of pediatric inpatient care quality?.
        Pediatrics. 2003; 111: 308-314
        • Mack J.W.
        • Co J.P.
        • Goldmann D.A.
        • et al.
        Quality of health care for children: role of health and chronic illness in inpatient care experiences.
        Arch Pediatr Adolesc Med. 2007; 161: 828-834
      4. Lumley T, Kronmal R, Ma S. Relative risk regression in medical research: models, contrasts, estimators, and algorithms. UW Biostatistics Working Paper Series Working Paper 293. 2006. Available at: http://biostats.bepress.com/uwbiostat/paper293. Accessed January 11, 2012.

        • Sun B.C.
        • Adams J.
        • Orav E.J.
        • et al.
        Determinants of patient satisfaction and willingness to return with emergency care.
        Ann Emerg Med. 2000; 35: 426-434
        • Boudreaux E.D.
        • Friedman J.
        • Chansky M.E.
        • Baumann B.M.
        Emergency department patient satisfaction: examining the role of acuity.
        Acad Emerg Med. 2004; 11: 162-168
        • Wuerz R.C.
        • Travers D.
        • Gilboy N.
        • et al.
        Implementation and refinement of the emergency severity index.
        Acad Emerg Med. 2001; 8: 170-176
        • Durani Y.
        • Brecher D.
        • Walmsley D.
        • et al.
        The Emergency Severity Index, version 4: reliability in pediatric patients.
        Pediatr Emerg Care. 2009; 25: 751-753
        • Boudreaux E.D.
        • D’Autremont S.
        • Wood K.
        • Jones G.N.
        Predictors of emergency department patient satisfaction: stability over 17 months.
        Acad Emerg Med. 2004; 11: 51-58
        • Toma G.
        • Triner W.
        • McNutt L.A.
        Patient satisfaction as a function of emergency department previsit expectations.
        Ann Emerg Med. 2009; 54: 360-367.e366
        • Morales L.S.
        • Elliott M.N.
        • Weech-Maldonado R.
        • et al.
        Differences in CAHPS adult survey reports and ratings by race and ethnicity: an analysis of the National CAHPS benchmarking data 1.0.
        Health Serv Res. 2001; 36: 595-617
        • Kim M.
        • Zaslavsky A.M.
        • Cleary P.D.
        Adjusting Pediatric Consumer Assessment of Health Plans Study (CAHPS) scores to ensure fair comparison of health plan performances.
        Med Care. 2005; 43: 44-52
      5. National Emergency Department Overcrowding Score (NEDOCS). Available at: http://nedocs.org/. Accessed November 22, 2012.

        • Lion K.C.
        • Mangione-Smith R.
        • Martyn M.
        • et al.
        Comprehension on family-centered rounds for limited English proficient families.
        Acad Pediatr. 2013; 13: 236-242
        • Park C.Y.
        • Lee M.A.
        • Epstein A.J.
        Variation in emergency department wait times for children by race/ethnicity and payment source.
        Health Serv Res. 2009; 44: 2022-2039
        • Goldman R.D.
        • Amin P.
        • Macpherson A.
        Language and length of stay in the pediatric emergency department.
        Pediatr Emerg Care. 2006; 22: 640-643
        • Karliner L.S.
        • Perez-Stable E.J.
        • Gildengorin G.
        The language divide. The importance of training in the use of interpreters for outpatient practice.
        J Gen Intern Med. 2004; 19: 175-183
        • Beckett M.K.
        • Elliott M.N.
        • Richardson A.
        • Mangione-Smith R.
        Outpatient satisfaction: the role of nominal versus perceived communication.
        Health Serv Res. 2009; 44: 1735-1749