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Cordova-Ramos EG, Kerr S, Kalluri NS, Ho T, Austad K, Drainoni ML, Parker MG. Communication Practices for Families With Languages Other Than English in US Neonatal Care Units. Hosp Pediatr 2024:e2023007607. [PMID: 39143920 DOI: 10.1542/hpeds.2023-007607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND AND OBJECTIVES The lack of provision of culturally and linguistically appropriate services (CLAS) to families with languages other than English (LOE) is a highly modifiable driver of health care inequities. In a nationally representative sample of level 2 to 4 US NICUs, we examined patterns and predictors of communication practices for families with LOE and ascertained clinical leaders' beliefs about barriers to CLAS provision. METHODS We surveyed clinical leaders from 500 randomly selected US NICUs. Responses were weighted by the number of eligible NICUs per region and nonresponse rates. Outcomes included: consistent parental language documentation (≥75% of the time versus <75%) and consistent professional interpreter use (in-person or remote interpretation ≥75% of the time versus <75%). We used logistic regression to examine the associations of predictors (region, hospital characteristics, and the proportion of racial and ethnic minority and families with LOE served) with outcomes. RESULTS The overall response rate was 34%. A total of 63% of NICUs collected parental language data consistently, and 41% used interpreters consistently. Patterns of interpreter use varied by service hours and type of communication event. Teaching status, highest level of neonatal care, and larger NICU size were associated with consistent language documentation. Only a larger NICU size was associated with consistent interpreter use. Barriers to CLAS provision included untimely access to interpreter services and suboptimal quality of certain interpretation modalities. CONCLUSIONS Implementation guidance, accountability for compliance with existing mandates, and interventions tailored to the NICU context are needed to reduce linguistic disparities.
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Affiliation(s)
- Erika G Cordova-Ramos
- Department of Pediatrics, Boston Medical Center
- Evans Center for Implementation and Improvement Sciences, Department of Medicine
| | | | - Nikita S Kalluri
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Timmy Ho
- Deparment of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kirsten Austad
- Evans Center for Implementation and Improvement Sciences, Department of Medicine
- Department of Family Medicine, Boston Medical Center
| | - Mari-Lynn Drainoni
- Evans Center for Implementation and Improvement Sciences, Department of Medicine
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Margaret G Parker
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Strechen I, Wilson P, Eltalhi T, Piche K, Tschida-Reuter D, Howard D, Sutor B, Tiong I, Herasevich S, Pickering B, Barwise A. Harnessing health information technology to promote equitable care for patients with limited English proficiency and complex care needs. Trials 2024; 25:450. [PMID: 38961501 PMCID: PMC11223355 DOI: 10.1186/s13063-024-08254-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Patients with language barriers encounter healthcare disparities, which may be alleviated by leveraging interpreter skills to reduce cultural, language, and literacy barriers through improved bidirectional communication. Evidence supports the use of in-person interpreters, especially for interactions involving patients with complex care needs. Unfortunately, due to interpreter shortages and clinician underuse of interpreters, patients with language barriers frequently do not get the language services they need or are entitled to. Health information technologies (HIT), including artificial intelligence (AI), have the potential to streamline processes, prompt clinicians to utilize in-person interpreters, and support prioritization. METHODS From May 1, 2023, to June 21, 2024, a single-center stepped wedge cluster randomized trial will be conducted within 35 units of Saint Marys Hospital & Methodist Hospital at Mayo Clinic in Rochester, Minnesota. The units include medical, surgical, trauma, and mixed ICUs and hospital floors that admit acute medical and surgical care patients as well as the emergency department (ED). The transitions between study phases will be initiated at 60-day intervals resulting in a 12-month study period. Units in the control group will receive standard care and rely on clinician initiative to request interpreter services. In the intervention group, the study team will generate a daily list of adult inpatients with language barriers, order the list based on their complexity scores (from highest to lowest), and share it with interpreter services, who will send a secure chat message to the bedside nurse. This engagement will be triggered by a predictive machine-learning algorithm based on a palliative care score, supplemented by other predictors of complexity including length of stay and level of care as well as procedures, events, and clinical notes. DISCUSSION This pragmatic clinical trial approach will integrate a predictive machine-learning algorithm into a workflow process and evaluate the effectiveness of the intervention. We will compare the use of in-person interpreters and time to first interpreter use between the control and intervention groups. TRIAL REGISTRATION NCT05860777. May 16, 2023.
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Affiliation(s)
- Inna Strechen
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, MN, USA.
| | - Patrick Wilson
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Targ Eltalhi
- Language Services, Mayo Clinic, Rochester, MN, USA
| | | | | | - Diane Howard
- Language Services Operations Administrator, Mayo Clinic, Rochester, MN, USA
| | - Bruce Sutor
- Department of Psychiatry and Psychology and Medical Director of Language Services, Mayo Clinic, Rochester, MN, USA
| | - Ing Tiong
- Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Svetlana Herasevich
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, MN, USA
| | - Brian Pickering
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, MN, USA
| | - Amelia Barwise
- Biomedical Ethics Research Program and Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Satterwhite S, Nguyen MLT, Honcharov V, McDermott AM, Sarkar U. "Good Care Is Slow Enough to Be Able to Pay Attention": Primary Care Time Scarcity and Patient Safety. J Gen Intern Med 2024; 39:1575-1582. [PMID: 38360962 PMCID: PMC11255151 DOI: 10.1007/s11606-024-08658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND There is growing, widespread recognition that expectations of US primary care vastly exceed the time and resources allocated to it. Little research has directly examined how time scarcity contributes to harm or patient safety incidents not readily capturable by population-based quality metrics. OBJECTIVE To examine near-miss events identified by primary care physicians in which taking additional time improved patient care or prevented harm. DESIGN Qualitative study based on semi-structured interviews. PARTICIPANTS Twenty-five primary care physicians practicing in the USA. APPROACH Participants completed a survey that included demographic questions, the Ballard Organizational Temporality Scale and the Mini-Z scale, followed by a one hour qualitative interview over video-conference (Zoom). Iterative thematic qualitative data analysis was conducted. KEY RESULTS Primary care physicians identified several types of near-miss events in which taking extra time during visits changed their clinical management. These were evident in five types of patient care episodes: high-risk social situations, high-risk medication regimens requiring patient education, high acuity conditions requiring immediate workup or treatment, interactions of physical and mental health, and investigating more subtle clinical suspicions. These near-miss events highlight the ways in which unreasonably large patient panels and packed schedules impede adequate responses to patient care episodes that are time sensitive and intensive or require flexibility. CONCLUSIONS Primary care physicians identify and address patient safety issues and high-risk situations by spending more time than allotted for a given patient encounter. Current quality metrics do not account for this critical aspect of primary care work. Current healthcare policy and organization create time scarcity. Interventions to address time scarcity and to measure its prevalence and implications for care quality and safety are urgently needed.
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Affiliation(s)
- Shannon Satterwhite
- Department of Family and Community Medicine, UC Davis Health, Sacramento, CA, USA
| | - Michelle-Linh T Nguyen
- Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Vlad Honcharov
- Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Aoife M McDermott
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
- Aston University, Birmingham, UK
| | - Urmimala Sarkar
- Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
- UCSF Pride Hall, San Francisco, CA, USA.
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Douglas KE, Fox MT, Cheston CC, Behara ML, Schoppel KA. Improving Interpreter Access in the Pediatric Emergency Department: A Quality Improvement Initiative. Pediatr Qual Saf 2024; 9:e748. [PMID: 38993271 PMCID: PMC11236402 DOI: 10.1097/pq9.0000000000000748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 06/19/2024] [Indexed: 07/13/2024] Open
Abstract
Background An increasing proportion of the population in the United States have limited English proficiency (LEP). Hospitals that receive federal funding must offer interpreter services. However, access is often lacking for patients. Patients with LEP are at higher risk for adverse events, and the Emergency Department is a particularly high-risk environment for these events. Methods This quality improvement initiative took place from April 2021 to August 2022 in an urban, tertiary care Pediatric Emergency Department. A driver diagram informed four Plan-Do-Study-Act cycles, and data were collected through medical record review, patient surveys, and staff surveys. We tracked outcomes using run and control chart data. Results During the study period, the proportion of patients with LEP reporting "always" having an interpreter was unchanged (no centerline shift-control chart rules). Documentation of interpreter use for encounters with patients with LEP improved. Preferred language documentation and documentation of the need for an interpreter in the electronic medical record showed no change. Process measure data for staff-reported use of professional interpreters significantly increased, and the use of ad hoc interpreters decreased significantly. Length of stay did not change for English or LEP patients. Conclusions This quality improvement initiative improved appropriate documentation of LEP and decreased use of nonqualified interpreters, although no change occurred in the proportion of patients who reported always having an interpreter. Patient satisfaction was unaffected.
