Access challenges for patients with limited English proficiency: a secret-shopper study of in-person and telehealth behavioral health services in California safety-net clinics.

The recent growth of telehealth may be impacting access to care for patients, including those with limited English proficiency (LEP). Using a secret-shopper design, simulated patients contacted 386 safety-net clinics in California in both Spanish and English from February-March 2023. Callers stated that they were new patients seeking medication for depression, and they documented time to an appointment and available visit modalities (telehealth and in-person). Multinomial logistic regression models examined associations between clinic characteristics and available modalities. English-speaking callers were more likely to speak with a live scheduler and to obtain appointment information from a scheduler who could engage with them in their preferred language. Among Spanish-speaking callers who reached a live scheduler, 22% reached someone who did not engage (eg, were hung up on) and, as a result, could not obtain appointment information. The mean estimated time to a prescribing visit was 36 days and did not differ by language. Sixty-four percent of clinics offered both telehealth and in-person visits, 14% only offered in-person visits, and 22% only offered telehealth visits. More attention and resources are needed to support patients with LEP at the point of scheduling and to ensure choice of visit modality for all patient populations.

Legal, Practical, and Ethical Considerations for Making Online Patient Portals Accessible for All.

Largely driven by the financial incentives of the HITECH Act's Meaningful Use program as part of federal US health care reform, access to portal Web sites has rapidly expanded, allowing many patients to view their medical record information online. Despite this expansion, there is little attention paid to the accessibility of portals for more vulnerable patient populations-especially patients with limited health literacy or limited English proficiency, and individuals with disabilities. We argue that there are potential legal mandates for improving portal accessibility (e.g., the Civil Rights and the Rehabilitation Acts), as well as ethical considerations to prevent the exacerbation of existing health and health care disparities. To address these legal, practical, and ethical considerations, we present standards and broad recommendations that could greatly improve the reach and impact of portal Web sites.

Civil Rights Laws as Tools to Advance Health in the Twenty-First Century.

To improve health in the twenty-first century, to promote both access to and quality of health care services and delivery, and to address significant health disparities, legal and policy approaches, specifically those focused on civil rights, could be used more intentionally and strategically. This review describes how civil rights laws, and their implementation and enforcement, help to encourage health in the United States, and it provides examples for peers around the world. The review uses a broad lens to define health for both classes of individuals and their communities--places where people live, learn, work, and play. Suggestions are offered for improving health and equity broadly, especially within societal groups and marginalized populations. These recommendations include multisectorial approaches that focus on the social determinants of health.

Barriers to collecting patient race, ethnicity, and primary language data in physician practices: an exploratory study.

BACKGROUND: Experts recommend that physician practices collect and use patient race, ethnicity, and primary language data to document and address health care disparities and improve health care quality for diverse populations. Little is known about demographic data collection in small practice settings. OBJECTIVE: To conduct an exploratory study to examine demographic data collection in physician practices to reduce disparities and provide qualitative descriptions of facilitators and barriers to data collection. DESIGN: Semistructured telephone interviews. SETTING: Medical practices with 5 or fewer physicians. PARTICIPANTS: Practice managers, nurse managers, and physicians from 20 practices nationwide. RESULTS: Of the 20 practices interviewed, 9 reported collecting demographic data. Only 1 practice feature facilitated demographic data collection: use of an electronic medical record (EMR) system (7 of 10 practices with an EMR collected data). Participation in pay-for-performance programs, cultural competency training, and measuring clinical quality did not facilitate data collection. One practice linked demographic and quality data. A few used the data to track language service needs. The main perceived barriers to demographic data collection included concerns about privacy, the legality of collecting the information, possible resistance from patients and staff, difficulty recording the data, and uncertainty about whether the data would be useful. CONCLUSIONS: Few small practices use data to track or address disparities in health care. Most perceived barriers to data collection can be surmounted. There is hope for improved collection and use of data through the spread of information technology with comprehensive national health reform.

Access to hospital interpreter services for limited English proficient patients in New Jersey: a statewide evaluation.

CONTEXT/OBJECTIVES: We surveyed New Jersey (NJ) hospitals to assess current language services and identify policy recommendations on meeting limited English proficiency (LEP) patients' needs. METHODS: Survey with 37 questions regarding hospital/patient features, interpreter services, and resources/policies needed to provide quality interpreter services. RESULTS: Sixty-seven hospitals responded (55% response rate). Most NJ hospitals have no interpreter services department, 80% provide no staff training on working with interpreters, 31% lack multilingual signs, and 19% offer no written translation services. Only 3% of hospitals have full-time interpreters, a ratio of 1 interpreter:240,748 LEP NJ residents. Most hospitals stated third-party reimbursement for interpreters would be beneficial, by reducing costs, adding interpreters, meeting population growth, and improving communication. CONCLUSIONS: Most NJ hospitals have no full-time interpreters, interpreter services department, or staff training on working with interpreters, and deficiencies exist in hospital signage and translation services. Most NJ hospitals stated third-party reimbursement for interpreter services would be beneficial.

The medical tongue: U.S. laws and policies on language access.

For twenty-three million Americans who speak English less than "very well," language barriers lead to lower quality of and worse access to health care. Although the breadth of existing federal and state language access laws might seem sufficient, the lack of comprehensive implementation and enforcement leaves millions of patients with limited English proficiency forced to accept a lower quality of care than English speakers receive. This paper reviews existing laws and offers solutions focusing on five themes: access, funding, education, quality improvement, and accountability. Improving language access is essential to ensure that the language one speaks does not affect one's health or mortality.

The legal framework for language access in healthcare settings: Title VI and beyond.

Over the past few decades, the number and diversity of limited English speakers in the USA has burgeoned. With this increased diversity has come increased pressure--including new legal requirements--on healthcare systems and clinicians to ensure equal treatment of limited English speakers. Healthcare providers are often unclear about their legal obligations to provide language services. In this article, we describe the federal mandates for language rights in health care, provide a broad overview of existing state laws and describe recent legal developments in addressing language barriers. We conclude with an analysis of key policy initiatives that would substantively improve health care for LEP patients.