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  • Measure Summary
  • NQMC:005613
  • Aug 2009

Language services: the percent of clinical encounters where interpreters wait less than 15 minutes to provide interpreter services to provider and patient.

Robert Wood Johnson Foundation. Aligning forces for quality. Language services performance measures implementation guide, version 1.1. Washington (DC): George Washington University; 2009 Aug. 84 p.

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in December 2015.

Measure Hierarchy

Language Services Performance Measures

Age Group

UMLS Concepts (what is this?)

SNOMEDCT_US
English language (297487008), Interpreter (40570005), Interpreter present (314431000), Language interpreter (308005007), Need for interpreter (315593009), Need for interpreter (315594003), Presence of interpreter (314430004), Translator/interpreter (265941001)

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Clinical Quality Measure: Access

Description

This measure is used to assess the percent of clinical encounters where interpreters wait less than 15 minutes to provide interpreter services to provider and patient.

Rationale

Interpreters are frequently in high demand at hospitals providing care to diverse patient populations, and as a result, must closely monitor their time spent in non-interpretation activities. Interpreter services staff must work with provider and clinic staff to ensure successful coordination of provider's schedules with interpreter schedules. This measure provides information on the extent to which interpreters spend time waiting to provide interpreter services for a provider and patient, creating delays for other interpreter services encounters and diminishing productivity.

Evidence for Rationale

Robert Wood Johnson Foundation. Aligning forces for quality. Language services performance measures implementation guide, version 1.1. Washington (DC): George Washington University; 2009 Aug. 84 p.

Primary Health Components

Limited English proficiency (LEP); interpreter services; wait time

Denominator Description

The total number of interpreter encounters (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

The number of interpreter encounters in which the interpreter waits less than 15 minutes to begin interpreting (see the related Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences

Additional Information Supporting Need for the Measure

  • 22.3 million U.S. residents (8.4%) have limited English proficiency (LEP).
  • Between 1990 and 2000, the number with LEP grew by 53%.
  • 80% of hospitals reported treating LEP patients on a regular basis.
  • Hispanics who do not speak English at home are less likely to receive all recommended health care services.
  • Follow-up compliance, adherence to medications, and patient satisfaction are significantly lower for LEP populations than they are for English speaking patients.
  • Language barriers are associated with less health education, worse interpersonal care, and lower patient satisfaction.
  • LEP populations are less likely to receive preventative health services such as mammograms.
  • Long waits delay diagnosis and treatment adding to emotional distress and physical harm may result. Waiting times should be reduced for both patients and those who give care. Delays suggest care is not designed with the welfare of the patient at the center.
  • Persons with LEP experience disproportionately high rates of infectious disease and infant mortality.
  • Persons with LEP are more likely to report risk factors for serious and chronic diseases such as diabetes and heart disease.
  • Physicians who are unable to communicate effectively with their patients often compensate by engaging in costly practices such as: more diagnostic procedures; more invasive procedures; overprescribing medications.
  • Language barrier between physicians and their patients are associated with a $38 increase in test charges and 20-minute longer emergency department (ED) stay.
  • ED decision making behavior (e.g., diagnostic testing, admission, IV hydration) is more costly when non-English speaking patients did not receive care from bilingual physician or with an interpreter present.
  • The average cost per interpretation for health maintenance organizations (HMOs) patients was $79 and the total cost per year was $279, a relatively small cost given total medical expenditures, and given improved patient utilization of preventive and primary care services that may reduce long-term medical costs.

Evidence for Additional Information Supporting Need for the Measure

Andrulis D, Goodman N, Pryor N. What a difference an interpreter can make: health care experiences of uninsured with limited English proficiency. The Access Project; 2003 Apr.

Cheng EM, Chen A, Cunningham W. Primary language and receipt of recommended health care among Hispanics in the United States. J Gen Intern Med. 2007 Nov;22 Suppl 2:283-8. PubMed External Web Site Policy

David RA, Rhee M. The impact of language as a barrier to effective health care in an underserved urban Hispanic community. Mt Sinai J Med. 1998 Oct-Nov;65(5-6):393-7. PubMed External Web Site Policy

Flores G. Language barriers to health care in the United States. N Engl J Med. 2006 Jul 20;355(3):229-31. PubMed External Web Site Policy

Hampers LC, Cha S, Gutglass DJ, Binns HJ, Krug SE. Language barriers and resource utilization in a pediatric emergency department. Pediatrics. 1999 Jun;103(6 Pt 1):1253-6. PubMed External Web Site Policy

Hampers LC, McNulty JE. Professional interpreters and bilingual physicians in a pediatric emergency department: effect on resource utilization. Arch Pediatr Adolesc Med. 2002 Nov;156(11):1108-13. PubMed External Web Site Policy

Hasnain-Wynia RJ, Yonek R, Pierce D, Kang GC. Hospital language services for patients with limited English proficiency: results from a national survey. The Commonwealth Fund; 2006 Oct.