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Affiliation(s)
- Katherine E. Douglas
- From the Division of Emergency Medicine, Boston Children’s Hospital, Boston, Mass
| | - Miriam T. Fox
- Division of Cardiology, Boston Children’s Hospital, Boston, Mass
| | - Christine C. Cheston
- Boston University Chobanian and Avedisian School of Medicine, Boston, Mass
- Department of Pediatrics, Boston Medical Center, Boston, Mass
| | - M. Laxmi Behara
- Boston University Chobanian and Avedisian School of Medicine, Boston, Mass
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Glass S, Klein MJ, Derrington S, Kamerkar A. Caregiver Satisfaction with Medical Providers' Communication: Comparison Between Spanish-Speaking Caregivers with Limited English Proficiency (LEP) and Caregivers Who Are English-Proficient (EP). J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02029-6. [PMID: 38809467 DOI: 10.1007/s40615-024-02029-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/18/2024] [Accepted: 05/12/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVES Barriers to communication have been observed with patients and families who prefer a language other than English for medical conversations, referred to as individuals with limited English proficiency (LEP). We used the pediatric Family Satisfaction with ICU 24R (FS-ICU) survey to assess communication satisfaction for English-proficient (EP) and Spanish-speaking LEP caregivers. We added additional questions related to attendance at morning rounds, frequency of provider updates, interpreter use, and general satisfaction with communication. METHODS This was a single-center, prospective, observational cohort study in the pediatric intensive care unit (PICU) and cardiothoracic intensive care unit (CICU) of a tertiary, academic, free-standing children's hospital. Caregivers of children < 18 years old admitted for at least 48 h to the PICU or CICU between June and September 2022 were eligible for enrollment. MEASUREMENTS AND MAIN RESULTS 24 LEP and 74 EP caregivers completed the survey questions. The LEP group had lower household income and education levels and higher incidence of public insurance. FS-ICU scores for both LEP and EP caregivers suggested high satisfaction, without significant difference between the groups. However, qualitative analysis revealed dissatisfaction for LEP caregivers related to information, inclusion, and language barriers. EP caregivers had more positive references to information and emotional connection but indicated dissatisfaction around consistency and responsiveness. 18% of LEP caregivers reported regularly attending rounds, versus 67% of the EP group (p value < .001). 39% of LEP versus 52% of EP caregivers reported multiple daily updates, although the difference was not statistically significant. 29% of LEP respondents reported nonfluent MD/NPs using an interpreter never, rarely, or some of the time. CONCLUSIONS There was no difference in satisfaction scores between LEP and EP caregivers. LEP caregivers had lower socioeconomic status based on public insurance and reported income and education level. Qualitative data allowed more nuanced understanding of communication satisfaction, which correlated with LEP caregivers' reported lower attendance at morning rounds, inconsistent interpreter use, and a trend toward less frequent provider updates.
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Affiliation(s)
- Susan Glass
- Division of Pediatric Critical Care Medicine, Children's Hospital New Orleans, 200 Henry Clay Ave, New Orleans, LA, 70118, USA.
- LSU School of Medicine, Louisiana State University, New Orleans, LA, USA.
| | - Margaret J Klein
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Sabrina Derrington
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Asavari Kamerkar
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Arya AN, Hyman I, Holland T, Beukeboom C, Tong CE, Talavlikar R, Eagan G. Medical Interpreting Services for Refugees in Canada: Current State of Practice and Considerations in Promoting this Essential Human Right for All. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:588. [PMID: 38791802 PMCID: PMC11121150 DOI: 10.3390/ijerph21050588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 05/26/2024]
Abstract
Language barriers, specifically among refugees, pose significant challenges to delivering quality healthcare in Canada. While the COVID-19 pandemic accelerated the emergence and development of innovative alternatives such as telephone-based and video-conferencing medical interpreting services and AI tools, access remains uneven across Canada. This comprehensive analysis highlights the absence of a cohesive national strategy, reflected in diverse funding models employed across provinces and territories, with gaps and disparities in access to medical interpreting services. Advocating for medical interpreting, both as a moral imperative and a prudent investment, this article draws from human rights principles and ethical considerations, justified in national and international guidelines, charters, codes and regulations. Substantiated by a cost-benefit analysis, it emphasizes that medical interpreting enhances healthcare quality and preserves patient autonomy. Additionally, this article illuminates decision-making processes for utilizing interpreting services; recognizing the pivotal roles of clinicians, interpreters, patients and caregivers within the care circle; appreciating intersectional considerations such as gender, culture and age, underscoring the importance of a collaborative approach. Finally, it provides recommendations at provider, organizational and system levels to ensure equitable access to this right and to promote the health and well-being of refugees and other individuals facing language barriers within Canada's healthcare system.
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Affiliation(s)
- Akshaya Neil Arya
- Department of Family Medicine, McMaster University, Hamilton, ON L8S 3L8, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
- Kitchener-Waterloo Centre for Family Medicine Refugee Health Clinic, Kitchener, ON N2G 1C5, Canada;
| | - Ilene Hyman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
| | - Tim Holland
- Department of Bioethics, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Newcomer Health Clinic, Halifax, NS B3L 4P1, Canada
| | - Carolyn Beukeboom
- Kitchener-Waterloo Centre for Family Medicine Refugee Health Clinic, Kitchener, ON N2G 1C5, Canada;
- Arthur Labatt Family School of Nursing, Western University, London, ON N6A 3K7, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Catherine E. Tong
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Rachel Talavlikar
- Department of Family Medicine, University of Calgary, Calgary, AB T3H 0N9, Canada;
- Mosaic Refugee Health Clinic, Calgary, AB T2A 5H5, Canada
| | - Grace Eagan
- Language Services & Digital Strategy, Access Alliance Multicultural Health & Community Services, Toronto, ON M5T 3A9, Canada;
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Valle Coto MG, Iñiguez RX, Lentskevich MA, Ally SA, Farfan JF, Park YS, Gangopadhyaya AG, Ortega P. Teaching foundational language equity concepts in the pre-clinical curriculum. BMC MEDICAL EDUCATION 2024; 24:485. [PMID: 38698378 PMCID: PMC11064417 DOI: 10.1186/s12909-024-05474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/26/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Despite the prevalence of non-English languages in the US population, existing medical training to teach communication with linguistically diverse communities is limited to electives or solely focuses on medical interpreting. Language-appropriate communication skills are seldom comprehensively integrated in medical education. This study describes the development and evaluation of an intervention to teach foundational language equity concepts. METHODS The authors implemented a pre-clinical language equity course at three medical school campuses between August 2020 and March 2022. Sessions focused on the impact of language in health, physician language proficiency standards, and working with medical interpreters. The study sought to (1) understand students' language skills and prior clinical experiences with patients with non-English language preference and (2) evaluate the curriculum's impact. Students self-reported their language skills and experiences as part of a voluntary pre-questionnaire. Pre and post-questionnaires evaluated knowledge, attitudes, and intent to apply language equity concepts. Descriptive statistics and chi-squared tests were used to examine trends; themes were identified from free-text responses. RESULTS Overall, 301 students completed the course, 252 (83%) completed at least one questionnaire; for each session, between 35% and 46% of learners completed both pre and post-questionnaires. Three quarters (189/252) reported non-English languages. Over half (138/252) reported previous non-English language patient care, and 28% (62/224) had served as ad hoc (untrained) interpreters. Only two students (< 1%) had ever been assessed for medical language abilities. Students demonstrated improved post-course language equity knowledge, strategies for interpreter-mediated encounters, and likelihood to report a plan for language skills assessment (all p < .001). Most plans were multifaceted (61%, 38/62), involving goals like completing a language course, taking a proficiency exam, openly discussing skills and uncertainties with team members, and increasing professional interpreter utilization. CONCLUSIONS A longitudinal language equity curriculum can be feasibly integrated in pre-clinical education, highlight the linguistic diversity of the student body, and serve as a first step in ensuring that all students have a strong language equity foundation prior to clinical rotations. Future steps include evaluating the intervention's potential long-term effects on professional interpreter utilization, student clinical performance, and institutional culture that promotes multilingualism.
