Elizabeth A. Jacobs

Overcoming Language Barriers in Health Care: Costs and Benefits of Interpreter Services

OBJECTIVESnWe assessed the impact of interpreter services on the cost and the utilization of health care services among patients with limited English proficiency.nnnMETHODSnWe measured the change in delivery and cost of care provided to patients enrolled in a health maintenance organization before and after interpreter services were implemented.nnnRESULTSnCompared with English-speaking patients, patients who used the interpreter services received significantly more recommended preventive services, made more office visits, and had more prescriptions written and filled. The estimated cost of providing interpreter services was

Low rates of colorectal, cervical, and breast cancer screening in Asian Americans compared with non-Hispanic whites: Cultural influences or access to care?

279 per person per year.nnnCONCLUSIONSnProviding interpreter services is a financially viable method for enhancing delivery of health care to patients with limited English proficiency.

Understanding African Americans' Views of the Trustworthiness of Physicians

Asian Americans have lower cancer screening rates compared with non‐Hispanic whites (NHWs). Little is known about mechanisms that underlie disparities in cancer screening. The objectives of the current study were 1) to determine the relation between nativity, years in the United States, language, and cancer screening in NHWs and Asian Americans, independent of access to care and 2) to determine whether Asians reported different reasons than NHWs for not obtaining cancer screening.

Immigrant perceptions of discrimination in health care: the California Health Interview Survey 2003.

AbstractBACKGROUND: Many scholars have written about the historical underpinnings and likely consequences of African Americans distrust in health care, yet little research has been done to understand if and how this distrust affects African Americans’ current views of the trustworthiness of physicians.n OBJECTIVE: To better understand what trust and distrust in physicians means to African Americans.n DESIGN: Focus-group study, using an open-ended discussion guide.n SETTING: Large public hospital and community organization in Chicago, IL.n PATIENTS: Convenience sample of African-American adult men and women.n MEASUREMENTS: Each focus group was systematically coded using grounded theory analysis. The research team then identified themes that commonly arose across the 9 focus groups.n RESULTS: Participants indicated that trust is determined by the interpersonal and technical competence of physicians. Contributing factors to distrust in physicians include a lack of interpersonal and technical competence, perceived quest for profit and expectations of racism and experimentation during routine provision of health care. Trust appears to facilitate care-seeking behavior and promotes patient honesty and adherence. Distrust inhibits care-seeking, can result in a change in physician and may lead to nonadherence.n CONCLUSIONS: Unique factors contribute to trust and distrust in physicians among African-American patients. These factors should be considered in clinical practice to facilitate trust building and improve health care provided to African Americans.

Trust in Physicians and Racial Disparities in HIV Care

Background:U.S. healthcare disparities may be in part the result of differential experiences of discrimination in health care. Previous research about discrimination has focused on race/ethnicity. Because immigrants are clustered in certain racial and ethnic groups, failure to consider immigration status could distort race/ethnicity effects. Objectives:We examined whether foreign-born persons are more likely to report discrimination in healthcare than U.S.-born persons in the same race/ethnic group, whether the immigration effect varies by race/ethnicity, and whether the immigration effect is “explained” by sociodemographic factors. Research Design:The authors conducted a cross-sectional analysis of the 2003 California Health Interview Survey consisting of 42,044 adult respondents. Logistic regression models use replicate weights to adjust for nonresponse and complex survey design. Outcome Measure:The outcome measure of this study was respondent reports that there was a time when they would have gotten better medical care if they had belonged to a different race or ethnic group. Results:Seven percent of blacks and Latinos and 4% of Asians reported healthcare discrimination within the past 5 years. Immigrants were more likely to report discrimination than U.S.-born persons adjusting for race/ethnicity. For Asians, only the foreign-born were more likely than whites to report discrimination. For Latinos, increased perceptions of discrimination were attributable to sociodemographic factors for the U.S.-born but not for the foreign-born. Speaking a language other than English at home increased discrimination reports regardless of birthplace; private insurance was protective for the U.S.-born only. Conclusions:Immigration status should be included in studies of healthcare disparities because nativity is a key determinant of discrimination experiences for Asians and Latinos.