Institute of Medicine (IOM), Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington (DC): National Academy Press; 2001. 360 p.

Jacobs EA, Shepard DS, Suaya JA, Stone EL. Overcoming language barriers in health care: costs and benefits of interpreter services. Am J Public Health. 2004 May;94(5):866-9. PubMed External Web Site Policy

Ku L, Flores G. Pay now or pay later: providing interpreter services in health care. Health Aff (Millwood). 2005 Mar-Apr;24(2):435-44. PubMed External Web Site Policy

Ku L, Waidmann T. How race/ethnicity, immigration status and language affect health insurance coverage, access to care and quality of care among the low-income population. Washington (DC): Kaiser Commission on Medicaid and the Uninsured; 2003 Aug. 29 p.

Ngo-Metzger Q, Sorkin DH, Phillips RS, Greenfield S, Massagli MP, Clarridge B, Kaplan SH. Providing high-quality care for limited English proficient patients: the importance of language concordance and interpreter use. J Gen Intern Med. 2007 Nov;22 Suppl 2:324-30. PubMed External Web Site Policy

Office of Minority Health and Health Disparities. Eliminating racial and ethnic disparities.

U.S. Bureau of the Census. American Community Survey: language spoken at home (table S1601). 2005.

Woloshin S, Schwartz LM, Katz SJ, Welch HG. Is language a barrier to the use of preventive services. J Gen Intern Med. 1997 Aug;12(8):472-7. PubMed External Web Site Policy

Extent of Measure Testing

The measure was pilot tested in one inpatient and in one outpatient care setting in two (2) large metropolitan hospitals October 2006.

The measure was used by the 10 grantee hospitals in the Speaking Together National Language Services Collaborative from November 2006 - May 2008. Ten (10) hospitals reported data monthly on 40,000 - 60,000 patients seen in inpatient and ambulatory care settings. Hospitals ranged in size from 11,500 - 44,000 admissions, included 2 children's hospitals and were comprised of both academic teaching and non-teaching community hospitals.

The measures specifications were revised based on the learning from the Speaking Together Collaborative and input from the participating hospitals.

Refer to original measure documentation for additional information.

Evidence for Extent of Measure Testing

Robert Wood Johnson Foundation. Aligning forces for quality. Language services performance measures implementation guide, version 1.1. Washington (DC): George Washington University; 2009 Aug. 84 p.

State of Use

Current routine use

Current Use

Collaborative inter-organizational quality improvement

Decision-making by managers about resource allocation

Internal quality improvement

Monitoring and planning

Quality of care research

Measurement Setting

Ambulatory/Office-based Care

Hospital Inpatient

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Does not apply to this measure (e.g., measure is not provider specific)

Least Aggregated Level of Services Delivery Addressed

Clinical Practice or Public Health Sites

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

All ages

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

Staying Healthy

IOM Domain

Effectiveness

Timeliness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Encounter

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
The total number of interpreter encounters provided by:

  • On-site interpreter encounters with hospital operated interpreters, and on-site contract and/or agency interpreters
  • Encounters with hospital operated telephone interpreting and hospital operated video interpreters
  • Scheduled and unscheduled interpreter encounters

Note: Stratified by language.

Exclusions

  • Encounters with bilingual providers and other bilingual hospital workers/employees
  • Outside vendor telephone interpreting and outside vendor video interpreting

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
The number of interpreter encounters in which the interpreter waits less than 15 minutes to being interpreting, for encounters provided by:

  • On-site interpreter encounters with hospital operated interpreters, and on-site contract and/or agency interpreters
  • Encounters with hospital operated telephone interpreting and hospital operated video interpreters
  • Scheduled and unscheduled interpreter encounters

Note: Stratified by language.

Exclusions

  • Any interpreter encounter where interpreter waits more than 15 minutes to begin interpreting
  • Encounters with bilingual providers and/or other bilingual hospital workers/employees
  • Outside vendor telephone interpreting and outside vendor video interpreting

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Analysis by high-risk subgroup (stratification by vulnerable populations)

Description of Allowance for Patient or Population Factors

Data reported as aggregate numerator and denominator, monthly, stratified by language.

Interpreter encounters for non-English speaking populations can be stratified by language so that organizations can identify language resource needs for effective planning.

Standard of Comparison

Internal time comparison

Original Title

L4: interpreter wait time to deliver interpreter services.

