Bridging Language Barriers to Advance Health Care Equity in Developmental Screenings

Bridging Language Barriers to Advance Health Care Equity in Developmental Screenings 1024 575 Pam Georgiana

A QI project to utilize interpreters for screening questionnaires eliminated completion disparities between English speakers and people who prefer a language other than English.

 In primary care pediatrics, there are several standard screenings for development delay in children younger than 30 months. Nationwide Children’s Hospital has a high rate of screening completion – over 90%. However, a team of doctors at Nationwide who were concerned about equity in health care dug a little deeper into the data and found something concerning. After pulling electronic health records data from twelve pediatric primary care centers, the team discovered that the completion rate for families needing an interpreted screener was 86%. Courtney M. Brown, MD, physician in Primary Care Pediatrics, and Dane A. Snyder, MD, section chief of Primary Care Pediatrics and a professor of Pediatrics at The Ohio State University College of Medicine, led the team.

“It was not a large difference,” Dr. Brown says, “but it was a systemic difference in the level of care a certain group of people was receiving. In the interest of health equity, those sorts of small differences are not something we should accept.”

As a result of her findings, Dr. Brown implemented a quality improvement initiative at one primary care center to uncover what causes fewer completed screenings for children of families who prefer a language other than English. The hospital recently changed the standard procedure of delivering the screeners from a paper questionnaire to a digital one on a tablet. The digital questionnaire was only available in English. If a family needed a non-English screener, staff must offer them a paper version. Then, after the family complete the paper screener, a staff member must enter their data into the patient’s electronic health record. This difference in standard workflow caused some families to fall through the cracks when clinics became busy.

With these insights, Dr. Brown and the team applied basic quality improvements to the standard screener process, including using interpreters instead of paper questionnaires for families needing assistance. The nurses verbally asked the questions via an interpreter and recorded the answers directly into the electronic health record.

“The new process added some time to the intake process for our staff, but we were able to eliminate other redundant tasks to speed things up a little. In the end, the team felt it was the right thing to do for our patients.” Dr. Brown says.

This simple change increased the completion rate for patients needing interpreters from 86% to 93%. Screening completion for patients not needing interpreters remained at 92%.[1] “We were able to eliminate a systemic disparity certain families were experiencing,” says Dr. Brown. “Many of our patients rely on our language services, so it is important to uncover these gaps so that we can close them.”

Dr. Brown’s next step is to study what happens when a screening finds a developmental issue. For example, for patients who need speech therapy, she would like to review how many families who prefer a language other than English scheduled and attended further evaluation and/or received treatment.

“Even with interpretation services, language barriers can cause hesitancy and confusion. I want to ensure that we are really clear with families when further care is needed. It’s important that families understand what happens next and who to talk to,” Dr. Brown says.

Nationwide’s focus on health equity started years ago with the creation of the Office for Health Equity, addressing the differences many patients experience when receiving healthcare. Dr. Brown is proud to be a part of that team. She says, “Even though our overall screening data looked good, we know it was worth looking at more closely to see if subgroups of people were not receiving equitable care. Because we did, we will help more families in the future.”



Brown CM, Dillon B, Toth C, et al. Quality Improvement to Eliminate Disparities in Developmental Screening for Patients Needing Interpreters. Pediatric Quality and Safety. 2023;8(4):e679. Published 2023 Aug 7.

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.