The Case for Bilingual Self-Administered Health Questionnaires

By James E. Huizenga, M.D., President, BiMedical.Net

Ask any English-speaking patient if they had to fill out some type of questionnaire before being seen by a physician and the answer is a resounding “Yes!” 

Ask the same question of limited English proficient (LEP) patients and they will likely answer “No!” 

This discrepancy in healthcare delivery has existed mainly due to the general lack of high quality bilingual forms for the medical industry. With the advent of new Internet-based tools that make bilingual forms more readily available, this difference in care may now be easily overcome.  

Today, in the United States, millions of citizens and visitors face a dangerous barrier to healthcare that does not involve insurance or any issue related to cost or the ability to pay. They face instead a communications barrier. According to U.S. census data, more than 47 million people speak a language other than English at home, and nearly 23 million are considered LEP.  Overall, more than 176 different languages are spoken across the country.

While most healthcare facilities are required to provide language access services, they face their own barriers as they strive to meet this requirement. The consistent use of easy-to-access bilingual self-administered health questionnaires promises to make communication with LEP patients faster, more cost-efficient, and ultimately safer and more accurate.

Role of Self Administered Health Questionnaires

Self-administered health questionnaires (SAHQs) have become ubiquitous instruments used to transfer health information from patient to provider. Providers use these forms to review baseline health information, usually in preparation for a more detailed history and examination. Ultimately, the questionnaires are vital tools that achieve broad healthcare goals, including increased efficiency, increased patient safety, and enhanced documentation.

While the time and efficiency savings offered by SAHQs are good arguments for their wider use, the more important factor to consider is that, used correctly, these forms can increase diagnostic accuracy and patient safety. Research confirms that patient-completed history questionnaires improve the quantity and quality of useful health information, and that both physician and patient satisfaction increase when the forms are utilized.  

One study found that when providers care for patients after using a SAHQ, they tend to recognize more new problems. This study also showed that, in some cases, the questionnaire was actually more effective than the interviewing physician in obtaining some health history information. Another study evaluated the effectiveness of a patient completed admission questionnaire versus a nursing interview and found significantly more errors of omission occurring in the unstructured interview.

LEP Patient Challenges    

As more hospital visits and other healthcare encounters involve patients with limited English capabilities, the responsibility for communicating with this growing LEP patient population will continue to fall on the shoulders of healthcare providers. Title VI of the Civil Rights Act requires any organization receiving federal dollars to provide equal access to services for patients with limited English proficiency, and as a result, almost every hospital in the country must provide adequate language access.

Unfortunately, the federal requirement for the provision of language access is itself open to interpretation, with different healthcare facilities offering different levels of assistance. Professional medical interpreters are the gold standard of language assistance, but numerous studies have found that they are underutilized, even when readily available. One 2004 study, “Physician Perspectives on Communications Barriers,” suggests that the underutilization of interpreters stems from time and cost concerns, as well as a belief among many physicians that they are meeting LEP patient needs without the use of professional interpreters.

While the use of professional interpreters is essential and must be more widely embraced and encouraged, making self-administered health questionnaires available for those with limited English skills will provide a vital bridge of information to help improve the efficiency and quality of care. In some cases, the use of these forms will make the work of an interpreter more efficient, which may encourage broader use of interpreters.

Benefits of Bilingual SAHQs

Providing SAHQs in a bilingual format must then be a priority for healthcare providers. Today, questionnaires offered in a wide variety of languages can be easily accessed via the Internet. Those questionnaires that are compiled and verified by medical and language experts will offer the same benefits of the English-language SAHQs, including the following:

• Completeness of Medical Records: Bilingual questionnaires should enhance both the quality and accuracy of the medical record.
• Time Savings: SAHQs are very efficient at transferring information. Bilingual SAHQs promise even more efficiency by making the use of interpreters more effective.
• Privacy: With an interpreter present during all parts of the history and perhaps even the physical examination, a lack of privacy is at times uncomfortable for the LEP patient, and at worst, inhibitive of complete information transfer. A bilingual questionnaire offers added privacy.
• Cost Savings: Bilingual SAHQs are available at affordable prices. Their use leads to direct savings in interpreter and provider time, as well as savings associated with decreased throughput time.   
• Improved Patient and Physician Satisfaction: SAHQs have been proven to improve satisfaction levels, and bilingual questionnaires should do the same.
• Decreased Risk and Increased Quality Improvement: Bilingual SAHQs allow the provider to rapidly narrow the differential diagnosis and begin evaluation and treatment prior to the arrival of an interpreter.  
• Improved Outcomes and Patient Safety: Providers who have a better foundation of health information from an LEP patient should be able to spend more time with an interpreter on the specific details of a patient encounter.  

Given that bilingual self-administered health questionnaires are readily available, healthcare providers should make every effort to utilize them for the benefit of operational efficiency and ultimately the benefit of improved patient care and safety.

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Dr. James E. Huizenga

Board certified emergency physician who practices in Dayton, OH.  His interest in language barriers, process improvement programs, and software development led to his position as president of BiMedical.Net LLC and project lead for Language Line® BiMedical.net, an on-line bilingual questionnaire tool aimed at the healthcare segment available through Language Line Services.