西班牙语裔拉丁裔医疗接触中不准确的语言口译及其临床意义
Inaccurate Language Interpretation and Its Clinical Significance in the Medical Encounters of Spanish-speaking Latinos.
作者信息
Nápoles Anna M, Santoyo-Olsson Jasmine, Karliner Leah S, Gregorich Steven E, Pérez-Stable Eliseo J
机构信息
Department of Medicine, Division of General Internal Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California San Francisco (UCSF), San Francisco, CA.
出版信息
Med Care. 2015 Nov;53(11):940-7. doi: 10.1097/MLR.0000000000000422.
BACKGROUND
Limited English-proficient patients suffer poorer quality of care and outcomes. Interpreters can ameliorate these disparities; however, evidence is lacking on the quality of different interpretation modes.
OBJECTIVE
Compare accuracy of interpretation for in-person (IP) professional, professional videoconferencing (VC), and ad hoc (AH) interpretation.
DESIGN
A cross-sectional study of transcribed audiotaped primary care visits.
SUBJECTS
Subjects included 32 Spanish-speaking Latino patients and 14 clinicians.
MEASURES
Independent coding of transcripts by 4 coders (2 were internists) for accurate and inaccurate interpretation instances. Unit of analysis was a segment of continuous speech or text unit (TU). Two internists independently verified inaccurate interpretation instances and rated their clinical significance as clinically insignificant, mildly, moderately, or highly clinically significant.
RESULTS
Accurate interpretation made up 70% of total coded TUs and inaccurate interpretation (errors) made up 30%. Inaccurate interpretation occurred at twice the rate for AH (54% of coded TUs) versus IP (25%) and VC (23%) interpretation, due to more errors of omission (P<0.001) and answers for patient or clinician (P<0.001). Mean number of errors per visit was 27, with 7.1% of errors rated as moderately/highly clinically significant. In adjusted models, the odds of inaccurate interpretation were lower for IP (OR=0.25, 95% CI, 0.19, 0.33) and VC (OR=0.31; 95% CI, 0.17, 0.56) than for AH interpreted visits; the odds of a moderately/highly clinically significant error were lower for IP (OR=0.25; 95% CI, 0.06, 0.99) than for AH interpreted visits.
CONCLUSIONS
Inaccurate language interpretation in medical encounters is common and more frequent when untrained interpreters are used compared with professional IP or through VC. Professional VC interpretation may increase access to higher quality medical interpretation services.
背景
英语水平有限的患者所接受的医疗服务质量和治疗效果较差。口译员可以改善这些差异；然而，关于不同口译模式的质量缺乏相关证据。
目的
比较面对面（IP）专业口译、专业视频会议（VC）口译和临时（AH）口译的准确性。
设计
一项对转录的初级保健就诊录音带进行的横断面研究。
研究对象
研究对象包括32名讲西班牙语的拉丁裔患者和14名临床医生。
测量方法
由4名编码员（2名内科医生）对转录本进行独立编码，以确定准确和不准确的口译实例。分析单位是一段连续的语音或文本单元（TU）。两名内科医生独立核实不准确的口译实例，并将其临床意义评定为临床无意义、轻度、中度或高度临床意义。
结果
准确口译占总编码TU的70%，不准确口译（错误）占30%。与IP（25%）和VC（23%）口译相比，AH口译（编码TU的54%）的不准确口译发生率是其两倍，这是由于更多的遗漏错误（P<0.001）以及对患者或临床医生的回答错误（P<0.001）。每次就诊的平均错误数为27，其中7.1%的错误被评定为中度/高度临床意义。在调整模型中，IP口译（OR=0.25，95%CI，0.19，0.33）和VC口译（OR=0.31；95%CI，0.17，0.56）的不准确口译几率低于AH口译就诊；IP口译（OR=0.25；95%CI，0.06，0.99）的中度/高度临床意义错误几率低于AH口译就诊。
结论
在医疗问诊中，语言口译不准确的情况很常见，与专业的面对面口译或通过视频会议口译相比，使用未经培训的口译员时这种情况更频繁。专业的视频会议口译可能会增加获得更高质量医疗口译服务的机会
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