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Affiliation(s)
| | | | - Marina A Lentskevich
- Department of Medical Education, University of Illinois College of Medicine, 808 S. Wood Street, MC 591, Chicago, IL, 606012, USA
| | - Syeda Akila Ally
- Department of Medical Education, University of Illinois College of Medicine, 808 S. Wood Street, MC 591, Chicago, IL, 606012, USA
| | - Julia F Farfan
- Department of Medical Education, University of Illinois College of Medicine, 808 S. Wood Street, MC 591, Chicago, IL, 606012, USA
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois College of Medicine, 808 S. Wood Street, MC 591, Chicago, IL, 606012, USA
| | - Ananya G Gangopadhyaya
- Department of Medical Education, University of Illinois College of Medicine, 808 S. Wood Street, MC 591, Chicago, IL, 606012, USA
| | - Pilar Ortega
- Department of Medical Education, University of Illinois College of Medicine, 808 S. Wood Street, MC 591, Chicago, IL, 606012, USA.
- Department of Diversity, Equity, and Inclusion, Accreditation Council for Graduate Medical Education, Chicago, IL, USA.
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Cooke P, Morales-Alemán MM, Ferreti G. Healthcare Provider Perceptions of the Use of Medical Interpretation in Primary Care. South Med J 2024; 117:221-225. [PMID: 38701841 PMCID: PMC11168477 DOI: 10.14423/smj.0000000000001680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
OBJECTIVES Sixty-three percent of Latinos/as/x in Alabama, speak English "not well" or "not at all." Effective provider-patient communication is the foundation of successful clinical interactions. Medical interpretation is important to the healthcare provision for patients with limited English proficiency (LEP). We examined Alabama providers' perceptions of working with medical interpreters to identify strategies to improve healthcare provision for LEP patients. METHODS We conducted nine semistructured qualitative interviews with primary healthcare providers in western Alabama. We used NVivo to conduct thematic coding and content analysis. RESULTS Of the nine providers, one self-identified as Latina and the others identified as White. Four participants worked in community clinics and five worked at university-based clinics. Four themes emerged: preference for in-person interpreters over technology-based interpretation; providers' perceptions and expectations of the roles of professional interpreters; challenges in the communication process; and use of family members or other ad hoc interpreters. CONCLUSIONS To meet the needs of Latino/a/x communities, clinical settings should invest in adequate staffing of in-person interpreters, infrastructure and workflow improvements, and the hiring and training of polylingual providers. Capacity-building opportunities to establish team building between interpreters and providers could be useful tools in improving healthcare provision for LEP patients.
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Affiliation(s)
- Paris Cooke
- University of Alabama at Birmingham School of Medicine, Birmingham
| | | | - Gwendolyn Ferreti
- Department of Peace and Social Justice Studies, Berea College, Berea, Kentucky
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Gong H, Liu X, Xiong H, Yang Y. Non-professional Medical Interpreting as a Contextualized Practice: Chinese Volunteer Interpreters' Role-Spaces in Mediating Provider-Patient Conflicts Amid the Pandemic. HEALTH COMMUNICATION 2024; 39:15-24. [PMID: 36444114 DOI: 10.1080/10410236.2022.2152215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Non-professional medical interpreters are frequent participants of bilingual health communication. Yet, scholarly attention paid to this group's roles in less routinized medical encounters is insufficient. Adopting the concept of "role-space," this study explores volunteer medical interpreters' (VMIs) roles in mediating provider-patient conflicts at a designated hospital tasked to admit and treat foreign patients in City Y, China. In-depth interviews with eight VMIs, two doctors, two patients, and one Foreign Affairs officer indicate that VMIs took on the roles of provider proxy, patient advocates, information gatekeepers, and emotional supporters while navigating through challenges at the macro-, meso- and micro-level; Their practices led to four role-spaces that featured high presentation of VMIs' self-driven actions during dyadic communication with patients only and, in most cases, minimal interaction management and participant alignment in provider-patient encounters.
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Affiliation(s)
- He Gong
- Research Center of Journalism and Social Development, School of Journalism and Communication, Renmin University of China
| | - Xiyuan Liu
- Department of Communication, University of Colorado Denver
| | - Hui Xiong
- School of Journalism and Communication, Xiamen University
| | - Yiting Yang
- School of Journalism and Communication, Xiamen University
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10
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Tse G, Kuzma N, Khan A. Perspective: Artificial intelligence and patient communication. J Hosp Med 2024. [PMID: 38340353 DOI: 10.1002/jhm.13301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/21/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Gabriel Tse
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nicholas Kuzma
- Section of Hospital Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
| | - Alisa Khan
- Department of Pediatrics, Divison of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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11
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Chan BMC, Suurmond J, van Weert JCM, Schouten BC. Uncovering communication strategies used in language-discordant consultations with people who are migrants: Qualitative interviews with healthcare providers. Health Expect 2024; 27:e13949. [PMID: 39102688 PMCID: PMC10750019 DOI: 10.1111/hex.13949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/13/2023] [Accepted: 12/12/2023] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Global migration has led to a sharp increase in the number of language-discordant consultations (LDCs) in healthcare. Evidence on how healthcare providers (HCPs) meet migrant patients' needs while mitigating language barriers is lacking. DESIGN Using purposive and snowball sampling, we recruited twenty-seven Dutch HCPs (Mage = 45.07, SD = 11.46) and conducted semi-structured interviews to collect qualitative, open-ended data for identifying the communication strategies used with migrant patients in LDCs. We analysed the transcripts using deductive and inductive approaches (e.g., constant comparative method from Grounded Theory). Final pattern codes (i.e., key themes) were discussed among the research team until mutual agreement had been achieved. RESULTS Five key themes emerged from the analyses: HCPs often 'got-by' with (1) instrumental and (2) affective communication strategies used in language-concordant consultations to start medical consultations. When some instrumental communication strategies were deemed ineffective (e.g., lingua franca, gesturing, etc.) to bridge language barriers, HCPs turned to (3) incorporating digital tools (e.g., Google Translate). When HCPs were unable to communicate with migrant patients at all, (4) informal, ad-hoc and professional interpreters were involved. Finally, HCPs often (5) involved additional support to engage migrant patients to engage in treatment-related behaviours. DISCUSSION AND CONCLUSIONS Our results highlight the importance of raising awareness among HCPs about using various combinations of different strategies. The development of a guideline indicating the optimal combination of communication strategies for different medical consultation goals may be useful in reshaping the current communication behaviour of HCPs in LDCs. PATIENT OR PUBLIC CONTRIBUTION HCPs were the study population involved in this qualitative study. Refugee health advisors, general practitioners and linguistic specialists (i.e., members of the Right2Health consortium) with experience with the Dutch healthcare system were involved throughout the development of this research. This includes a review of the research question, participant information sheet and interview topic guide as well as providing interpretations of the data and feedback to this manuscript.
