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Patient Safety/Quality

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Health plans take action to improve services for members with limited English proficiency

The quality of communication between patients and clinicians can have a significant impact on health outcomes, and limited English proficiency can interfere with effective communication. Over 10 million U.S. residents speak English poorly or not at all, constituting a language chasm in the health care system, according to researchers at AHRQ.

A team of researchers led by Cindy Brach, in AHRQ's Center for Delivery, Organization, and Markets, reviewed the research literature and found that language barriers have a demonstrable negative impact on access, quality, patient satisfaction, and in some instances, cost. Furthermore, the research demonstrates that language assistance—bilingual clinicians and interpreter services—is effective in improving care. To determine how health plans actually implement language assistance programs, the researchers identified and interviewed representatives of 14 health plans that are trailblazers in the area of linguistic competence.

Although each of the plans operated in somewhat different ways, most performed four critical functions: collecting member language data, recruiting and identifying bilingual staff and physicians, organizing and financing interpreter services, and educating members and physicians about interpreter services. The data collected suggest six priority activities for plans seeking to improve their linguistic competence:

  1. Develop a language assistance plan.
  2. Collect and use language data.
  3. Don't rely exclusively on physicians who historically have served populations with limited English proficiency.
  4. Educate physicians and hold them accountable.
  5. Recognize language assistance as an integral part of quality.
  6. Negotiate with purchasers.

The authors also gleaned lessons for purchasers, such as paying for interpreter services, making expectations explicit, and requiring reporting on language assistance. Policymakers can also play a role in crossing the language chasm through activities such as encouraging and supporting collection of language data and developing national measures and standards. Finally, the authors note that there are many unanswered questions about the impact of cultural and linguistic competence on health care delivery and health outcomes. They refer readers to Setting the Agenda for Research on Cultural Competence in Health Care, which was published by the Office of Minority Health and AHRQ in 2004.

For more details, see "Crossing the language chasm," by Cindy Brach, Irene Fraser, and Kathy Paez, in the March/April 2005 Health Affairs 24(2), pp. 424-434. Reprints (AHRQ Publication No. 05-R038) are available from the AHRQ Publications Clearinghouse.

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