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Inaccurate Language Interpretation and Its Clinical Significance in the Medical Encounters of Spanish-speaking Latinos

Nápoles, Anna M. PhD, MPH; Santoyo-Olsson, Jasmine MS; Karliner, Leah S. MD, MAS; Gregorich, Steven E. PhD; Pérez-Stable, Eliseo J. MD

doi: 10.1097/MLR.0000000000000422
Original Articles
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Background: Limited English-proficient patients suffer poorer quality of care and outcomes. Interpreters can ameliorate these disparities; however, evidence is lacking on the quality of different interpretation modes.

Objective: Compare accuracy of interpretation for in-person (IP) professional, professional videoconferencing (VC), and ad hoc (AH) interpretation.

Design: A cross-sectional study of transcribed audiotaped primary care visits.

Subjects: Subjects included 32 Spanish-speaking Latino patients and 14 clinicians.

Measures: Independent coding of transcripts by 4 coders (2 were internists) for accurate and inaccurate interpretation instances. Unit of analysis was a segment of continuous speech or text unit (TU). Two internists independently verified inaccurate interpretation instances and rated their clinical significance as clinically insignificant, mildly, moderately, or highly clinically significant.

Results: Accurate interpretation made up 70% of total coded TUs and inaccurate interpretation (errors) made up 30%. Inaccurate interpretation occurred at twice the rate for AH (54% of coded TUs) versus IP (25%) and VC (23%) interpretation, due to more errors of omission (P<0.001) and answers for patient or clinician (P<0.001). Mean number of errors per visit was 27, with 7.1% of errors rated as moderately/highly clinically significant. In adjusted models, the odds of inaccurate interpretation were lower for IP (OR=0.25, 95% CI, 0.19, 0.33) and VC (OR=0.31; 95% CI, 0.17, 0.56) than for AH interpreted visits; the odds of a moderately/highly clinically significant error were lower for IP (OR=0.25; 95% CI, 0.06, 0.99) than for AH interpreted visits.

Conclusions: Inaccurate language interpretation in medical encounters is common and more frequent when untrained interpreters are used compared with professional IP or through VC. Professional VC interpretation may increase access to higher quality medical interpretation services.

Department of Medicine, Division of General Internal Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California San Francisco (UCSF), San Francisco, CA

Supported by the California Endowment (grant number 20061003) and the Resource Centers for Minority Aging Research program of the National Institute on Aging (grant number P30 AG15272).

The authors declare no conflict of interest.

Reprints: Eliseo J. Pérez-Stable, MD, Department of Medicine, Division of General Internal Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California San Francisco (UCSF), 1545 Divisadero Street, P.O. Box 0320, San Francisco, CA 94143-0320. E-mail: eliseo.perez-stable@ucsf.edu.

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