Measure Collection Name

Language Services Performance Measures

Submitter

Center for Health Care Quality, Department of Health Policy, George Washington University School of Public Health and Health Services - Academic Affiliated Research Institute

Developer

Center for Health Care Quality, Department of Health Policy, George Washington University School of Public Health and Health Services - Academic Affiliated Research Institute

Funding Source(s)

Robert Wood Johnson Foundation

Composition of the Group that Developed the Measure

Marsha Regenstein, PhD, MCP - Research Professor, Department of Health Policy Co-Director, Center for Health Care Quality, The George Washington University

Jennifer Huang, MS - Research Scientist, Center for Health Care Quality, The George Washington University

Holly Mead, PhD - Assistant Research Professor, Center for Health Care Quality, The George Washington University

Jennifer Trott, MPH - Research Associate, Center for Health Care Quality, The George Washington University

Catherine West, MS, RN - Senior Research Scientist, Center for Health Care Quality, The George Washington University

Wilma Alvarado-Little - Co-Chair, National Council on Interpreting in Health Care Board Program Manager Center for the Elimination of Minority Health Disparities, University at Albany, SUNY Albany, NY

Oscar Arocha, MM - Director of Interpreter Services, Department and Guest Support Services, Boston Medical Center, Boston, MA

Rochelle Ayala, MD - Administrator and Chief Medical Officer for Primary Care Services, Memorial Healthcare System. Hollywood, FL

Sang-ick Chang, MD - Vice President and Medical Director of Ambulatory Services, San Mateo Medical Center, San Mateo, CA

Lou Hampers, MD, MPH - The Children's Hospital Denver. Denver, CO

Anita Hunt - Director Guest Services/Performance Improvements Regional Medical Center at Memphis, Memphis, TN

Matt Wynia, MD, MPH - Director, The Institute for Ethics American Medical Association

Wendy Jameson - Director, California Health Care Safety Net Institute, Oakland, CA

Bret A. McFarlin, DO - Director, Internal Medicine Broadlawns Medical Center, Des Moines, IA

Gloria Garcia Orme, RN, MS - Director, Patient Relations, San Francisco General Hospital, San Francisco, CA

Melinda Paras - CEO, Paras and Associates, Albany, CA

Martine Pierre-Louis, MPH - Director, Community and Patient Access Services, Harborview Medical Center, Seattle, WA

Angelique Ramirez, MD - Medical Director, Community Oriented Primary Care, Parkland Health & Hospital System, Dallas, TX

Cynthia Roat - Quality Assurance Specialist Board Co-Chair, National Council on Interpreting in Health Care

Bruce Siegel, MD, MPH - Director, Center for Health Care Quality, The George Washington University, School of Public Health and Health Services

Richard A. Wright, MD, MPH, FACPE - Management Consultant, Wright Consulting

Bret A. McFarlin, DO - Director, Internal Medicine, Broadlawns Medical Center

Gloria Garcia Orme, RN, MS - Director, Patient Relations, San Francisco General Hospital

Boston Medical Center

Children's Hospital of Phildelphia

Maribet McCarty, PhD, RN - Director, Measurement and Data, Regions Hospital

Sidney Van Dyke, MA - Manager, Interpreter Services, Regions Hospital

Loretta Saint-Louis, PhD - Multilingual Quality Specialist, Cambridge Health Alliance

Sarah Rafton, MSW - Center for Diversity, Children's Hospital & Regional Medical Center

Kathy Miraglia, MS - Manager, Interpreter Services, University of Rochester Medical Center

Sally Moffat, RN - Director, Community Outreach and Language Services, Phoenix Children's Hospital

Dena Brownstein, MD - Associate Medical Director, Patient Safety, Seattle Children's Hospital

Financial Disclosures/Other Potential Conflicts of Interest

No disclosures.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2009 Aug

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in December 2015.

Source(s)

Robert Wood Johnson Foundation. Aligning forces for quality. Language services performance measures implementation guide, version 1.1. Washington (DC): George Washington University; 2009 Aug. 84 p.

Measure Availability

Source not available electronically.

For more information, contact Marsha Regenstein, PhD, Professor at the Milken Institute School of Public Health, George Washington University School of Public Health and Health Services, 950 New Hampshire Avenue, Suite 212, Washington, DC 20052; Telephone: 202-994-8662; Fax: 202-994-3500; E-mail: marshar@gwu.edu.

NQMC Status

This NQMC summary was completed by ECRI Institute on May 17, 2010. The information was verified by the measure developer on July 2, 2010.

This NQMC summary was retrofitted into the new template on July 29, 2011.

The information was reaffirmed by the measure developer on December 22, 2015.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

For additional information regarding the use of these measures, contact Catherine West at Cathy.West@gwumc.edu.

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