Project Details - Ongoing
Grant Number:R01 HS024949
- Funding Mechanism(s):
AHRQ Funded Amount:$1,912,757
- Principal Investigator(s):
- Project Dates:9/30/2016 to 7/31/2022
- Care Setting:
- Medical Condition:
- Type of Care:
- Health Care Theme:
Individuals of minority groups are medically underserved in the United States, and those with limited English proficiency (LEP) have the most limited access to health care and mental health services. Lack of available translation services contributes to poor health care access and utilization for LEP patients, who have higher rates of hospital admissions, misdiagnosis, improper treatment, and poorer health comprehension and outcomes. In psychiatry, diagnosis, assessment, and treatment relies more heavily on speech and communication than in other medical specialties, and even well-trained interpreters can have difficulty interpreting some psychiatric symptoms, especially those of psychosis. Live interpreters are not always available, and certification of their training level is not mandated. Even with interpreters present, LEP hampers a patient’s understanding of health care providers’ instructions, explanations, and history-taking questions.
This project aims to improve access to high-quality mental health services for diverse populations by improving the flow of clinical work across care settings, primary, and specialty care, using online asynchronous methods of communicating. The investigators have previously shown that the use of Asynchronous Telepsychiatry (ATP)—a virtual mental health visit—is a more rapid and efficient way for primary care providers to gain access to psychiatric expertise. The project team is now building an automated language translation process into the ATP system to allow clinical evaluations to occur across languages without the use of human interpreters. In this current study, after the early phase of further tool development and testing, the project will compare two methods of cross-language psychiatric assessment:
- Method A (current gold standard of in-person real-time interpreting practice): A Spanish-speaking patient is diagnostically assessed in person by an English-speaking psychiatrist through a Spanish-speaking interpreter.
- Method B (comparative practice – ATP): A Spanish-speaking patient is interviewed in Spanish by a trained mental health interviewer. The interview is recorded in real time, translated into English with sub-titles added to the video file, and sent to an English-speaking psychiatrist to asynchronously—that is, at a later time—review the video and make a diagnosis.
All patients will undergo evaluation by both methods. Half of the patients will be randomized to be assessed by Method A first, followed by Method B and half to be assessed by Method B first, followed by Method A.
The specific aims of this project are as follows:
- Iteratively evaluate and refine the automated asynchronous interpretation tool already developed in prior studies.
- Compare patient satisfaction of Method A versus Method B.
- Compare the diagnostic accuracy and psychiatrist inter-rater reliability of Method A versus Method B and demonstrate psychiatrist inter-rater reliability for Method B.
- Compare the interview and language interpretation quality and accuracy of Method A versus Method B.
This project has the potential to expand clinical capacity by reducing the need for onsite interpretation services. While the project is focused on Spanish-speaking patients in the field of psychiatry, this technical approach can be generalized toward primary care and other medical disciplines and could be applied to other languages.