Comparing Remote Interpreter Modalities in the Pediatric Emergency Department

Study Overview
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Brief Summary
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Professional interpretation improves quality of care for patients with limited English proficiency (LEP). However, many health care settings lack access to professional interpreters, and even in locations with good access, logistical factors and perceived barriers have limited their widespread use. Remote methods of professional interpretation, including telephone and video, hold great promise for expanding access, but only limited data exist on the relative impacts of these modalities on patient care and provider uptake. Comparing how these modalities impact multiple aspects of health care quality, including family comprehension, provider communication, and consistency of provider interpreter use will inform dissemination of strategies for delivery of safe, efficient, and equitable care to LEP families. Aim 1: To determine whether randomly assigned remote interpreter modality (telephone versus video) impacts parent-reported quality of communication and interpretation, diagnosis comprehension, and length of stay (LOS) among LEP Spanish-speaking families seen in a pediatric Emergency Department (ED). Hypothesis 1: Parent-reported quality of communication and interpretation and parent diagnosis comprehension will be higher among families assigned to video interpretation compared to telephone interpretation. Hypothesis 2: LOS will not differ between families assigned to video and telephone interpretation. Aim 2: To determine whether assigned interpreter modality is associated with provider decision to communicate without professional interpretation. Hypothesis 3: Parent-reported provider communication without professional interpretation (e.g. using the patient or a family member to interpret for some part of the visit) will be lower for families assigned to video interpretation compared to telephone interpretation.

Official Title
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Impact of Remote Interpreter Modality on Comprehension, Communication Quality, and Consistency of Interpreter Use in the Pediatric Emergency Department

Conditions
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Limited English Proficient Patients and Families

Intervention / Treatment
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* Other: Telephone Interpretation
* Other: Video Interpretation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Preferred language for medical care of Spanish At least one primary caregiver requires interpretation Presenting to Seattle Children's ED during recruiting hours Exclusion Criteria: Triage level 1 (life-threatening illness) No parent or legal guardian present Reason for visit is concern for abuse reason for visit is primary behavioral or psychiatric complaint

Ages Eligible for Study
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Minimum Age: 1 Day
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Telephone Interpretation<br>These families will be assigned to use telephone interpretation throughout the ED visit. | Other: Telephone Interpretation<br>* Professional interpretation provided over the phone by a national network of certified medical interpreters<br>|
| Experimental: Video Interpretation<br>These families will be assigned to use video interpretation throughout the ED visit. | Other: Video Interpretation<br>* Professional interpretation provided over video by a national network of certified medical interpreters<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Communication Quality | We will use the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Child Visit Survey 2.0 communication composite, which includes 5 items. | Once, 1-7 days after the ED visit | 
| Interpretation Quality | Interpretation quality will be measured with the Interpreter Satisfaction Survey (7 items). | Once, 1-7 days after ED visit | 
| Diagnosis Comprehension | Parents will be asked to name their child's diagnosis. Clinician-recorded diagnosis will be obtained from chart review for comparison. Responses will be classified as correct, incorrect, or vague/incomplete, using a method we have employed previously. | Once, 1-7 days after ED visit | 
| Consistency of Interpreter Use | Parents will be asked to report on the frequency with which providers used each of a list of potential communication methods (e.g. telephone interpreter, family or friend, spoke in English without an interpreter present). Response options are never, sometimes, frequently, or always. | Once, 1-7 days after ED visit | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Length of ED stay | Time from arrival in Emergency Department to discharge home or admission to the hospital. | Once, after ED visit |