Study Overview
The overarching goal of this proposal was to evaluate the impact of a systems intervention to certify the proficiency of clinicians’ non-English language skills and simultaneously create easy access to professional interpreters through videoconferencing – the LASI initiative – on communication and clinical outcomes for LEP patients. We hypothesized that the LASI initiative would lead to fewer partial and non-concordant visits without professional interpreter use, better patient awareness and completion of clinician recommendations after a primary care visit, and improved clinical outcomes for patients with chronic conditions.
To test our hypotheses, we conducted a natural experiment (Aim 1 patient telephone interviews, Aim 2 electronic medical-record-based analysis) comparing interpreter utilization and effective communication as well as clinical outcomes before and after implementation of the LASI intervention. We complemented the first two aims with comparison of communication factors across English and non-English language-concordant and discordant-professionally interpreted visits (Aim 3 audio recordings). Finally, we conducted focus groups with patients and semi-structured interviews with clinicians to give context to our findings, and to gain understanding of the facilitators and barriers to LASI implementation (Aim 4). (Figure 1)
Figure 1. LASI Study Overview
Resources
- Patient-oriented results infographics (Spanish-English)
- Patient-oriented results infographics (Chinese-English)
- Final research report
Publications
- Kornbluth L, Kaplan CP, Diamond L, Karliner LS. Communication methods between outpatients with limited-English proficiency and ancillary staff: LASI study results. Patient Educ Couns. 2021 May 6:S0738-3991(21)00305-0. doi: 10.1016/j.pec.2021.05.001. Epub ahead of print. PMID: 34023171.
- Garcia ME, Hinton L, Gregorich SE, Livaudais-Toman J, Kaplan CP, Feldman M, Karliner L. Primary Care Physician Recognition and Documentation of Depressive Symptoms Among Chinese and Latinx Patients During Routine Visits: A Cross-Sectional Study. Health Equity. 2021 Apr 26;5(1):236-244. doi: 10.1089/heq.2020.0104. PMID: 33937610; PMCID: PMC8082035.
- Pathak S, Gregorich SE, Diamond LC, Mutha S, Seto E, Livaudais-Toman J, Karliner L. Patient Perspectives on the Quality of Professional Interpretation: Results from LASI Study. J Gen Intern Med. 2021 Aug;36(8):2386-2391. doi: 10.1007/s11606-020-06491-w. Epub 2021 Jan 29. PMID: 33515189; PMCID: PMC7845580.
- Nouri SS, Pathak S, Livaudais-Toman J, Gregorich SE, Kaplan CP, Diamond L, Karliner L. Use and Usefulness of After-Visit Summaries by Language and Health Literacy among Latinx and Chinese Primary Care Patients. J Health Commun. 2020 Aug 2;25(8):632-639. doi: 10.1080/10810730.2020.1833385. Epub 2020 Oct 15. PMID: 33059522; PMCID: PMC8362332.
- Roter DL, Gregorich SE, Diamond L, Livaudais-Toman J, Kaplan C, Pathak S, Karliner L. Loss of patient centeredness in interpreter-mediated primary care visits. Patient Educ Couns. 2020 Nov;103(11):2244-2251. doi: 10.1016/j.pec.2020.07.028. Epub 2020 Aug 10. PMID: 32819755; PMCID: PMC8454264.
- Garcia ME, Hinton L, Gregorich SE, Livaudais-Toman J, Kaplan C, Karliner L. Unmet Mental Health Need Among Chinese and Latino Primary Care Patients: Intersection of Ethnicity, Gender, and English Proficiency. J Gen Intern Med. 2020 Apr;35(4):1245-1251. doi: 10.1007/s11606-019-05483-9. Epub 2019 Oct 30. PMID: 31667737; PMCID: PMC7174511.
- Karliner LS, Gregorich SE, Mutha S, Kaplan C, Livaudais-Toman J, Pathak S, Garcia ME, Diamond L. Language Access Systems Improvement initiative: impact on professional interpreter utilisation, a natural experiment. BMJ Open. 2024 Jan 4;14(1):e073486. doi: 10.1136/bmjopen-2023-073486. PMID: 38176864; PMCID: PMC10773371.