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Affiliation(s)
- Brittany M. C. Chan
- Department of Communication Science, Amsterdam School of Communication Science (ASCoR)University of AmsterdamAmsterdamThe Netherlands
| | - Jeanine Suurmond
- Department of Public and Occupational Health, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Julia C. M. van Weert
- Department of Communication Science, Amsterdam School of Communication Science (ASCoR)University of AmsterdamAmsterdamThe Netherlands
| | - Barbara C. Schouten
- Department of Communication Science, Amsterdam School of Communication Science (ASCoR)University of AmsterdamAmsterdamThe Netherlands
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Gutman CK, Portillo EN, Lion KC. Access and Inequities: Differential Effects of Digital Access by Race, Ethnicity, and Language. J Pediatr 2024; 265:113825. [PMID: 37977330 PMCID: PMC10872506 DOI: 10.1016/j.jpeds.2023.113825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Colleen K. Gutman
- Departments of Emergency Medicine and Pediatrics, University of Florida College of Medicine, Gainesville, Fl
| | - Elyse N. Portillo
- Division of Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - K. Casey Lion
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA
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13
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Sharfuddin N, Mathura P, Mac A, Ling E, Tan M, Khatib E, Suranyi Y, Kassam N. Advancing language concordant care: a multimodal medical interpretation intervention. BMJ Open Qual 2024; 13:e002511. [PMID: 38232982 PMCID: PMC10806550 DOI: 10.1136/bmjoq-2023-002511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Ensuring language concordant care through medical interpretation services (MIS) allows for accurate information sharing and positive healthcare experiences. The COVID-19 pandemic led to a regional halt of in-person interpreters, leaving only digital MIS options, such as phone and video. Due to longstanding institutional practices, and lack of accessibility and awareness of these options, digital MIS remained underused. A Multimodal Medical Interpretation Intervention (MMII) was developed and piloted to increase digital MIS usage by 25% over an 18-month intervention period for patients with limited English proficiency. METHODS Applying quality improvement methodology, an intervention comprised digital MIS technology and education was trialled for 18 months. To assess intervention impact, the number of digital MIS minutes was measured monthly and compared before and after implementation. A questionnaire was developed and administered to determine healthcare providers' awareness, technology accessibility and perception of MIS integration in the clinical workflow. RESULTS Digital MIS was used consistently from the beginning of the COVID-19 pandemic (March 2020) and over the subsequent 18 months. The total number of minutes of MIS use per month increased by 44% following implementation of our intervention. Healthcare providers indicated that digital MIS was vital in facilitating transparent communication with patients, and the MMII ensured awareness of and accessibility to the various MIS modalities. CONCLUSION Implementation of the MMII allowed for an increase in digital MIS use in a hospital setting. Providing digital MIS access, education and training is a means to advance patient-centred and equitable care by improving accuracy of clinical assessments and communication.
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Affiliation(s)
- Nazia Sharfuddin
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Harvard Medical School, Boston, Massachusetts, USA
| | - Pamela Mathura
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Amanda Mac
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Emily Ling
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Merve Tan
- Medicine, Koc Universitesi, Istanbul, Turkey
| | - Emad Khatib
- Inonu University School of Medicine, Malatya, Turkey
| | | | - Narmin Kassam
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
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14
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Bakillah E, Finn CB, Sharpe J, Kelz RR. The effect of Section 1557 of the Affordable Care Act on surgical outcomes in non-English primary language speakers. Am J Surg 2024; 227:189-197. [PMID: 37852843 DOI: 10.1016/j.amjsurg.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/01/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND In 2016, Section 1557 mandated use of qualified language interpreter services. We examined the effect of Section 1557 on surgical outcomes. METHODS Utilizing the Healthcare Cost and Utilization Project State Inpatient Database (2013-2020), we performed a difference-in-differences analysis of adult surgical patients (Maryland, New Jersey). The exposure was implementation of Section 1557 (pre-period: 2013-2015; post-period: 2017-2020). The treatment group was non-English primary language speakers (n-EPL). The comparison group was English primary language speakers (EPL). Outcomes included length-of-stay, postoperative complications, mortality, discharge disposition, and readmissions. RESULTS Among 2,298,584 patients, 198,385 (8.6%) were n-EPL. After implementation of Section 1557, n-EPL saw no difference in readmission rates but did experience significantly higher rates of mortality (+0.43%, p = 0.049) and non-routine discharges (+1.81%, p = 0.031) in Maryland, and higher rates of post-operative complications (+0.31%, p = 0.001) in both states, compared to pre-Section 1557. CONCLUSIONS Contrary to our hypothesis, Section 1557 did not improve surgical outcomes for n-EPL.
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Affiliation(s)
- Emna Bakillah
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Caitlin B Finn
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - James Sharpe
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel R Kelz
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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15
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Pruskil S, Fiedler J, Pohontsch NJ, Scherer M. Experiences with remote interpreting tools in primary care settings: a qualitative evaluation of the implementation and usage of remote interpreting tools during a feasibility trial in Germany. BMJ Open 2023; 13:e073620. [PMID: 37963703 PMCID: PMC10649768 DOI: 10.1136/bmjopen-2023-073620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE This study aims to evaluate the usage and implementation of video remote (VR) interpreting and telephone remote (TR) interpreting in primary healthcare settings. DESIGN This publication forms part of a larger three-pronged study in which we compared both remote interpreting modalities to each other and to a control group. This paper conveys the findings of the qualitative evaluation of the implementation and usage of both remote interpreting solutions. The quantitative evaluation of the 6-month intervention period (September 2018-February 2019) has been reported previously. After this period, we conducted focus groups with the healthcare professionals involved. The focus groups were recorded, transcribed verbatim and analysed using the structured qualitative content analysis. SETTING We provided either VR or TR tools to 10 different primary healthcare practices (general medicine, gynaecology and paediatrics) in the city of Hamburg, Germany. PARTICIPANTS Three physicians and two physician's assistants took part in the TR focus group. The VR focus group consisted of four physicians. RESULTS The main topics identified were the importance of communication for diagnostic and therapeutic processes, previous solutions to language barriers, as well as advantages and disadvantages of the two remote interpreting solutions. Advantages included the possibility to adequately communicate with language discordant patients and the high quality of the interpreting. Disadvantages included the habituation time required for new technology as well as time constraints. CONCLUSION Our evaluation found that these solutions were highly appreciated, if not considered indispensable, for the delivery of appropriate medical care to language-discordant patients. Differences between the two modalities were named and concrete suggestions for improvement were made. Policy-makers should consider providing VR or TR as an adequate and safe interpreting service alternative when professional in-person interpreters are not available or too expensive.
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Affiliation(s)
- Susanne Pruskil
- Department of Public Health, Altona, Hamburg, Germany
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Fiedler
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nadine Janis Pohontsch
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Gilbert AS, Antoniades J, Hwang K, Gonzalez E, Hlavac J, Enticott J, Lin X, Woodward-Kron R, Low LF, LoGiudice D, White J, Cavuoto MG, Brijnath B. The MINDSET Study: Co-Designing Training for Interpreters in Dementia and Cognitive Assessments. DEMENTIA 2023; 22:1604-1625. [PMID: 37455144 DOI: 10.1177/14713012231190578] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
There is a growing demand for interpreter-mediated cognitive assessments for dementia. However, most interpreters lack specialist knowledge of dementia and cognitive assessment tools. This can negatively affect the way instructions and responses are conveyed between clinicians and patients, undermining clinicians' ability to accurately assess for cognitive impairment. This article reports on the co-design of an online dementia training package, MINDSET, which aims to address this gap. Two iterative online co-design workshops were conducted in October and November 2021, using a World Café approach. Sixteen clinicians, interpreters, and multilingual family carers of a person with dementia participated. Based on these workshops, training and assessment materials were developed and tested with 12 interpreters from April to June 2022. The training package comprises online modules: 1) Knowledge of Dementia and Australia's Aged Care System, 2) Briefings and Introductions, 3) Interpreting Skills, 4) Interpreting Ethics, and 5) Cross-cultural Communication. The codesign process highlighted divergent perspectives between clinicians and interpreters on an interpreter's role during a cognitive assessment, but it also facilitated negotiation and consensus building, which enriched the training content. The training is now developed and will be evaluated in a randomized control trial and subsequent implementation study.
