Inclusion of language preference in clinical o ne-Liners and its association with use and documentation of interpreter services among inpatients with non-English language preference

Patients with non-English language preference (NELP) experience disparities in care quality and outcomes, often due to underuse of professional interpreter services. One proposed strategy to address this gap is incorporating patients’ language preference into prominent sections of clinical documentation, such as the one-liner (OL) of clinical notes. Whether this approach is associated with increased subsequent use and documentation of professional interpreter services has not been empirically evaluated. We conducted a retrospective cohort study of 2,336 general medicine admissions for 1,487 adult patients with self-reported NELP at a large academic medical center between January 1, 2019, and December 31, 2023. We used natural language processing and large language model tools to identify the presence language preference in the OL of admitting H&P notes and to extract documentation of interpreter services use from clinical notes. The primary outcome was the rate of interpreter service encounters per admission-day. Secondary outcomes included note-based documentation of interpreter services use. Multilevel binomial and logistic regression models adjusted for demographics and clinical characteristics. Language preference was documented in the OL of H&P notes in 21.2% of admissions. In adjusted analyses, inclusion of language preference in the OL was associated with 16% higher rate of interpreter service encounters per admission-day (adjusted incidence rate ratio [AIRR] 1.16, 95% CI 1.03–1.31) and increased odds of interpreter services use documentation across all notes (adjusted odds ratio [AOR], 1.71; 95% CI 1.40–2.08). Effect modification by language was observed for documentation outcomes, with higher odds observed among non-Spanish-speaking patients (AOR, 2.96; 95% CI, 2.18–4.01). Inclusion of a patient’s language preference in the OL of an admitting note was associated with higher interpreter encounter rates and improved documentation during hospitalization. Incorporating language preference into core clinical documentation, alongside existing EHR flags, may represent a scalable, low-burden approach associated with increased interpreter engagement. Prospective studies are needed to evaluate whether this practice improves patient-centered outcomes and can be implemented consistently across care settings.