Medical Care Research and Review

Twenty-one million Americans are limited in English proficiency (LEP), but little is known about the effect of medical interpreter services on health care quality. Asystematic literature review was conducted on the impact of interpreter services on quality of care. Five database searches yielded 2,640 citations and a final database of 36 articles, after applying exclusion criteria. Multiple studies document that quality of care is compromised when LEP patients need but do not get interpreters. LEP patients' quality of care is inferior, and more interpreter errors occur with untrained ad hoc interpreters. Inadequate interpreter services can have serious consequences for patients with mental disorders. Trained professional interpreters and bilingual health care providers positively affect LEP patients' satisfaction, quality of care, and outcomes. Evidence suggests that optimal communication, patient satisfaction, and outcomes and the fewest interpreter errors occur when LEP patients have access to trained professional interpreters or bilingual providers.

The comprehensive insurance coverage afforded low-income elders with both Medicare and Medicaid coverage (dual enrollees) has substantially reduced financial barriers to care. However, other studies show reduced and less appropriate utilization patterns among dual enrollees compared to Medicare beneficiaries with private supplemental insurance, suggesting access barriers remain. This study found that 59 percent of elderly dual enrollees needed an ambulatory medical or long-term care service in a 1-year period. One third of these individuals experienced barriers to access; organizational and geographic barriers were more prevalent than financial barriers. African American race, trouble paying basic living expenses, fair or poor health status, and an unfavorable assessment of physician information giving were significantly associated with an increased likelihood of organizational and geographic access barriers among elderly dual enrollees.

This study assessed the impact of managed care on publicly funded adolescent substance abuse treatment by comparing differences in service utilization and outcomes across prospective samples from two states: Oregon, which uses managed care practices in service financing and delivery, and Washington, which does not. One hundred and six adolescents from Washington and 94 from Oregon, who entered outpatient substance abuse treatment in 1998 and 1999, completed self-report surveys about their substance use before and after receiving treatment (follow-up rate = 75 percent). In addition, clinical chart reviews conducted at the 6-month follow-up assessed the type and amount of treatment these adolescents received during the study period. It was found that service utilization and treatment outcomes were comparable across the two state samples. The evidence presented here suggests that managed care is capable of delivering substance abuse treatment services of comparable quality to state-administered substance abuse treatment services.

Variations in physician practice patterns have important implications for quality and cost. The purpose of this article is to explain variation in physicians' practice patterns in terms of physician personal characteristics, practice setting, patient population, and managed care involvement. Data on 2,455 primary care physicians were derived from the Community Tracking Study Physician Survey (1996-1997). Factor scores were determined based on responses to three clinical scenarios that represent discretionary medical decisions. These scenarios include a specialist referral for benign prostatic hyperplasia, prescription drugs for elevated cholesterol, and an office visit for vaginal discharge. Physician age, being a foreign medical school graduate, being a solo practitioner, and having a larger proportion of Medicaid patients were all associated with higher factor scores, a greater likelihood of ordering a service. Being board certified was associated with lower factor scores. Managed care involvement was not a significant predictor of factor scores.

Can a well-designed public performance report affect the public image of hospitals? Using a pre/postdesign and telephone interviews, consumer views and reports of their use of public hospital report are examined. The findings show that the report did influence consumer views about the quality of individual hospitals in the community 2 to 4 months after the release of the report.