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Affiliation(s)
- Andrew S Gilbert
- National Ageing Research Institute, Parkville, VIC, Australia
- La Trobe University, Bundoora, VIC, Australia
| | - Josefine Antoniades
- National Ageing Research Institute, Parkville, VIC, Australia
- Monash University, Clayton, VIC, Australia
| | - Kerry Hwang
- National Ageing Research Institute, Parkville, VIC, Australia
- University of Melbourne, Parkville, VIC, Australia
| | | | - Jim Hlavac
- Monash University, Clayton, VIC, Australia
| | | | | | | | - Lee-Fay Low
- University of Sydney, Sydney, NSW, Australia
| | - Dina LoGiudice
- University of Melbourne, Parkville, VIC, Australia
- Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Marina G Cavuoto
- National Ageing Research Institute, Parkville, VIC, Australia
- Monash University, Clayton, VIC, Australia
| | - Bianca Brijnath
- National Ageing Research Institute, Parkville, VIC, Australia
- University of Melbourne, Parkville, VIC, Australia
- University of Western Australia, Perth, WA, Australia
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17
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Lion KC, Zhou C, Fishman P, Senturia K, Cole A, Sherr K, Opel DJ, Stout J, Hazim CE, Warren L, Rains BH, Lewis CC. A sequential, multiple assignment randomized trial comparing web-based education to mobile video interpreter access for improving provider interpreter use in primary care clinics: the mVOCAL hybrid type 3 study protocol. Implement Sci 2023; 18:8. [PMID: 36915138 PMCID: PMC10012737 DOI: 10.1186/s13012-023-01263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/12/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Individuals who use a language other than English for medical care are at risk for disparities related to healthcare safety, patient-centered care, and quality. Professional interpreter use decreases these disparities but remains underutilized, despite widespread access and legal mandates. In this study, we compare two discrete implementation strategies for improving interpreter use: (1) enhanced education targeting intrapersonal barriers to use delivered in a scalable format (interactive web-based educational modules) and (2) a strategy targeting system barriers to use in which mobile video interpreting is enabled on providers' own mobile devices. METHODS We will conduct a type 3 hybrid implementation-effectiveness study in 3-5 primary care organizations, using a sequential multiple assignment randomized trial (SMART) design. Our primary implementation outcome is interpreter use, calculated by matching clinic visits to interpreter invoices. Our secondary effectiveness outcome is patient comprehension, determined by comparing patient-reported to provider-documented visit diagnosis. Enrolled providers (n = 55) will be randomized to mobile video interpreting or educational modules, plus standard interpreter access. After 9 months, providers with high interpreter use will continue as assigned; those with lower use will be randomized to continue as before or add the alternative strategy. After another 9 months, both strategies will be available to enrolled providers for 9 more months. Providers will complete 2 surveys (beginning and end) and 3 in-depth interviews (beginning, middle, and end) to understand barriers to interpreter use, based on the Theoretical Domains Framework. Patients who use a language other than English will be surveyed (n = 648) and interviewed (n = 75) following visits with enrolled providers to understand their experiences with communication. Visits will be video recorded (n = 100) to assess fidelity to assigned strategies. We will explore strategy mechanism activation to refine causal pathway models using a quantitative plus qualitative approach. We will also determine the incremental cost-effectiveness of each implementation strategy from a healthcare organization perspective, using administrative and provider survey data. DISCUSSION Determining how these two scalable strategies, alone and in sequence, perform for improving interpreter use, the mechanisms by which they do so, and at what cost, will provide critical insights for addressing a persistent cause of healthcare disparities. TRIAL REGISTRATION NCT05591586.
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Affiliation(s)
- K Casey Lion
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, 98145-5005, USA.
| | - Chuan Zhou
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, 98145-5005, USA
| | - Paul Fishman
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Kirsten Senturia
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Allison Cole
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
- Department of Industrial & Systems Engineering, University of Washington, Seattle, WA, USA
| | - Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - James Stout
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Carmen E Hazim
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
| | - Louise Warren
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Bonnie H Rains
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Cara C Lewis
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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18
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Medrano FJ, Fernandez AJ, Sudore RL, Kirkpatrick JN, Benda NC, Creber RM, Goyal P, Beavers C, Maurer MS, Rich MW, Alexander KP, Krishnaswami A. Limited English Proficiency in Older Adults Referred to the Cardiovascular Team. Am J Med 2023; 136:432-437. [PMID: 36822259 DOI: 10.1016/j.amjmed.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 02/24/2023]
Abstract
Limited English proficiency (LEP) is defined as individuals in whom English is not the primary language and who have limited ability to read, speak, write, or understand the English language. Cardiovascular (CV) team members routinely encounter language barriers in their practice. These barriers have a significant impact on the quality of CV care that patients with LEP receive. Despite evidence demonstrating the negative association between language barriers and health disparities, the impact on CV care is insufficiently known. In addition, older adults with CV disease and LEP are facing increasing risk of adverse events when complex medical information is not optimally delivered. Overcoming language barriers in CV care will need a thoughtful approach. Although well recognized, the initial step will be to continue to highlight the importance of language needs identification and appropriate use of professional interpreter services. In parallel, a health system-level approach is essential that describes initiatives and key policies to ensure a high-level quality of care for a growing LEP population. This review aims to present the topic of LEP during the CV care of older adults, for continued awareness along with practical considerations for clinical use and directions for future research.
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Affiliation(s)
| | | | | | - James N Kirkpatrick
- Cardiovascular Division, Department of Medicine, Department of Bioethics and Humanities, University of Washington, Seattle
| | - Natalie C Benda
- Columbia University Irving Medical Center, Columbia University School of Nursing, New York, NY
| | - Ruth Masterson Creber
- Columbia University Irving Medical Center, Columbia University School of Nursing, New York, NY
| | - Parag Goyal
- Division of Cardiology and Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Craig Beavers
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY
| | - Michael W Rich
- Cardiovascular Division, Washington University, St. Louis, Mo
| | - Karen P Alexander
- Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Ashok Krishnaswami
- Division of Cardiology, Kaiser Permanente San Jose Medical Center, Calif; Section of Geriatric Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, Calif; Geriatric Research, Education and Clinical Center, VA Palo Alto Health Care System, US Department of Veterans Affairs, Calif.
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19
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Garcia ME, Mutha S, Napoles AM, Malevanchik L, Williams M, Karliner LS. "Long Overdue": Nurse and Resident Physician Perspectives on Implementation of Dual-Handset Interpreter Phones in the Inpatient Setting. Health Equity 2023; 7:100-108. [PMID: 36876231 PMCID: PMC9982138 DOI: 10.1089/heq.2022.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 02/18/2023] Open
Abstract
Background Patients with language barriers suffer significant health disparities, including adverse events and poor health outcomes. While remote language services can help improve language access, these modalities remain persistently underused. The objective of this study was to understand clinician experiences and challenges using dual-handset interpreter telephones and to inform recommendations for future language access interventions. Methods We conducted four focus groups with nurses (N=14) and resident physicians (N=20) to understand attitudes toward dual-handset interpreter telephones in the hospital, including general impressions, effects on communication, situations in which they did and did not use them, and impact on clinical care. Three researchers independently coded all transcripts using a constant comparative approach, meeting repeatedly to discuss coding and to reconcile differences to reach consensus. Results We identified five salient themes, including increased language access (improved convenience, flexibility, and versatility of phones over in-person or ad hoc interpreters); effects on interpersonal processes of care (improved ability to communicate directly with patients); effects on clinical processes of care (improvements in critical patient care functions, including pain and medication management); impact on time (needing extra time for interpreted encounters and perceived delays impacting future use); and patients for whom, and circumstances in which, the dual-handset interpreter telephone is inadequate (e.g., complex discussions, hands-on instruction, or multiple speakers are present). Conclusions Our findings indicate that clinicians value dual-handset interpretation in bridging communication barriers and highlight recommendations to guide future implementation interventions to increase the uptake of remote language services in hospital settings.
