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Improving the Provision of Language Services at an Academic Medical Center: Ensuring High-Quality Health Communication for Limited-English-Proficient Patients

Standiford, Connie J. MD; Nolan, Elizabeth RN; Harris, Michelle MA; Bernstein, Steven J. MD, MPH

doi: 10.1097/ACM.0b013e3181bf4659
Quality and Safety

Purpose To evaluate and improve the provision of language services at an academic medicine center caring for a diverse population including many limited-English-proficient (LEP) patients.

Method The authors performed a prospective observational study between November 2006 and December 2008 evaluating the provision of language services at the University of Michigan Health System. The primary performance measures were (1) screening patients for their preferred language for health care, (2) assessing the proportion of LEP patients receiving language services from a qualified language services provider, and (3) assessing whether there were any disparities in diabetes care for LEP patients compared with English-speaking patients.

Results The proportion of patients screened for preferred language increased from 59% to 96% with targeted inventions, such as training staff to capture preferred language for health care and correcting prior inaccurate primary language data entry. The proportion of LEP outpatients with a qualified language services provider increased from 19% to 83% through the use of staff and contract interpreters, over-the-phone interpreting and bilingual providers. There were no systematic differences in diabetes quality performance measures between LEP and English-proficient patients.

Conclusions Academic medical centers should measure their provision of language services and compare quality and safety data (e.g., performance measures and adverse events) between LEP and English-speaking patients to identify disparities in care. Leadership support and ongoing training are needed to ensure language-specific services are embedded into clinical care to meet the needs of our diverse patient populations.

Dr. Standiford is associate professor, Department of Internal Medicine, and associate medical director of ambulatory care services, University of Michigan, Ann Arbor, Michigan.

Ms. Nolan is director, Patient Education Resource Center, Cardiovascular Center, University of Michigan Hospitals and Health Centers, Ann Arbor, Michigan.

Ms. Harris is director, Interpreter Services, University of Michigan Hospitals and Health Centers, Ann Arbor, Michigan.

Dr. Bernstein is professor, Department of Internal Medicine, University of Michigan, and research scientist, Center for Clinical Practice Management, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.

Correspondence should be addressed to Dr. Standiford, Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, 2600 Green Road, Suite 150, Ann Arbor, MI 48105; telephone: (734) 763-0174; fax: (734) 647-3273; e-mail: (

© 2009 Association of American Medical Colleges