Identification of limited English proficient patients in clinical care.
BACKGROUND
Standardized means to identify patients likely to benefit from language assistance are needed.


OBJECTIVE
To evaluate the accuracy of the U.S. Census English proficiency question (Census-LEP) in predicting patients' ability to communicate effectively in English.


METHODS
We investigated the sensitivity and specificity of the Census-LEP alone or in combination with a question on preferred language for medical care for predicting patient-reported ability to discuss symptoms and understand physician recommendations in English.


METHODS
Three hundred and two patients > 18 who spoke Spanish and/or English recruited from a cardiology clinic and an inpatient general medical-surgical ward in 2004-2005.


RESULTS
One hundred ninety-eight (66%) participants reported speaking English less than "very well" and 166 (55%) less than "well"; 157 (52%) preferred receiving their medical care in Spanish. Overall, 135 (45%) were able to discuss symptoms and 143 (48%) to understand physician recommendations in English. The Census-LEP with a high-threshold (less than "very well") had the highest sensitivity for predicting effective communication (100% Discuss; 98.7% Understand), but the lowest specificity (72.6% Discuss; 67.1% Understand). The composite measure of Census-LEP and preferred language for medical care provided a significant increase in specificity (91.9% Discuss; 83.9% Understand), with only a marginal decrease in sensitivity (99.4% Discuss; 96.7% Understand).


CONCLUSIONS
Using the Census-LEP item with a high-threshold of less than "very well" as a screening question, followed by a language preference for medical care question, is recommended for inclusive and accurate identification of patients likely to benefit from language assistance.
Karliner
Leah S
LS
Division of General Internal Medicine and Medical Effectiveness Research Center for Diverse Populations, Department of Medicine, University of California San Francisco, San Francisco, CA 94143-0320, USA.
Napoles-Springer
Anna M
AM
Schillinger
Dean
D
Bibbins-Domingo
Kirsten
K
Pérez-Stable
Eliseo J
EJ
D000328:Adult; D016507:Cardiology Service, Hospital / Q000592:standards; D019352:Censuses; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D005260:Female; D006630:Hispanic or Latino / Q000208:ethnology; D006766:Hospitals, County / Q000592:standards; D006801:Humans; D007807:Language Tests / Q000592:standards; D008297:Male; D008875:Middle Aged; D019303:Multilingualism; D013503:Surgery Department, Hospital / Q000592:standards; D014481:United States