The 27 million households in the United States who report having limited English proficiency (LEP) face a critical language barrier to all fundamental aspects of their lives, including accessing and receiving equitable healthcare. Medical miscommunications, misdiagnoses, and treatment errors disproportionately affect individuals with LEP and contribute to health disparities. Language concordance is the gold standard in healthcare and occurs when patients can directly converse with their health care providers or with certified medical interpreters in their preferred language. In this grant, we seek to remove cultural and linguistic barriers to equitable health care for people with LEP who access emergency and primary care services at an inner-city safety net hospital by using a multi-factorial implementation sciences approach to address three constituencies: people with LEP, the clinical workforce who care for people with LEP, and hospital-based policies and practices that support people with LEP. For people with LEP, our approach is awareness of language access rights and access to interpreter training. We will work with eight multi-ethnic community-based organizations and their clients to develop and disseminate culturally and linguistically responsive language access rights awareness campaigns. For community residents who are fluently bilingual, we will provide scholarships for language fluency and certified medical interpreter courses to increase the number of certified medical interpreters in languages additional to Spanish. For patients with LEP who access emergency or primary care services at the hospital, we will provide updated patient-facing materials to increase awareness and encourage them to ask for certified interpreter services. We will also create a curricular component for academic and community-based ESL programs to broaden awareness about language access and interpreter courses for non-native English-speaking students. Fo
r the clinical workforce who care for people with LEP, our approach is education/awareness, environmental cues, and changes in informatics systems (EHR). We will create a best practices educational program in four areas: language access rights for people with LEP including changes in Electronic Health Record (EHR) documentation, fluency exam/certified interpreter programs, health literate skills (i.e., Teach-Back) when working with interpreters, and not using ad-hoc interpreters when treating patients with LEP. A central component of this program is behavior change through modification of EHR documentation along with other environmental cues for the clinical workforce. For policy and practices, we will review and analyze existing policies and procedures in the hospital’s Language Interpretive Services, Emergency Department, Nursing, Marketing, Informatics, and Human Resources departments as well as the health equity/language access identification policies at the two schools of medicine who educate and provide the physician and advanced provider clinical staff to the hospital. Our goal is to decrease gaps in policy and practice for supporting individuals with LEP who currently need or who seek healthcare. The establishment of a hospital-wide Language Access Committee with relevant stakeholders and end users will ensure that meaningful changes are made to current policies, procedures, and practices. This kind of multi-sector collaboration among academia, clinical medicine, and community organizations to remove cultural and linguistic barriers to equitable health care for people with LEP has the potential to provide a replicable and sustainable model for other communities and health systems. Health literate, culturally and linguistically responsive healthcare reduces hospital readmissions, improves health outcomes, and removes barriers to equitable healthcare for people with LEP.