MBA, University of Colorado School of Medicine, Section of Pediatric Emergency Medicine, 13123 E 16th Ave, B251, Aurora CO 80045, USA.
Pediatrics. 2010 Mar;125(3):e631-8. doi: 10.1542/peds.2009-0769. Epub 2010 Feb 22.
Language barriers affect health care interactions. Large, randomized studies of the relative efficacy of interpreter modalities have not been conducted.
To compare the efficacy of telephonic and in-person medical interpretation to visits with verified bilingual physicians.
This was a prospective, randomized trial. The setting was an urban pediatric emergency department at which approximately 20% of visits are by families with limited English proficiency. The participants were families who responded affirmatively when asked at triage if they would prefer to communicate in Spanish. Randomization of each visit was to (1) remote telephonic interpretation via a double handset in the examination room, (2) an in-person emergency department-dedicated medical interpreter, or (3) a verified bilingual physician. Interviews were conducted after each visit. The primary outcome was a blinded determination of concordance between the caregivers' description of their child's diagnosis with the physician's stated discharge diagnosis. Secondary outcomes were qualitative measures of effectiveness of communication and satisfaction. Verified bilingual providers were the gold standard for noninferiority comparisons.
A total of 1201 families were enrolled: 407 were randomly assigned to telephonic interpretation and 377 to in-person interpretation, and 417 were interviewed by a bilingual physician. Concordance between the diagnosis in the medical record and diagnosis reported by the family was not different between the 3 groups (telephonic: 95.1%; in-person: 95.5%; bilingual: 95.4%). The in-person-interpreter cohort scored the quality and satisfaction with their visit worse than both the bilingual and telephonic cohorts (P < .001). Those in the bilingual-provider cohort were less satisfied with their language service than those in the in-person and telephonic cohorts (P < .001). Using the bilingual provider as a gold standard, noninferiority was demonstrated for both interpreter modalities (telephonic and in-person) for quality and satisfaction of the visit.
Both telephonic and in-person interpretation resulted in similar concordance in understanding of discharge diagnosis compared with bilingual providers. In general, noninferiority was also seen on qualitative measures, although there was a trend favoring telephonic over in-person interpretation.
语言障碍会影响医疗保健互动。尚未进行过关于口译模式相对效果的大型随机研究。
比较电话口译和现场医学口译与经证实的双语医生就诊的效果。
这是一项前瞻性、随机试验。该研究地点是一家城市儿科急诊室，约有 20%的就诊者是英语水平有限的家庭。参与者是在分诊时回答愿意用西班牙语交流的家庭。每次就诊的随机分配为：（1）在检查室使用双听筒进行远程电话口译，（2）现场配备一名急诊部专用医学口译员，或（3）由经证实的双语医生就诊。每次就诊后进行访谈。主要结局是盲法确定护理人员对患儿诊断的描述与医生出院诊断之间的一致性。次要结局是沟通效果和满意度的定性测量。经证实的双语医生是进行非劣效性比较的金标准。
共纳入 1201 个家庭：407 个家庭被随机分配至电话口译组，377 个家庭被分配至现场口译组，417 个家庭由双语医生就诊。病历中的诊断与家庭报告的诊断之间的一致性在 3 组之间没有差异（电话口译组：95.1%；现场口译组：95.5%；双语医生组：95.4%）。现场口译组对就诊质量和满意度的评分低于双语和电话口译组（P <.001）。双语组对语言服务的满意度低于现场口译组和电话口译组（P <.001）。使用双语医生作为金标准，证明了电话口译和现场口译这两种口译模式在就诊质量和满意度方面都具有非劣效性。
与双语医生相比，电话口译和现场口译在理解出院诊断方面都具有相似的一致性。一般来说，虽然电话口译优于现场口译的趋势，但在定性测量上也看到了非劣效性。
