Many pediatricians underuse interpreters to improve care of children, families with limited English

Findings highlight need for national reimbursement for language services

U.S. pediatricians are not using trained language interpreters as often as they should, despite evidence that such services are vital to improving the care of children and families with limited English, according to findings from research conducted jointly by the Johns Hopkins Children's Center and the American Academy of Pediatrics.

Using data from two national surveys of pediatricians caring for patients with limited English proficiency, the researchers compared differences in pediatricians’ use of language services from 2004 to 2010.

The study’s findings, published online July 8 in the journal Pediatrics, reveal that most (57 percent) pediatricians still report using family members to communicate with patients and their families, which previous studies have shown can lead to miscommunication and errors that compromise healthcare quality and patient safety.

“We found only small improvements in pediatricians’ use of language services over a six-year period,” says Johns Hopkins pediatrician Lisa DeCamp, M.D., lead investigator on the study. “Pediatricians continue to rely on the use of suboptimal communication methods, such as family members.”

These studies show improved communication, patient satisfaction and health care outcomes, as well as fewer interpretation errors, when patients with limited English have access to bilingual providers or trained professional interpreters.

“Family members are not preferred because we don’t know their skill level, and they are prone to make more errors in actual translation of the information, or they may censor information either from the patient or the provider because of their relationship with the patient,” DeCamp says.

DeCamp says previous research has affirmed that children from families with limited English are less likely to have health insurance, access to preventive health care and optimal communication between their parents and clinicians.

Also, past research shows, they tend to have lower parental care satisfaction and are more likely to experience adverse hospital events. Such factors point to a critical need for pediatricians’ use of language services like bilingual physicians and formally trained interpreters.

Interestingly, DeCamp says, she and fellow researchers found that pediatricians in states that offer reimbursement for language services were more than twice as likely to use those services as pediatricians in states that do not. While federal regulators mandate that health care organizations receiving federal funding provide meaningful access to language services, most do not meet this standard, the researchers say.

“Our findings suggest the need for policy change to support pediatricians’ use of appropriate language services,” says DeCamp. “National third-party reimbursement for language services may be one mechanism to increase formal interpreter use.”

Without such an accommodation, DeCamp explains, parents with limited or no English are more likely to misunderstand a physician’s instructions or the medication dosage being prescribed, a miscommunication that can be dangerous and, at times, even fatal.

“If the physician says give acetaminophen every four to six hours as needed for fever, but the parents hear ‘give it every two to three hours,’ and instead of 5 milliliters they give 15 milliliters, then that could pose a health hazard for the child,” DeCamp says. “Or if the doctor says take your child to the ED immediately and the parents misinterpret the orders and do it later, the child may not get the treatment he needs at the time he needs it.”

An estimated 25 million people in the United States speak English less than “very well” and thus are classified as having limited English proficiency. Pediatricians increasingly encounter such patients in their practices. Since 2004, the number of people with limited English in the United States has increased by 3 million people, with rapid growth among Latino populations in the Southeast and Midwest, DeCamp notes.