Hospital and Health System–Level Interventions to Improve Care for Limited English Proficiency Patients: A Systematic Review

Abstract

Although federal legislation mandates the provision of qualified interpreters for limited English proficiency (LEP) patients, language services are consistently underutilized by health care providers even when readily available. The objective of this study was to systematically review the literature and summarize evidence for interventions at the hospital or health system level that improve communication with, quality of care for, or health outcomes of LEP patients. The literature was systematically reviewed according to PRISMA guidelines to answer the following question: "For patients with limited English proficiency, which interventions at the hospital or health system level will result in improved communication, quality of care, or health outcomes?" The search yielded an initial 16,686 references, 19 of which met the inclusion criteria. Baseline rates of language service utilization were extremely low and remained at low levels postintervention in multiple studies. Most studies focused on language service utilization, patient communication, metric tracking, and access to care, whereas few studies evaluated quality of care or health outcomes of LEP patients. Multifaceted interventions that include elements of administrative emphasis, process evaluation, and education appear to improve language service use and communication. This review revealed large gaps in the evidence to guide hospital and health system improvement strategies for LEP patient care. Given the large and persistent performance gaps in the provision of language assistance for LEP patients, hospitals, health systems, and granting agencies should invest in implementation and dissemination research focused on language service use.