title: The Hispanic Clinic for Pediatric Surgery: A model to improve parent-provider communication for Hispanic pediatric surgery patients.
abstract: BACKGROUND
  26 million Americans have limited English proficiency (LEP). It is well established that language barriers adversely affect health and health care. Despite growing awareness of language barriers, there is essentially a void in the medical literature regarding the influence of language disparity on pediatric surgery patients. This study was designed to assess the impact of patient-provider language concordance on question-asking behavior and patient satisfaction for pediatric surgery patients.
  
  
  METHODS
  Participants included families of patients in a General Pediatric Surgery Clinic categorized into 3 groups by patient-provider language concordance: concordant English-speaking, LEP concordant Spanish-speaking, and LEP discordant Spanish-speaking using an interpreter. Clinical visits were audio recorded and the number of patient-initiated questions and the length of clinical encounter were measured. Families were administered a surgery-specific, 5-point Likert scale questionnaire modeled after validated surveys concerning communication, trust, perceived discrimination and patient-provider language concordance. Regression models were performed to analyze associations between language concordance and patient's question-asking behavior and between language concordance and survey results.
  
  
  RESULTS
  A total of 156 participants were enrolled including 57 concordant-English, 52 LEP concordant-Spanish and 47 LEP-discordant-Spanish. There was significant variation in the mean number of patient-initiated questions among the groups (p=0.002). Both the English and Spanish concordant groups asked a similar number of questions (p=0.9), and they both asked more questions compared to the Spanish-discordant participants (p=0.002 and p=0.001). Language discordance was associated with fewer questions asked after adjustment for socioeconomic status. Language concordant participants rated higher scores of communication. Both Spanish-concordant and Spanish-discordant patients reported significantly increased preference for, and value of language concordant care. Language discordant participants reported that they desired to ask more questions but were limited by a language barrier (p=0.001).
  
  
  CONCLUSIONS
  In a pediatric surgery clinic, language concordant care increases the number of patient-asked questions during a clinical visit and improves communication suggesting that discordant care is a potential source of disparities in access to information. Future efforts should focus on expanding access to language concordant providers in other surgery subspecialties as a step towards limiting disparities in surgical care for all patients.
authors.affiliation: School of Medicine-Stanford University.
authors.forename: Joshua
authors.initials: J
authors.lastname: Jaramillo
authors.affiliation: School of Medicine-Stanford University.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Snyder
authors.affiliation: School of Medicine-Stanford University.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Dunlap
authors.affiliation: Department of Psychology, University of California, Riverside.
authors.forename: Robert
authors.initials: R
authors.lastname: Wright
authors.affiliation: Department of Pediatrics-Lucile Packard Children's Hospital at Stanford University.
authors.forename: Fernando
authors.initials: F
authors.lastname: Mendoza
authors.affiliation: Division of Pediatric Surgery-Lucile Packard Children's Hospital at Stanford University. Electronic address: mbruzoni@stanford.edu.
authors.forename: Matias
authors.initials: M
authors.lastname: Bruzoni
mesh_terms: D000293:Adolescent; D002140:California; D002648:Child; D002675:Child, Preschool; D003144:Communication Barriers; D065246:Culturally Competent Care / Q000208:ethnology / Q000379:methods / Q000592:standards*; D005260:Female; D013502:General Surgery; D019538:Health Care Surveys; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007802:Language; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000208:ethnology* / Q000706:statistics & numerical data; D010372:Pediatrics; D010817:Physician-Patient Relations; D011446:Prospective Studies; D058996:Quality Improvement
keywords: Hispanic population; Language concordant care; Pediatric surgery