PEDIATRICIANS' USE OF LANGUAGE SERVICES FOR LIMITED ENGLISH PROFICIENT (LEP) CHILDREN AND FAMILIES
Dennis Z. Kuo, Karen G. O'Connor, Glenn Flores, Cynthia S. Minkovitz.. Pediatrics, Johns Hopkins University, Baltimore, MD; Division of Health Services Research, American Academy of Pediatrics, Elk Grove Village, IL; Pediatrics, Medical College of Wisconsin, Milwaukee, WI; Population & Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

BACKGROUND: Providing language services for LEP patients is essential to providing high quality health care. Professional interpreters are associated with improved quality and outcomes. Little is known about pediatricians' use of these services.

OBJECTIVE: To assess pediatricians' provision of language services to LEP patients and state characteristics associated with use of these services.

DESIGN/METHODS: National random sample, mailed Periodic Survey of American Academy of Pediatrics U.S. members, 2004 (response rate 58%; n=1829). Use of 6 language services was assessed among 698 non-trainees with LEP patients. Multivariate analyses were done to examine state factors (Medicaid/SCHIP reimbursement, LEP prevalence) associated with language services use after adjusting for physician (age, sex, ethnicity) and practice (location, setting) characteristics.

RESULTS: Pediatricians use multiple communication methods, including bilingual family members (70%), bilingual staff (58%), bilingual physicians (52%), professional interpreters (40%), and telephone interpreters (28%). Only 35% of practices provide translated written materials. In bivariate analyses, rural and solo/2-physician practices report higher use of family member interpreters and lower use of professional interpreters (p<.01). Family members are among the most frequently used method of interpretation regardless of LEP prevalence in states. In multivariate analysis, physicians in states with high proportions of LEP persons are less likely to use a professional interpreter (OR=0.5; 95% CI, 0.3-0.7). Public reimbursement for interpreters is associated with professional interpreter use (OR=2.1; 95% CI, 1.1-3.8) but not other language services.

CONCLUSIONS: Most pediatricians use untrained family members to interpret for their LEP patients and families. Rural and smaller practices are at greater risk of using family member interpreters but not professional interpreters. Most pediatricians do not provide translated written materials. Public reimbursement for professional language services may increase use of trained interpreters and quality of care for LEP children and their families.