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Affiliation(s)
- Maria E. Garcia
- Department of Medicine, Center for Aging in Diverse Communities, University of California, San Francisco, San Francisco, California, USA
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, Partnerships in Research in Implementation Science for Equity (PRISE) Center, University of California, San Francisco, San Francisco, California, USA
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sunita Mutha
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Anna M. Napoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Lev Malevanchik
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Mia Williams
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Leah S. Karliner
- Department of Medicine, Center for Aging in Diverse Communities, University of California, San Francisco, San Francisco, California, USA
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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20
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Yeboah D, McDaniel C, Lion KC. Language Matters: Why We Should Reconsider the Term "Limited English Proficiency". Hosp Pediatr 2023; 13:e11-e13. [PMID: 36464981 DOI: 10.1542/hpeds.2022-007014] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Desiree Yeboah
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Corrie McDaniel
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - K Casey Lion
- Department of Pediatrics, University of Washington, Seattle, Washington
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
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21
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Kosack A, Carson SL, Montenegro EYB, Owen M, Dodge S, Sim M, Cagigas X, Ahumada-Mocorro L, Kamzan A, Acuna Hernandez E, Lopez G, Guzman E, Sanchez Gomez D, Islas Z, Walker VP, Lerner C, Lloyd J. Improving Patient Experience Scores Using Simultaneous Interpretation on Family-Centered Rounds. Hosp Pediatr 2022; 12:1019-1035. [PMID: 36373287 DOI: 10.1542/hpeds.2022-006696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Patients speaking a primary language other than English face barriers to equitable care, particularly patient-provider communications. There is no gold standard for providing inpatient medical interpretation on family-centered rounds (FCR). We aimed to implement simultaneous, in-person interpretation of FCR for Spanish-speaking families and hypothesized improved satisfaction in care. METHODS In-person, Spanish Equipment-Assisted Simultaneous Medical Interpretation (EASMI) was implemented in March 2018 on FCR. Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) experience scores on communication domains were analyzed for Spanish and English-speaking families pre- (n = 118) and postimplementation (n = 552). Postimplementation, we conducted medical team surveys (n = 104) and semistructured interviews with Spanish-speaking families (n = 25) to determine satisfaction with interpretation modalities (phone, video, and EASMI). RESULTS Spanish-speaking families exhibited statistically significant improvements in Child HCAHPS top box scores compared to English-speaking families in multiple communication and informed care-related domains. For example, "How often did your child's doctors explain things to you in a way that was easy to understand?" top box scores improved from 58% to 95% for Spanish-speaking families, compared to 85% to 83% for English speakers, with the differential effect of the intervention showing statistical significance (P = .001). Medical team surveys demonstrated high satisfaction with EASMI. Qualitative themes from interviews and open-ended survey responses emphasized multiple care benefits with EASMI, including a perceived reduction of communication errors and increased family participation. CONCLUSIONS EASMI was associated with significant improvements in Child HCAHPS scores in communication domains and increased medical team and family members' satisfaction with interpretation. EASMI presents a novel method for equitable FCR for Spanish-speaking families.
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Affiliation(s)
- Amanda Kosack
- Department of Pediatrics, University of California Los Angeles Mattel Children's Hospital, Los Angeles, California
| | - Savanna L Carson
- Departments of Internal Medicine, General Internal Medicine, and Health Services Research
| | | | - Mary Owen
- Health Language Services, University of California Los Angeles, Los Angeles, California
| | - Sheridan Dodge
- Health Language Services, University of California Los Angeles, Los Angeles, California
| | | | | | - Lorena Ahumada-Mocorro
- Department of Patient Experience, Transplant Services team, and Care Coordination and Social Work program
| | - Audrey Kamzan
- Department of Pediatrics, University of California Los Angeles Mattel Children's Hospital, Los Angeles, California
| | - Ernesto Acuna Hernandez
- Department of Pediatrics, University of California Los Angeles Mattel Children's Hospital, Los Angeles, California
| | - Gabriela Lopez
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Elizabeth Guzman
- Department of Pediatrics, University of California Los Angeles Mattel Children's Hospital, Los Angeles, California
| | - Diana Sanchez Gomez
- Department of Pediatrics, University of California Los Angeles Mattel Children's Hospital, Los Angeles, California
| | - Zeuz Islas
- Department of Pediatrics, University of California Los Angeles Mattel Children's Hospital, Los Angeles, California
| | - Valencia P Walker
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health.,Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus Ohio
| | - Carlos Lerner
- Department of Pediatrics, University of California Los Angeles Mattel Children's Hospital, Los Angeles, California
| | - Jessica Lloyd
- Department of Pediatrics, University of California Los Angeles Mattel Children's Hospital, Los Angeles, California
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22
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Kane J, Thomson J, Khan A. Communicating in Real-Time: Simultaneous In-Person Interpretation on Family-Centered Rounds. Hosp Pediatr 2022; 12:e437-e439. [PMID: 36373279 DOI: 10.1542/hpeds.2022-006973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joelle Kane
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joanna Thomson
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alisa Khan
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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23
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Rajbhandari P, Garber MD. Improving Language Equity in Hospitalized Children of Families With LEP: Challenges and Solutions. Hosp Pediatr 2022; 12:e367-e373. [PMID: 36124635 DOI: 10.1542/hpeds.2022-006537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Prabi Rajbhandari
- Division of Hospital Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio
| | - Matthew D Garber
- Division of Hospital Medicine, Department of Pediatrics, Wolfson Children's Hospital University of Florida Health, Jacksonville, Florida
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24
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Mecham JC, Salazar MM, Perez RM, Castaneda U, Stamps BG, Chavez AS, Kling JM. Exploring the Factors that Influence Ethical Spanish Use among Medical Students and Solutions for Improvement. TEACHING AND LEARNING IN MEDICINE 2022; 34:522-529. [PMID: 34314270 DOI: 10.1080/10401334.2021.1949996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
IssueThere is a need for greater access to Spanish language services in United States healthcare. One approach to increasing language concordant care is the use of second language skills by healthcare staff. The desire to use second language skills may have unintended consequences when individuals step beyond their language abilities and can cause more harm than do good for limited-English proficiency patients. Medical students are in a unique position that places them at increased risk for inappropriately using second language skills. Evidence: The use of qualified healthcare interpreters has been shown to mitigate some of the disparities seen with limited-English proficiency patients including poorer healthcare outcomes, less access to care, and lower patient satisfaction. In spite of this knowledge, studies have demonstrated the phenomenon of residents and physicians "getting by" without the use of an interpreter, even when they recognized that their language competency was insufficient to provide high quality care. Regardless of language ability, medical students are asked to engage in conversations with Spanish speaking patients that are beyond their level of language competency. Students vary in their perceived language ability and level of comfort engaging in different clinical scenarios with limited-English proficiency patients. Implications: Students are in a unique position of vulnerability to pressures to use second language skills in situations that step beyond their abilities. We explore how hierarchy intensifies previously established factors, including a lack of adequate training or evaluation and other structural barriers, in contributing to medical students' inappropriate use of Spanish with limited-English proficiency patients. We propose an approach that includes student education, standardization of clinic rules regarding interpretation, and comprehensive faculty development to address this important patient care issue.
