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APHA Scientific Session and Event Listing

Dennis Z. Kuo, MD, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 364, Baltimore, MD 21287, 410-614-0910, dkuo5@jhmi.edu, Karen G. O'Connor, Division of Health Services Research, American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove Village, IL 60007-1098, Glenn Flores, MD, Center for the Advancement of Underserved Children, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, and Cynthia S. Minkovitz, MD, MPP, Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E4636, Baltimore, MD 21205.

Research Objectives: Patients with LEP confront multiple barriers to health care access in the United States. Adequate language services are essential to providing high quality health care for children. Trained professional interpreters and bilingual providers are associated with improved quality of care for patients with LEP, but little is known about pediatricians' use of language services. The research objectives were to examine pediatricians' use of language services to patients with LEP and the physician, practice, and state characteristics associated with these services.

Study Design: Data were obtained from the Periodic Survey of Fellows #60, a nationally representative survey of American Academy of Pediatrics (AAP) members. 1,829 surveys were mailed and responses obtained from 58%. Use of six language services (bilingual physicians, bilingual staff, bilingual family members, professional interpreters, telephone interpreters, and translated written materials) was assessed. Multivariate analysis examined factors associated with each language service after adjusting for physician, practice, and state characteristics.

Principal Findings: Respondents report a mean of 13.4% (median=5.0%) of patients with LEP. Bilingual family members (70%) and bilingual staff (58%) are the most frequently reported language services. 40% of respondents use professional interpreters and 28% use telephone interpreters. Only 35% of practices provide translated written materials. Pediatricians in rural and solo/2-physician practices report higher use of family members and lower use of professional interpreters (p<.01). Family members are among the most frequently used method of interpretation regardless of LEP prevalence in states. In multivariate analysis, pediatricians in states with higher proportions of persons with LEP are more likely to use bilingual staff (OR 4.63; 95% CI 3.22, 6.67) but less likely to use professional interpreters (OR .46; 95% CI .31, .69). Pediatricians in states with Medicaid/SCHIP reimbursement for language services are more likely to use professional interpreters (OR 2.05; 95% CI 1.10, 3.83).

Conclusions: Almost three-quarters of US pediatricians use untrained family member interpreters to communicate with patients and families with LEP. Pediatricians in regions with the highest proportions of persons with LEP are least likely to provide appropriate language services. Provision of language services should be improved as part of ongoing efforts to improve quality of care; special attention is needed to providing translated written materials to patients and reducing the use of family members as interpreters. Medicaid/SCHIP reimbursement for professional language services may increase use of trained interpreters and quality of care for children and families with LEP.

Learning Objectives:

• To identify the different type of language services used by pediatricians
• To understand that public health insurance reimbursement for professional language services may increase use of trained interpreters and quality of care

Keywords: Barriers to Care, Underserved Populations

Presenting author's disclosure statement:

Any relevant financial relationships? No