Ivette Motola, MD, MPH, FACEP, FAAEM

Ivette Motola, MD, MPH, FACEP, FAAEM

2004-2005

Director, Division of Prehospital and Emergency Healthcare, The Gordon Center for Research in Medical Education; Associate Professor of Medicine, Division of Emergency Medicine, University of Miami Miller School of Medicine, Miami, FL

Born in Cuba and raised in Miami after coming to the United States during the Mariel-Key West boatlift, Dr. Motola is committed to improving emergency health care for Latino and other minority populations. Recognizing that emergency departments are the last and, sometimes, the only access to health care for underserved patients, she has dedicated her career to helping reduce disparities in access to health care. Her active involvement in serving minority and underserved populations is reflected by her contribution to community outreach programs, her role as mentor to Latino students, and her steadfast advocacy on behalf of patients with language and cultural barriers. Dr. Motola plans to develop and implement programs that provide culturally and linguistically competent health care for Latino patients. By analyzing the level of care and conducting outcomes research in emergency care provided to patients with limited English proficiency, Dr. Motola plans to reduce disparities in access to care and improve the level of care these populations receive.

Dr. Motola received her medical degree from the University of Rochester School of Medicine and Dentistry in 2000, and completed her residency training in Emergency Medicine at the Harvard Affiliated Emergency Medicine Residency (Massachusetts General Hospital and Brigham and Women’s Hospital) in Boston, MA in 2004. She received an M.P.H. from the Harvard School of Public Health in 2005 as a CFHU Fellow.

2010

2009

2008

2007

2006

2005

Innovative Approaches to Bridging the Language Chasm

Objective:

To determine whether Remote Simultaneous Medical Interpretation (RSMI) is a useful adjunct to providing linguistic service to Limited English Proficient Patients in the Emergency Department (ED).

Background:

Language barriers between patients and health care providers can be large obstacles in providing effective, quality health care. As of the 2000 Census, 47 million Americans aged 5 years or older speak a language other than English at home and 10.5 million people have Limited English Proficiency (LEP).  Given that over 1 million immigrants arrive in the United States each year, this number has risen and will continue to rise.  Previous studies have shown that patients with LEP are less likely to have primary care providers, less likely to obtain preventive care and more likely to use Emergency Departments.  Once in the ED, if language barriers are not addressed, there is an increased rate of diagnostic tests, IVF hydration, hospital admission and medical errors compared to English speaking patients and patients who receive a trained medical interpreter.

Although increasing federal, state and organizational policy requires increased linguistic competency, implementing effective programs to provide consistent and cost-effective interpretation is challenging.    The need to practice interpretation in multiple languages in the ED 24 hours a day requires a combination of different modes of interpretation.  A system that provides for rapidly accessible interpreters and does not significantly prolong visit length would likely lead to increase use of professional interpreters even in busy EDs.  This, in turn, would help meet the needs of LEP patients, improve their quality of care and safety, and help contain costs.

Methods:

The investigation is a randomized controlled study in which language discordant patients who spoke Spanish received either RSMI or Usual and Customary (U&C) interpretation.  A combination of questionnaires and audio-recordings from visits were used to assess patients’ knowledge of their discharge instructions as compared to providers’ instructions, as well as visit length, patient satisfaction with visit and interpretation mode and perception of patient’s understanding.

Findings:

The randomized groups were similar except for a higher education and English proficiency amongst the U&C group.  Both groups had a majority of patients with only a grade school education.  Despite randomization, only 57% of the patients randomized to RSMI received only that mode of interpretation.  In the first phases of analysis, logistic regression revealed an OR of 1.54, 95% CI (.98, 2.43) of patients in the RSMI group correctly recalling their discharge instructions compared to patients in the U&C group.  Although this was not statistically significant at a p=0.061 level, it is suggestive that  RSMI did just as well, if not better than the U&C patients at recalling their discharge instructions.

Conclusions:

-RSMI is an innovative approach to meeting language assistance needs for LEP patients.
-It has the capacity to decrease visit times and cost for interpretation, and, although it is not a replacement for proximate interpretation, remote interpreting is a useful adjunct.
-Although our study did not find any statistical significance between the groups on preliminary analysis, both groups had about a 60-70% correct recollection of discharge instructions.
-Education and training of staff in medical areas that serve LEP patients is imperative in increasing rates of interpreter use.

Faculty Preceptors:

Francesca Gany, MD, MS, Center for Immigrant Health, New York University, School of Medicine
Ephraim Shapiro, MBA, MPA, Center for Immigrant Health, New York University, School of Medicine