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Affiliation(s)
- Jeffrey C Mecham
- Mayo Clinic Alix School of Medicine, Mayo Clinic Scottsdale, Arizona, USA
| | - Marisa M Salazar
- Mayo Clinic Alix School of Medicine, Mayo Clinic Scottsdale, Arizona, USA
| | - Rachel M Perez
- Mayo Clinic Alix School of Medicine, Mayo Clinic Scottsdale, Arizona, USA
| | - Uriel Castaneda
- Mayo Clinic Alix School of Medicine, Mayo Clinic Scottsdale, Arizona, USA
| | | | | | - Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic Phoenix, Arizona, USA
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McKee KE, Gilbert RM, Spigle WA, Tilley BC, Corcos DM. Inclusion of Non-English-Speaking Participants in Studies of Parkinson's Disease: A Call to Action. Mov Disord 2022; 37:1990-1995. [PMID: 35929651 PMCID: PMC9588513 DOI: 10.1002/mds.29179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kathleen E McKee
- Neurosciences Clinical Program, Intermountain Healthcare, Salt Lake City, Utah, USA
| | | | | | - Barbara C Tilley
- Biostatistics and Data Science, University of Texas Health Science Center, School of Public Health, Houston, Texas, USA
| | - Daniel M Corcos
- Departments of Physical Therapy & Human Movement Sciences and Biomedical Engineering, Northwestern University, Chicago, Illinois, USA
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Tougas H, Chan S, Shahrvini T, Gonzalez A, Chun Reyes R, Burke Parish M, Yellowlees P. The Use of Automated Machine Translation to Translate Figurative Language in a Clinical Setting: Analysis of a Convenience Sample of Patients Drawn From a Randomized Controlled Trial. JMIR Ment Health 2022; 9:e39556. [PMID: 36066959 PMCID: PMC9490520 DOI: 10.2196/39556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/10/2022] [Accepted: 07/10/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Patients with limited English proficiency frequently receive substandard health care. Asynchronous telepsychiatry (ATP) has been established as a clinically valid method for psychiatric assessments. The addition of automated speech recognition (ASR) and automated machine translation (AMT) technologies to asynchronous telepsychiatry may be a viable artificial intelligence (AI)-language interpretation option. OBJECTIVE This project measures the frequency and accuracy of the translation of figurative language devices (FLDs) and patient word count per minute, in a subset of psychiatric interviews from a larger trial, as an approximation to patient speech complexity and quantity in clinical encounters that require interpretation. METHODS A total of 6 patients were selected from the original trial, where they had undergone 2 assessments, once by an English-speaking psychiatrist through a Spanish-speaking human interpreter and once in Spanish by a trained mental health interviewer-researcher with AI interpretation. 3 (50%) of the 6 selected patients were interviewed via videoconferencing because of the COVID-19 pandemic. Interview transcripts were created by automated speech recognition with manual corrections for transcriptional accuracy and assessment for translational accuracy of FLDs. RESULTS AI-interpreted interviews were found to have a significant increase in the use of FLDs and patient word count per minute. Both human and AI-interpreted FLDs were frequently translated inaccurately, however FLD translation may be more accurate on videoconferencing. CONCLUSIONS AI interpretation is currently not sufficiently accurate for use in clinical settings. However, this study suggests that alternatives to human interpretation are needed to circumvent modifications to patients' speech. While AI interpretation technologies are being further developed, using videoconferencing for human interpreting may be more accurate than in-person interpreting. TRIAL REGISTRATION ClinicalTrials.gov NCT03538860; https://clinicaltrials.gov/ct2/show/NCT03538860.
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Affiliation(s)
- Hailee Tougas
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
| | - Steven Chan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Tara Shahrvini
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
| | - Alvaro Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
| | - Ruth Chun Reyes
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
| | - Michelle Burke Parish
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
| | - Peter Yellowlees
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
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Chartrand J, Jibb L, Grandmont C, Hardy-Bélanger É, Cheng S, Balasa R, Johnston D. Perceptions of healthcare professionals regarding home-based pediatric cancer care provided in French: A qualitative descriptive study. Can Oncol Nurs J 2022; 32:381-386. [PMID: 38919683 PMCID: PMC11195583 DOI: 10.5737/23688076323381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Goal This study aims to explore how healthcare professionals perceive home-based pediatric cancer care provided in French. Methodology A qualitative descriptive study was conducted using semi-directed individual interviews of 22 healthcare professionals. A thematic analysis of the transcribed interviews was carried out independently by two members of the research team. Findings Pediatric cancer care is readily available in French in Quebec, but access to French-language services in Ontario is limited. The possible causes and effects of this lack of access and potential solutions are discussed in this paper. Conclusion The perceptions compiled in this study should be taken into account to help provide quality home-based pediatric cancer care in French.
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Affiliation(s)
- Julie Chartrand
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5,
| | - Lindsay Jibb
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8,
| | | | | | - Sara Cheng
- Nursing Student, University of Ottawa, Ottawa, ON K1H 8M5
| | | | - Donna Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1,
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Chartrand J, Jibb L, Grandmont C, Hardy-Bélanger É, Cheng S, Balasa R, Johnston DD. Perceptions des professionnels de la santé quant aux soins oncologiques pédiatriques offerts en français à domicile: étude descriptive qualitative. Can Oncol Nurs J 2022; 32:375-380. [PMID: 38919676 PMCID: PMC11195585 DOI: 10.5737/23688076323375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
But Cette étude vise à comprendre les perceptions des professionnels de la santé quant aux soins oncologiques pédiatriques offerts à domicile en français. Méthodologie Une étude descriptive qualitative a été menée à l’aide d’entrevues individuelles semi-dirigées faites auprès de 22 professionnels de la santé. Une analyse thématique des transcriptions a été menée de façon indépendante par deux membres. Résultats Les soins oncologiques pédiatriques sont offerts en français surtout au Québec, alors qu’il y a un manque d’accès en Ontario. Les causes et les effets possibles de ce manque d’accès ainsi que les solutions sont discutés dans le présent article. Conclusion Les perceptions recueillies dans la présente étude devraient être prises en compte pour s’assurer d’offrir des soins oncologiques pédiatriques à domicile de qualité en français.
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Affiliation(s)
- Julie Chartrand
- École des sciences infirmières, Faculté des sciences de la santé, Université d'Ottawa, 451, chemin Smyth, Ottawa (Ontario) K1H 8M5, Courriel:
| | - Lindsay Jibb
- Faculté de sciences infirmières Lawrence S. Bloomberg, Université de Toronto, 155, rue College Toronto (Ontario) M5T 1P8, Courriel:
| | - Camille Grandmont
- étudiante infirmière, Université d'Ottawa, 451, chemin Smyth, Ottawa (Ontario) K1H 8M5
| | | | - Sara Cheng
- étudiante infirmière, Université d'Ottawa, 451, chemin Smyth, Ottawa (Ontario) K1H 8M5
| | - Rebecca Balasa
- Université d'Ottawa, 451, chemin Smyth, Ottawa (Ontario) K1H 8M5
| | - Dre Donna Johnston
- Département d'hématologie et d'oncologie, Centre hospitalier pour enfants de l'est de l'Ontario, 401, chemin Smyth, Ottawa (Ontario) K1H 8L1, Courriel:
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Munoz-Blanco S, Boss RD, DeCamp LR, Donohue PK. Developing an audio-based communication tool for NICU discharge of Latino families with limited English proficiency. PATIENT EDUCATION AND COUNSELING 2022; 105:1524-1531. [PMID: 34674921 DOI: 10.1016/j.pec.2021.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Research shows NICU Latino parents with limited English proficiency (LEP) feel less comfortable asking questions and participating in medical decision-making, which may negatively affect transition to community healthcare. Question prompt lists (QPL), suggested questions sometimes drawn from families and providers, can improve family-centered communication. We explored clinician and parent perceptions to inform development of and pilot a NICU discharge QPL. METHODS Focus groups with NICU and primary care providers explored perceived educational needs of Latino parents LEP and barriers to effective transition to community healthcare. Semi-structured interviews with Latino parents LEP explored perceptions of knowledge gaps and recommendations to improve the transition process. A Spanish audio QPL for parents and an English written version for providers were developed and pilot tested for acceptability. RESULTS Provider focus groups (n = 27) and parent interviews (n = 19) identified themes: decreased parent activation, knowledge gaps, limited-use interpreters, unfamiliarity with healthcare system, and social isolation as barriers to smooth NICU-to-home transition. Providers (n = 11) and parents (n = 10) favored QPL introduction early in NICU admission, finding it useful to improve communication and transition processes for families. CONCLUSION Our QPL may address challenges faced by Latino parents LEP when transitioning home. PRACTICE IMPLICATIONS QPLs may improve Latino NICU infants' healthcare outcomes.
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Affiliation(s)
- Sara Munoz-Blanco
- Johns Hopkins School of Medicine, Department of Pediatrics, 1800 Orleans St., Baltimore, MD 21287, United States.
| | - Renee D Boss
- Johns Hopkins School of Medicine, Department of Pediatrics, 1800 Orleans St., Baltimore, MD 21287, United States; Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Ave, Baltimore, MD 21205, United States.
| | - Lisa Ross DeCamp
- Johns Hopkins School of Medicine, Department of Pediatrics, 1800 Orleans St., Baltimore, MD 21287, United States.
| | - Pamela K Donohue
- Johns Hopkins School of Medicine, Department of Pediatrics, 1800 Orleans St., Baltimore, MD 21287, United States; Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St., Baltimore, MD 21205, United States.
