Improving Outcomes for Spanish-Speaking Surgical Patients with Limited English Proficiency

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Project Summary In 2018, nearly 67 million people in the US spoke a language other than English at home and, among them, 40% met criteria for limited English proficiency (LEP). People with LEP are at higher risk of adverse events during medical care. In fact, 1 in 12 patients is at risk for adverse events because of barriers created by language discordance, which occurs when the patient and provider do not share a common spoken language. Surgical disparities have been studied in various disciplines, but very few studies have focused on the impact of language. Understanding the impact that language and language discordance or concordance have on surgical outcomes represents a vital component of providing effective, high-quality patient care. Our overall objective is to improve outcomes for surgical patients with LEP. The central hypothesis is that socioeconomic and sociodemographic factors impact outcomes of surgical care for patients with LEP and that identifying those factors through quantitative and qualitative research rooted in a social ecological model (SEM) will provide an opportunity to design interventions that address these risk factors and reduce surgical disparities. Building on a deeper understanding of patient experiences and social risk factors, this project will test the use of a mobile technology for live medical interpretation provided directly to patients. We seek to determine if such a solution can improve communication and promote patient-initiated language concordant encounters, thereby leading to better surgical outcomes. While some research suggests the effects of language discordance may be mitigated by the use of trained interpreters, qualified interpreters are not reliably used for all patients with LEP, even at resource-rich health centers. These barriers threaten to compromise the provision of equitable and patient-centered care for this patient population. To that extent, we will test our central hypothesis by pursing three specific aims: (1) Determine whether language concordance is associated with surgical outcomes in a large retrospective surgical patient cohort; (2) Identify the social factors that influence the use of formal interpreter services to treat primary Spanish-speaking surgical patients with LEP; and (3) Evaluate if an immediate interpreter mobile application enables language concordant communication for primary Spanish-speaking patients with LEP. Likewise, studying the complex interaction of structural, interpersonal, and individual factors will enrich our understanding of the impact of language across the continuum of surgical care. The research proposed in this application is innovative because no one has sought to elucidate precisely how LEP may influence surgical outcomes and nor have they applied the SEM in an attempt to have a profound impact for vulnerable populations. Also, by providing the mobile interpretation application directly to patients (in addition to surgeons and nurses), we hope to empower patients with LEP to serve as drivers of their care and improve the patient-centeredness of their care. Ultimately, the findings of this study could be applied to other fields of medicine and patient populations to improve the care of millions of patients by mitigating language and communication barriers to reduce health inequities.