title: Identification of limited English proficient patients in clinical care.
abstract: 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.
authors.affiliation: 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.
authors.forename: Leah S
authors.initials: LS
authors.lastname: Karliner
authors.forename: Anna M
authors.initials: AM
authors.lastname: Napoles-Springer
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
authors.forename: Eliseo J
authors.initials: EJ
authors.lastname: Pérez-Stable
mesh_terms: 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