Current Research Initiatives

Remote Simultaneous Medical Interpreting (RSMI)

OVERVIEW
Over one million immigrants arrive in the United States each year. Census 2000 data indicate that over 30.5 million United States residents are foreign-born. These newcomers speak over 150 different languages. Forty-five million people over age 4 speak a language other than English at home. A significant proportion has Limited English Proficiency (LEP). LEP is “a limited ability to listen, speak, read, and write in English, and speak English less than 'very well'.” About 50% of LEP individuals speak Spanish, followed by Indo-European languages. As many as one in four immigrants in New York City demonstrate LEP, and in effect, are unable to adequately communicate with their health care providers in English. To considerably improve on current practices, a Remote Simultaneous Medical Interpreting (RSMI) system was implemented at Bellevue Hospital Center. Cutting edge technology allows patients and doctors to utilize the services of interpreters, located offsite, who are trained in simultaneous medical interpretation.

The primary purpose of the RSMI Outcomes Study is to document differences in medical outcomes experienced by LEP patients who use the RSMI system as compared with LEP patients who use Usual and Customary interpreting practices. The term Usual and Customary refers to the range of other methods in which interpretation is available, including trained volunteers and staff, commercial over-the-telephone interpreting services, and ad hoc interpreters such as a patient’s relatives and untrained staff.

This pioneering study is the first conducted on the impact of the RSMI system on medical outcomes among LEP patients in a primary care setting, as well as the first study to document RSMI costs as compared to costs of alternative methods. This study is being conducted in the Primary Care and Cardiology Clinics at Bellevue Hospital Center in New York City. In addition, a sub-study was conducted in the Bellevue Emergency Department to examine patients’ knowledge of exit instructions when various interpreting modes are utilized.

Additional studies focus on accuracy of information and education and patient/provider/interpreter satisfaction. The collective results will provide critical new information regarding interpreting methods. This body of knowledge will be available for health policymakers and hospital administrators in New York City’s and the nation’s health care facilities, thereby enabling more informed choices about interpreting practices.

OUTCOMES STUDY
This randomized control study is being conducted in the Bellevue Hospital Center Primary Care Clinic and the Cardiology Clinics. The experimental and control groups consist of newly enrolled Spanish-, Mandarin-, and Cantonese-speaking patients. Experimental patients and their primary care providers use the RSMI system at Bellevue. Control patients employ Usual and Customary interpreting practices in the same clinics. Two additional comparison groups include English-speaking patients matched for demographic characteristics apart from language, and Spanish-speaking LEP patients with Spanish-speaking providers. Patients are being followed for one year.

Patients study including chronic disease management indicators(hypertension, diabetes, and hypercholesterolemia); new diagnoses (depression); and adherence (follow-up appointment keeping, adherence to immunization, and adherence to screening guidelines).

Research Questions:
Does RSMI improve timely and accurate diagnosis of depressive disorders for LEP patients?
Is RSMI effective in enhancing initiation into appropriate follow-up care?
Does RSMI improve adherence to screening and immunization guidelines?
Does RSMI improve routine management, and, hence, outcomes, for chronic diseases including diabetes, hypertension, and hypercholesterolemia?

EMERGENCY DEPARTMENT SUB STUDY
The Sub Study conducted in Bellevue Emergency Department compared RSMI and Usual and Customary encounters in the Bellevue emergency room

Research Questions:
Does knowledge of exit instructions differ by mode of interpreting (RSMI, RCMI, and PCMI)?
Does provision of instructions vary by interpreting mode?
Does patient satisfaction vary by interpreting mode?

COST STUDY
To obtain data on the efficiencies of various modes of interpreting, a separate study is being conducted. Scripted encounters in several languages were recorded and timed. The timing analysis will also be augmented by visit length information gathered during the Outcomes study. An econometric analysis will also be performed

ERROR ANALYSIS STUDY
Four patient-provider scripts were prepared spanning different medical conditions and issues that arise in an outpatient setting, including diabetes mellitus, tuberculosis, depression, and menopause. The encounters in the study’s languages are recorded, all across four modes of interpreting in each language: Remote Simultaneous, Remote Consecutive, Proximal Consecutive/Trained, and Proximal Consecutive Ad Hoc. An error analysis tool is used to record both linguistic and medical errors. This tool allows the errors to be identified, classified, deemed significant or not, and further classified as to their potential medical significance. The Error Analysis is being conducted in Spanish, Mandarin, and Bengali.

FUNDERS
Thank you to our study funders, the Commonwealth Fund and the California Endowment.

THANK YOU
The RSMI study is being conducted with cooperation from Bellevue Hospital Center and New York City Health and Hospitals Corporation

Alternative Medical Models
CIH is seeking to determine the differential cost of a scheduled office visit under conditions of language discordance using two alternative medical interpreting models. These two alternative medical interpreting models are remote simultaneous medical interpreting (RSMI) and proximate consecutive medical interpreting (PCMI).


Satisfaction Study
A satisfaction study is being conducted at the Gouverneur Diagnostic and Treatment Center, of the South Manhattan Health Care Network (New York City Health and Hospitals Corporation), to measure the satisfaction of patients, providers, and interpreters with usual and customary practices and Remote-Simultaneous Medical Interpreting. A patient satisfaction instrument, a physician satisfaction instrument, and an interpreter satisfaction instrument are being used to evaluate levels of satisfaction with the interpreter services. These instruments, in questionnaire form, have been validated, translated, piloted for cultural validity and language appropriateness, and are being conducted in the target language of the limited English proficiency patients and in English in the case of the physicians and other medical and clerical staff, and the interpreters.


Error Analysis Study
CIH is currently conducting an error analysis study at the Gouverneur Diagnostic and Treatment Center, of the South Manhattan Health Care Network (New York Health and Hospitals Corporation) to evaluate quality of medical interpreting. The error analysis study will accomplish two main goals: 1) assess the individual interpreter's degree of accuracy and proficiency in their rendition of remote simultaneous and proximal consecutive medical interpreting methods; and 2) assess the overall communication accuracy between healthcare provider and patient through different methods of medical interpreting. An error analysis tool will evaluate quality, linguistic errors, and quantity, the number of errors, made during a given speech act; that is, an interpreter-assisted dialogue between a healthcare provider and a patient during a determined period of time. The Error Analysis Tool will examine translated transcribed interpretations, using both the remote simultaneous and proximal consecutive methods, to evaluate the frequency of linguistic errors.


Self Reported Bilingual Aptitude Screening
CIH is embarking on a study to evaluate the bilingual skills of medical doctors who have self reported bilingual aptitude. The results will help guide policy development.


Timing Study
There are many variables that might influence the final cost of medical interpreting. The time employed per medical encounter, depending on the interpreting modality utilized, may be a major one. The Timing Study measures the length of the medical encounter using various medical interpreting methods. More efficient medical interpreting services could expand their utilization without increasing cost.