1.  Residents report using different modes of communication with LEP patients depending on the clinical encounter.  Variation in professional interpreter use by type of clinical encounter and not clinical site or patient language underscores the importance of resident decision-making in determining whether LEP patients receive professional interpreter services.  Our findings confirm prior research which suggests there is considerable underuse of professional interpreters among resident physicians caring for LEP patients.  In addition, we found that residents perceive that their communication with hospitalized LEP patients to be worse compared to their communication with clinically similar English-speaking patients.  To improve provider interpreter training efforts, future studies with larger samples sizes are needed to determine how resident characteristics such as specialty, hours of training, and growing up speaking a non-English language at home predict resident physicians’ interpreter use when caring for LEP patients. From Admission to Discharge: Patterns of Interpreter Use Among Resident Physicians Amy Shen 1, BA; Jenna Kruger 1,2, MPH; Judy Quan 1,2, PhD; Alicia Fernandez 1,2, MD 1 UCSF School of Medicine, 2 Division of General Internal Medicine, University of California, San Francisco, CA  Communication with hospitalized LEP patients relies on individual providers’ decisions to use professional interpreters.  Underuse of professional interpreters adversely affects quality of care to patients with limited English proficiency (LEP). AIM  To assess resident physicians’ patterns of communication with LEP patients by hospital encounter type.  To identify predictors of professional interpreter use. RESULTS Partial support from R25MD006832 NIH-NIMHD. Special thanks to UCSF internal medicine, family medicine, and general surgery residency programs for their support and participation in this study. ACKNOWLEDGEMENTS Study Design Cross-sectional survey. Resident physicians reported on interpreter use with their last hospitalized LEP patient with whom they experienced a language barrier. Participants Internal medicine, general surgery, and family medicine resident physicians from one academic medical institution who care for LEP patients across three hospitals. Data Analysis Descriptive statistics were performed to ascertain residents’ percent use of professional interpretation, perceived quality of communication, and patterns of interpreter use for six routine hospital encounters. Logistic regression models were used to determine the independent contribution of clinical site, patient characteristics, and physician characteristics to resident physician use of professional interpreters. BACKGROUND Table 1. Characteristics of Resident Physicians (N= 149) CharacteristicN (%)* ++ Age, range (mean) 25-37 (28.7) Female84 (56) Level of training PGY-185 (57) PGY-2 34 (23) PGY-3+25 (17) Residency program Internal Medicine108 (73) General Surgery22 (15) Family Medicine19 (13) Race/ Ethnicity White80 (54) Asian/Pacific Islander42 (28) Hispanic/Latino16 (11) Black5 (3) Other4 (3) Spoke non-English language at home52 (35) Proficiency in non-English language +++ (“Speak well enough to provide care”) 80 (54) Spanish52 (65) Mandarin7 (9) Hindi6 (8) Other17 (21) Completed international medical work 80 (54) Hours of interpreter training 0 hours33 (22) 1-3 hours57 (38) 3-5 hours37 (25) >5 hours15 (10) % Patients with LEP, range (mean) 10-70 (35) Language of LEP patient Cantonese75 (50) Spanish30 (20) Russian15 (10) Other29 (21) Hospital of LEP patient Private hospital73 (49) Public hospital72 (48) Other4 (3) DISCUSSION In our sample, most residents (91%) reported that their quality of communication with hospitalized LEP patients was "slightly worse" (62%) or "much worse" (29%) compared to their communication with clinically similar English-speaking patients. Only patient language with adjusted odds ratio of 3.57 (95% Cl: 1.01, 12.67) was shown to be a significant, but borderline, predictor of much worse vs. other quality of communication rating in logistic regression models. % use by resident physicians % resident physicians % professional interpreter use % resident physicians In our sample, 71% of residents reported using professional interpreters for less than 60% of hospital clinical encounters. Professional interpreter use was dichotomized with different percentage cut-offs for different logistic regression models. There were no consistently significant predictors of professional interpreter use, through physician specialty, hours of interpreter training and growing up speaking a non-English language were associated with interpreter use in some models. Quality of communication Figure 3. Patterns of interpreter use among resident physicians for common hospital encounters. *The survey response rate was 73%. ++Total percentages may not add up to 100 due to rounding. +++Total numbers add up to > 80 because subjects could specify more than one non-English language spoken. Figure 1. Resident physicians’ percent use of professional interpretation during the hospital course of an LEP patient. Figure 2. Resident physicians’ self-rated quality of communication with an LEP patient compared to an English-speaking patient. Patterns of professional interpreter use substantially varied by type of clinical encounter, with more residents reporting getting by with ad-hoc interpreters, their own language skills or not talking to the patient due to time constraints during routine daily rounds and check-ins than during “high-stakes” planned encounters such as procedure consents or family meetings (45% and 41% vs. 9% and 16%, p-value<0.005). METHODS