Maxine Hall Health Center, San Francisco Department of Public Health, San Francisco, CA, 94115, USA.
J Immigr Minor Health. 2011 Apr;13(2):239-43. doi: 10.1007/s10903-010-9320-1.
As health systems strive to meet the needs of linguistically diverse patient populations, determining a physician's non-English language proficiency is becoming increasingly important. However, brief, validated measures are lacking. To determine if any of four self-reported measures of physician Spanish language proficiency are useful measures of fluency in Spanish. Physician self-report of Spanish proficiency was compared to Spanish-speaking patients' report of their physicians' language proficiency. 110 Spanish-speaking patients and their 46 physicians in two public hospital clinics with professional interpreters available. Physicians rated their Spanish fluency with four items: one general fluency question, two clinically specific questions, and one question on interpreter use. Patients were asked if their doctor speaks Spanish ("yes/no"). Concordance, sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated for each of the items, and receiver operating (ROC) curves were used to compare performance characteristics. Concordance between physician and patient reports of physician Spanish proficiency ranged from 84 to 91%. The PPV for each of the four items ranged from 91 to 99%, the NPV from 60 to 90%, and the area under their ROC curves from 90 to 95%. The general fluency question gave the best combination of PPV and NPV, and the item on holding sensitive discussions had the highest PPV, 99%. Physicians who reported fluency as "fair" were as likely to have patients report they did not speak Spanish as that they did. Physician self-report of Spanish language proficiency is highly correlated with patient report, except when physicians report "fair" general fluency. In settings where no financial or other incentives are linked to language skills, simple questions may be a useful way to assess physician language proficiency.
随着医疗体系努力满足语言多样化的患者群体的需求,确定医生的非英语语言能力变得越来越重要。然而,目前缺乏简短、经过验证的衡量标准。为了确定四种自我报告的医生西班牙语熟练度衡量标准中是否有任何一种可用于衡量西班牙语流利程度。比较了医生自我报告的西班牙语熟练度与西班牙语患者对医生语言熟练度的报告。在两家有专业口译员的公立医院诊所,共有 110 名讲西班牙语的患者和他们的 46 名医生参与。医生用四个项目评估他们的西班牙语流利程度:一个一般流利度问题、两个临床特定问题和一个关于口译员使用的问题。患者被问到他们的医生是否会说西班牙语(“是/否”)。为每个项目计算了一致性、敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV),并使用接收器操作(ROC)曲线比较了性能特征。医生和患者报告的医生西班牙语熟练度之间的一致性在 84%到 91%之间。四个项目的 PPV 范围在 91%到 99%之间,NPV 范围在 60%到 90%之间,ROC 曲线下的面积在 90%到 95%之间。一般流利度问题提供了最佳的 PPV 和 NPV 组合,关于进行敏感讨论的项目具有最高的 PPV,为 99%。报告“中等”流利度的医生与报告他们不会说西班牙语的患者比例与报告他们会说西班牙语的患者比例一样高。医生自我报告的西班牙语熟练度与患者报告高度相关,但当医生报告“中等”一般流利度时除外。在没有与语言技能相关的财务或其他激励措施的情况下,简单的问题可能是评估医生语言熟练度的一种有用方法。