HHS Removing Barriers for Patients with Limited English Proficiency

By Jonathan Springston, Editor, Relias Media

The U.S. Department of Health and Human Services (HHS) has provided an update on how the agency is improving healthcare access for patients with limited English proficiency (LEP) and related goals for the rest of 2023.

So far, much of the work has centered on providing more technical assistance and adding varied language options online. HHS notes LEP patients need the right communication tools to prevent misdiagnosis and delayed treatment while building trust in the healthcare system.

The rest of the report focuses on the work that remains. In 2022, HHS relaunched the Language Access Steering Committee, the members of which identified key items to address: access to in-language content through webpages, listserv announcements, and public outreach material; telephonic interpreter services; program and benefit information in other languages; and more federal funding to provide language access services. The committee grouped these under medium-term goals (two to four years) and long-term goals (five to eight years).

“The need for meaningful access to language services continues to grow across America,” said HHS Secretary Xavier Becerra. “As a child, I often needed to translate insurance and medical documents for my parents. That is still necessary for many families in this country today.”

The agency created this report in response to two 2021 executive orders on underserved communities and the immigration system. The Office for Civil Rights (OCR) is playing a vital role in identifying areas for improvement and ensuring HHS meets its goals.

“HHS is taking important steps to ensure that people have full and equal access to programs and services across the department so that no one is left behind because of the language they speak or other communications barriers based on ability,” said OCR Director Melanie Fontes Rainer. “OCR is committed to guaranteeing that health and human services are inclusive, equitable, accessible, and in compliance with civil rights laws for limited English proficient persons and their families.”

Meanwhile, healthcare systems and individual medical facilities are testing methods to improve communication for LEP patients. For example, in the emergency department (ED) of an urban tertiary care center, researchers created a brief automated bilingual computerized alcohol screening and intervention (AB-CASI) tool to screen for alcohol consumption and alcohol-related adverse health behaviors and consequences among Latino patients.

Those randomized to the intervention group were exposed to the AB-CASI tool, which included alcohol screening and a structured, interactive, brief negotiated interview in their preferred language (English or Spanish) while in the ED. Patients randomized to the standard care group received standard emergency medical care, including an informational sheet with recommended primary care follow-up. The primary outcome was the self-reported number of binge-drinking episodes within the last 28 days, assessed by the timeline follow-back method at 12 months after randomization. The number of binge-drinking episodes within the last 28 days was significantly lower in the AB-CASI group compared with the standard care group.

In an opinion article accompanying this study, the editorialists wrote “ask[ing] someone in their native language a question that perhaps they may be asking themselves can change a person’s behavior. It is almost as if, during the moment they are reading in their native language, they feel heard.”

“More than a call for research and funding, we make a call to action for improvement in practices pertaining to research, care, and treatment,” the editorialists added. “If we aim to achieve and truly bring high-quality and equitable healthcare, we need to approach and serve patients in the language they prefer, both in the hospital and in the laboratory.”

In the upcoming July issue of Medical Ethics Advisor, author Stacey Kusterbeck will report on the struggle to obtain interpreters for patients with LEP as it applies specifically to ethics consults.

For more on this and related subjects, be sure to read the latest issues of Hospital Case Management.