Assessing Perspectives on Interpreter Services: Identifying Measures to include in a Model for Assessing the Cost-effectiveness of Interpreter Services

Background: The importance of interpreters in the delivery of health services has been established. While a number of studies have examined the relationship between delivery of interpreter services and health care quality, few have examined the costs and benefits of professional trained medical interpreters. To identify outcomes related to both the benefits and drawbacks of having an interpreter from a patient's perspective, we conducted a series of semi-structured interviews with diabetic patients, clinicians, administrators and clinical staff in a public hospital system. The results of the study were used to inform a cost-effectiveness model for interpreter services.

Methods: Semi-structured phone interviews were conducted with Limited English Proficiency (LEP) diabetic patients who were actively receiving care at a public hospital system in Massachusetts (n=18). Interviews were conducted in the Spanish, Haitian Creole and Portuguese by trained bilingual, bicultural community volunteers. Semi-structured interviews were also conducted with staff members (n=5), clinicians (n=5) and two hospital system leaders. Frequencies and means were calculated for quantitative data. Thematic analysis was conducted on qualitative data. Inter-rater reliability was tested using four members of the research team.

Results: Overall, patients who used interpreters reported being satisfied with the communication with their provider. They felt interpreters improved quality of care, increased their compliance with care, facilitated navigation of the health care system and helped them make better use of the time during their visit. Clinicians, staff and leaders also reported positive experiences with interpreters and felt that interpreters increase quality of care and provide valuable assistance with culture brokering, although concerns about potential for errors arose. In terms of disease management, this group of interviewees felt interpreters increase patient compliance and made them more productive and efficient. For all interviewees two issues consistently arose. One was the availability of interpreters and concerns about being rushed or wait times. The other concern was interpreting mode, with widespread preference for face-to-face interpreting over phone interpreting.

Conclusions: Based on these interviews, benefits of having an interpreter include increased compliance with medications, labs and medical visits, increased patient and clinician satisfaction and decrease in non-emergent emergency room utilization. Identified drawbacks of interpreter use include increased length of visit and potential for misinterpretation due to interpreter errors. As we develop our cost-effectiveness model, these issues will require attaching perceived benefits to actual costs. This will be done by examining clinical outcomes including lab results, compliance with preventive care, and emergency room utilization.