Hampers Louis C, McNulty Jennifer E
Section of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital, Denver, Colo 80218, USA.
Arch Pediatr Adolesc Med. 2002 Nov;156(11):1108-13. doi: 10.1001/archpedi.156.11.1108.
To determine the impact of interpreters and bilingual physicians on emergency department (ED) resource utilization.
Cohorts defined by language concordance and interpreter use were prospectively studied preceding and following the availability of dedicated, professional medical interpreters.
Pediatric ED in Chicago, Ill.
We examined 4146 visits of children (aged 2 months to 10 years) with a presenting temperature of 38.5 degrees C or higher or a complaint of vomiting or diarrhea; 550 families did not speak English. In 170 cases, the treating physician was bilingual. In 239, a professional interpreter was used. In the remaining 141, a professional medical interpreter was unavailable.
Incidence and costs of diagnostic testing, admission rate, use of intravenous hydration, and length of ED visit.
Regression models incorporated clinical and demographic factors. Compared with the English-speaking cohort, non-English-speaking cases with bilingual physicians had similar rates of resource utilization. Cases with an interpreter showed no difference in test costs, were least likely to be tested (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.56-0.97), more likely to be admitted (OR, 1.7; 95% CI, 1.1-2.8), and no more likely to receive intravenous fluids, but had longer lengths of visit (+16 minutes; 95% CI, 6.2-26 minutes). The barrier cohort without a professional interpreter had a higher incidence (OR, 1.5; 95% CI, 1.04-2.2) and cost (+$5.78; 95% CI, $0.24-$11.21) for testing and was most likely to be admitted (OR, 2.6; 95% CI, 1.4-4.5) and to receive intravenous hydration (OR, 2.2; 95% CI, 1.2-4.3), but showed no difference in length of visit.
Decision making was most cautious and expensive when non-English-speaking cases were treated in the absence of a bilingual physician or professional interpreter.
确定口译员和双语医生对急诊科（ED）资源利用的影响。
在配备专业医疗口译员之前和之后，对根据语言一致性和口译员使用情况定义的队列进行前瞻性研究。
伊利诺伊州芝加哥的儿科急诊科。
我们检查了4146名就诊儿童（年龄在2个月至10岁之间），其就诊时体温达到或高于38.5摄氏度，或主诉呕吐或腹泻；550个家庭不会说英语。其中170例中，主治医生为双语医生。239例中，使用了专业口译员。其余141例中，没有专业医疗口译员可用。
诊断检查的发生率和费用、住院率、静脉补液的使用情况以及急诊就诊时长。
回归模型纳入了临床和人口统计学因素。与说英语的队列相比，由双语医生诊治的非英语队列的资源利用率相似。使用口译员的病例在检查费用上没有差异，接受检查的可能性最小（优势比[OR]，0.73；95%置信区间[CI]，0.56 - 0.97），住院的可能性更大（OR，1.7；95% CI，1.1 - 2.8），接受静脉补液的可能性没有增加，但就诊时间更长（增加16分钟；95% CI，6.2 - 26分钟）。没有专业口译员的障碍队列检查的发生率更高（OR，1.5；95% CI，1.04 - 2.2）和费用更高（增加5.78美元；95% CI，0.24 - 11.21美元），住院的可能性最大（OR，2.6；95% CI，1.4 - 4.5），接受静脉补液的可能性也最大（OR，2.2；95% CI，1.2 - 4.3），但就诊时长没有差异。
在没有双语医生或专业口译员的情况下治疗非英语患者时，决策最为谨慎且成本最高。
