Adequate clinical care is based on providing access to specialized health services and enabling patients to be able to understand their disease process and be understood.¹ The aim of this innovation is to provide linguistically and culturally tailored surgical care by establishing a Latinx Colorectal Surgery Clinic that uses an integrated team-based framework focusing on addressing limited English proficiency and accounting for health literacy while using the resources available in our institution. The clinic provides outpatient care for 1 full clinic day monthly.

Since none of the colorectal surgeons at our institution are proficient in Spanish, the interpreters on our team, in addition to their certification as Spanish medical interpreters by ALTA services, have been specifically trained to master the terminology and vocabulary pertinent to colorectal conditions and their treatments. For this, we have created an educational curriculum structured as a singular, 8-hour comprehensive session developed with the assistance of the Massachusetts Interpreter Institute. To maintain and continuously improve the interpreter care provided, recertification every 2 years is necessary, along with quarterly meetings for feedback. Furthermore, postvisit summaries are provided to all patients with an account of medical decisions and care plans adapted to their language and health literacy level. These summaries aim to enhance patient knowledge, self-management, and communication with health care professionals, with the goal of improving satisfaction and adherence to treatment.

The long-term aim is to solidify a comprehensive clinic model that is both adaptable and sustainable for other languages and health care institutions looking to serve diverse patient populations.

The strength of this clinic model consists of it being patient centered, not dependent on a single bilingual health care professional but rather on a multidisciplinary team, including a patient navigator, medical assistant, and trainees, all of whom are fluent in Spanish, so that interpreter presence is only required when the attending surgeon is present. Trainees who are bilingual undergo cultural and linguist assessment; once assessment is passed, they are invited to join the clinic. From the initial referral time, bilingual certified administrative staff coordinate all care and are available during office hours throughout the week to assist patients in scheduling and navigating their clinical care in their primary language. With the assistance of artificial intelligence, all documents are efficiently translated into their language of choice and to a literacy level that is appropriate to each patient’s health literacy assessment results.² Postvisit summaries are sent to them through a secure and encrypted digital communication platform (Doximity) as written documents and audio files, which are produced using artificial intelligence text-to-speech software (Speechify). Both the written and audio postvisit summaries are verified by medical staff. Since our inception in October 2022, we have maintained a stable team with 1 Spanish-speaking patient navigator hired by the Colon & Rectal Surgery Division for our patient base (n = 102), and our interpreters, all trained in colorectal care.

According to the 2022 Census data, the Latinx population represents 19.8% of Boston and 13.1% of Massachusetts, while the 2012-2016 American Community Survey indicates that 37.4% of Boston’s population speaks a non-English language at home. Predictions suggest that by 2035, the Latinx population in the state of Massachusetts will grow to over 1.15 million.³ In the Colorectal Surgery Division at our institution, from 2014 to 2022, 7.1% of patients were identified as having limited English proficiency, with Latinx individuals making up 30% to 40% of this group.

Our clinic team receives specialized training in cultural competence, developed in collaboration with members and resources from the Harvard Medical School’s Culturally Competent Care Education Committee. This training, comprising three 1-hour sessions, focuses on cultural sensitivity, communication strategies, and understanding diverse health beliefs, addressing both linguistic needs and cultural nuances. In colorectal surgery, communication involves detailed patient education about critical aspects such as preoperative instructions, ostomy management, and wound care. This necessitates not only linguistic proficiency but also a deep understanding of cultural nuances to ensure patients are fully informed and comfortable with their care plans.

Studies have shown that the use of trained medical interpreters can improve communication, satisfaction, and adherence to care.⁴ When language-concordant care by a medical professional is not available, interpreter-based care can achieve the same results over time if it is consistent and patients have a culturally appropriate environment during their clinic experience.⁵

There is substantial evidence highlighting the vital relevance of adjusting documents and patient education written information to different health literacy levels.⁶ Furthermore, the addition of postvisit summaries as a documented account of treatment strategies can enhance patient understanding, self-care abilities, and communication between patients and health care professionals.⁷

Moreover, postvisit summaries have been shown to improve adherence to physician recommendations, which is a key outcome desired to improve at our institution.⁸ Previous research on the usefulness of postvisit summaries shows that almost all patients find them useful during their process of care, and certain non–US-born patient populations seem to resort to them when available more often than their counterparts born in the US.⁹

As implementation outcomes, the satisfaction survey results have shown the following: on a 1-5 scale (the Patient Satisfaction Questionnaire short form), general satisfaction was rated at 4.25, interpersonal manner at 4.5, communication at 4.5, and accessibility and convenience at 3.5. A notable 84.2% of respondents strongly agreed that receiving care in Spanish improved their comfort, while 15.8% agreed. Importantly, all patients (100%) indicated a preference for receiving care in their primary language. These findings provide compelling evidence that the intervention is moving in the right direction, successfully addressing key aspects of patient satisfaction and language preferences.

Currently, our innovation is tailored to a specific patient group. We plan a 2-year evaluation of clinic operations, focusing initially on Spanish-speaking patients, who form the majority of our Latinx base. This assessment will include satisfaction rates, care processes, and clinical outcomes, aiming to refine and expand our services. After this phase, we’ll extend services to Portuguese-speaking patients.

Institutions adopting similar models should analyze their patient populations and workforce to align services with patient needs. In our case, we have used existing bilingual staff, including administrators, medical assistants, and surgical trainees, who resonate with our clinic’s mission. This approach has eliminated the need for additional hires, thus reducing implementation costs (Table).

The clinic focuses on perioperative care and is already established at our institution. Our approach to preoperative visits is specifically improving adherence to preoperative measures, such as mechanical and antibiotic bowel preparation that have been found to be low in the Latinx population at our institution. Our emphasis during the postoperative phase is on ensuring adequate pain control, promoting functional recovery for a smooth return to work, and optimizing adherence to venous thromboembolism prophylaxis. At all visits, patients receive postvisit, language-concordant written and audio summaries. These materials provide the next steps to follow after the clinic visit and an explanation of their current disease process.

Corresponding Author: Evangelos Messaris, MD, PhD, MBA, Department of Surgery, Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Gryzmich Building 6th Floor, Boston, MA 02215 (emessari@bidmc.harvard.edu).

Published Online: September 18, 2024. doi:10.1001/jamasurg.2024.1570

Conflict of Interest Disclosures: This project was funded with the 2022 Center for Healthcare Delivery Science Innovation Grant awarded to Drs Ore and Messaris, Beth Israel Deaconess Medical Center/Harvard Medical School. No other disclosures were reported.

Additional Contributions: We would like to thank Anne Fabrizio, MD, Carolina Vigna, MD, and Deric Fernandez, BS, for their ongoing support launching and developing the clinic.

Additional Information: Implementation data, cost breakdowns, and comprehensive information will be readily available at no cost to any institution that expresses an interest in adopting our clinic model. We firmly believe in the importance of sharing knowledge and resources to enhance health care delivery. Our aim is to empower institutions across the board, enabling them to implement our clinic model effectively and efficiently. Feel free to reach out to us, and we will gladly provide the necessary support and information to facilitate your implementation journey.