The Impact of an Enhanced Interpreter Service Intervention on Hospital Costs and Patient Satisfaction

Mistrust among African Americans is often considered a potential source of racial disparities in HIV care. We sought to determine whether greater trust in ones provider among African-American patients mitigates racial disparities. We analyzed data from 1,104 African-American and 201 white patients participating in a cohort study at an urban, academic HIV clinic between 2005 and 2008. African Americans expressed lower levels of trust in their providers than did white patients (8.9 vs. 9.4 on a 0-10 scale; p < 0.001). African Americans were also less likely than whites to be receiving antiretroviral therapy (ART) when eligible (85% vs. 92%; p = 0.02), to report complete ART adherence over the prior 3 days (83% vs. 89%; p = 0.005), and to have a suppressed viral load (40% vs. 47%; p = 0.04). Trust in ones provider was not associated with receiving ART or with viral suppression but was significantly associated with adherence. African Americans who expressed less than complete trust in their providers (0-9 of 10) had lower ART adherence than did whites (adjusted OR, 0.40; 95% CI, 0.25-0.66). For African Americans who expressed complete trust in their providers (10 of 10), the racial disparity in adherence was less prominent but still substantial (adjusted OR, 0.59; 95% CI, 0.36-0.95). Trust did not affect disparities in receipt of ART or viral suppression. Our findings suggest that enhancing trust in patient-provider relationships for African-American patients may help reduce disparities in ART adherence and the outcomes associated with improved adherence.

Association Between Neighborhood Context and Smoking Prevalence Among Asian Americans

BACKGROUNDMany health care providers do not provide adequate language access services for their patients who are limited English-speaking because they view the costs of these services as prohibitive. However, little is known about the costs they might bear because of unaddressed language barriers or the costs of providing language access services.OBJECTIVETo investigate how language barriers and the provision of enhanced interpreter services impact the costs of a hospital stay.DESIGNProspective intervention study.SETTINGPublic hospital inpatient medicine service.PARTICIPANTSThree hundred twenty-three adult inpatients: 124 Spanish-speakers whose physicians had access to the enhanced interpreter intervention, 99 Spanish-speakers whose physicians only had access to usual interpreter services, and 100 English-speakers matched to Spanish-speaking participants on age, gender, and admission firm.MEASUREMENTSPatient satisfaction, hospital length of stay, number of inpatient consultations and radiology tests conducted in the hospital, adherence with follow-up appointments, use of emergency department (ED) services and hospitalizations in the 3xa0months after discharge, and the costs associated with provision of the intervention and any resulting change in health care utilization.RESULTSThe enhanced interpreter service intervention did not significantly impact any of the measured outcomes or their associated costs. The cost of the enhanced interpreter service was

The importance of teaching clinicians when and how to work with interpreters

234 per Spanish-speaking intervention patient and represented 1.5% of the average hospital cost. Having a Spanish-speaking attending physician significantly increased Spanish-speaking patient satisfaction with physician, overall hospital experience, and reduced ED visits, thereby reducing costs by

African American Physicians and Organized Medicine, 1846-1968: Origins of a Racial Divide

92 per Spanish-speaking patient over the study period.CONCLUSIONThe enhanced interpreter service intervention did not significantly increase or decrease hospital costs. Physician–patient language concordance reduced return ED visit and costs. Health care providers need to examine all the cost implications of different language access services before they deem them too costly.

Caring for Patients with Limited English Proficiency: The Perspectives of Small Group Practitioners

OBJECTIVESnTo study neighborhood-level determinants of smoking among Asian Americans, we examined 3 neighborhood factors (ethnic enclave, socioeconomics, and perceived social cohesion) and smoking prevalence in a population-based sample.nnnMETHODSnWe linked data from the 2003 California Health Interview Survey to tract-level data from the 2000 Census. We used multivariate logistic regression models to estimate the associations between smoking and neighborhood-level factors, independent of individual factors.nnnRESULTSnTwenty-two percent of 1693 Asian men and 6% of 2174 Asian women reported current smoking. Women living in an Asian enclave were less likely to smoke (adjusted odds ratio [AOR] = 0.27; 95% confidence interval [CI] = 0.08, 0.88). Among men, higher levels of perceived neighborhood social cohesion were associated with lower odds of smoking (AOR = 0.74; 95% CI = 0.61, 0.91).nnnCONCLUSIONSnThe association between contextual factors and smoking differed for men and women. For women, living in an Asian enclave may represent cultural behavioral norms. For men, neighborhood trust and cohesiveness may buffer stress. Smoking prevention and cessation interventions among Asian Americans may be more effective if they address contextual factors.