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Soleimani J, Marquez A, Fathma S, Weister TJ, Barwise AK. Detecting professional interpreter use among patients with limited English proficiency: Derivation and validation study. SAGE Open Med 2022; 10:20503121221098146. [PMID: 35600712 PMCID: PMC9118401 DOI: 10.1177/20503121221098146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives: The objective of this derivation and validation study was to develop and validate a search strategy algorithm to detect patients who used professional interpreter services. Methods: We identified all adults who had at least one intensive care unit admission during their hospital stay across the Mayo Clinic Enterprise between 1 January 2015 and 30 June 2020. Three random subsets of 100 patients were extracted from 60,268 patients to develop the search strategy algorithm. Two physician reviewers conducted gold standard manual chart review and any discrepancies were resolved by a third reviewer. These results were compared with the search strategy algorithm each time it was refined. Sensitivity and specificity were calculated during each phase by comparing the search strategy results to the reference gold standard for both derivation cohorts and the final validation cohort. Results: The first search strategy resulted in a sensitivity of 100% and a specificity of 89%. The second revised search strategy achieved a sensitivity of 100% and a specificity of 87%. The final version of the search strategy was applied to the validation subset and sensitivity and specificity were 100% and 89%, respectively. Conclusion: We derived and validated a search strategy algorithm to assess interpreter use among hospitalized patients. Using a search strategy algorithm with high sensitivity and specificity can reduce the time required to abstract data from the electronic medical records compared with manual data abstraction.
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Affiliation(s)
- Jalal Soleimani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
- Amelia Barwise, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Alberto Marquez
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sawsan Fathma
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Timothy J Weister
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Alhalel J, Francone N, Post S, O'Brian CA, Simon MA. How Should Representation of Subjects With LEP Become More Equitable in Clinical Trials? AMA J Ethics 2022; 24:E319-325. [PMID: 35405059 PMCID: PMC9052781 DOI: 10.1001/amajethics.2022.319] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Underrepresentation of individuals with limited English proficiency (LEP) who speak Spanish is ongoing in phase 3 biomedical clinical trials and exacerbates health inequity. This article suggests strategies for increasing representation of Spanish speakers in clinical rials by emphasizing the importance of early engagement with Spanish language communities, inclusive participant recruitment, and collaborative trial design and implementation. Although investigators and institutions administering government-funded research must meet federal requirements for language assistance, journal editors, peer reviewers, institutional review board members, academic health centers, and all beneficiaries of the biomedical and behavioral research enterprise in the United States must motivate linguistic inclusion.
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Affiliation(s)
- Jonathan Alhalel
- Fourth-year medical student at the Northwestern University Feinberg School of Medicine in Chicago, Illinois
| | - Nicolás Francone
- Fourth-year medical student the Northwestern University Feinberg School of Medicine in Chicago, Illinois
| | - Sharon Post
- Scientific editor at the Center for Health Equity Transformation in the Feinberg School of Medicine at Northwestern University in Chicago, Illinois
| | - Catherine A O'Brian
- Scientific editor at the Center for Health Equity Transformation in the Feinberg School of Medicine at Northwestern University in Chicago, Illinois
| | - Melissa A Simon
- The George H. Gardner, MD, Professor of Clinical Gynecology and vice chair of research in the Department of Obstetrics and Gynecology at the Northwestern University Feinberg School of Medicine in Chicago, Illinois
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Gutman CK, Lion KC, Fisher CL, Aronson PL, Patterson M, Fernandez R. Breaking through barriers: the need for effective research to promote language-concordant communication as a facilitator of equitable emergency care. J Am Coll Emerg Physicians Open 2022; 3:e12639. [PMID: 35072163 PMCID: PMC8759339 DOI: 10.1002/emp2.12639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 02/05/2023] Open
Abstract
Individuals with limited English proficiency (LEP) are at high risk for adverse outcomes in the US health care system. This is particularly true for patients with LEP seeking care in the emergency department (ED). Although professional language interpretation improves the quality of care for these patients, it remains underused. The dynamic, discontinuous nature of an ED visit poses distinct challenges and opportunities for providing equitable, high-quality care for patients with LEP. Evidence-based best practices for identifying patients with LEP and using professional interpretation are well described but inadequately implemented. There are few examples in the literature of rigorous interventions to improve quality of care and outcomes for patients with LEP. There is an urgent need for high-quality research to improve communication with patients with LEP along the continuum of emergency care in order to achieve equity in outcomes.
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Affiliation(s)
- Colleen K Gutman
- Department of Emergency Medicine University of Florida College of Medicine Gainesville Florida USA
| | - K Casey Lion
- Department of Pediatrics University of Washington School of Medicine Seattle, Washington USA
- Center for Child Health, Behavior, and Development Seattle Children's Research Institute Seattle, Washington USA
| | - Carla L Fisher
- STEM Translational Communication Center University of Florida College of Journalism and Communication Gainesville Florida USA
- UF Health Cancer Center, Center for Arts in Medicine University of Florida Gainesville Florida USA
| | - Paul L Aronson
- Department of Pediatrics Yale School of Medicine New Haven Connecticut USA
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
| | - Mary Patterson
- Department of Emergency Medicine University of Florida College of Medicine Gainesville Florida USA
- Center for Experiential Learning and Simulation University of Florida College of Medicine Gainesville Florida USA
| | - Rosemarie Fernandez
- Department of Emergency Medicine University of Florida College of Medicine Gainesville Florida USA
- Center for Experiential Learning and Simulation University of Florida College of Medicine Gainesville Florida USA
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Silva MD, Adelman RD, Singh V, Gupta R, Moxley J, Sobota RM, Tsai S, Abel BT, Reid MC. Healthcare Provider Perspectives Regarding Use of Medical Interpreters During End-of-Life Conversations With Limited English Proficient Patients. Am J Hosp Palliat Care 2022; 39:220-227. [PMID: 34000817 PMCID: PMC10080979 DOI: 10.1177/10499091211015916] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Healthcare providers increasingly care for patients with Limited English Proficiency (LEP). There is limited research evaluating healthcare provider utilization practices, attitudes, perceived benefits and barriers regarding the use of medical interpreters in end of life (EOL) and goals of care (GOC) conversations. OBJECTIVES To elicit healthcare providers' opinions of the role, factors that impact decisions to use medical interpreters and perceived utility of using medical interpreters when conducting EOL and GOC conversations with LEP patients and their families. DESIGN Cross-sectional survey of internal medicine trainees and attending physicians from a U.S. medical center. RESULTS A total of 117 surveys were collected with a response rate of 51%. In-person medical interpreters received higher ratings with regard to their helpfulness compared to telephone medical interpreters during EOL and GOC conversations. Being an attending physician and having received training in the use of a medical interpreter predicted higher composite scores reflecting greater awareness of the roles of medical interpreters and endorsement of best communication practices. In-person interpreters were viewed by a subset of participants as "standard of care" during EOL and GOC conversations. CONCLUSION Having more years in practice and receiving training in the use of medical interpreters correlated with more favorable attitudes toward the role of medical interpreters and positive communication practices. Incorporating early training in the use of medical interpreters could help enhance communication practices and outcomes during EOL and GOC conversations with LEP patients.
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Affiliation(s)
- Milagros D. Silva
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Ronald D. Adelman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Vishwas Singh
- Section of Hospital Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Renuka Gupta
- Section of Hospital Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jerad Moxley
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Stephanie Tsai
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Brittany T. Abel
- Department of Medicine, University of California San Francisco, CA, USA
| | - M. Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
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Benda NC, Wesley DB, Nare M, Fong A, Ratwani RM, Kellogg KM. Social Determinants of Health and Patient Safety: An Analysis of Patient Safety Event Reports Related to Limited English-Proficient Patients. J Patient Saf 2022; 18:e1-e9. [PMID: 32168283 DOI: 10.1097/pts.0000000000000663] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Racial and ethnic disparities in healthcare safety have persisted for decades, particularly for patients with language barriers. Previous studies have investigated the frequency and nature of safety events impacting patients with language barriers; others have proposed solutions to fix them. A gap analysis, however, of how we are currently addressing safety issues and why these efforts have not been effective is lacking. METHOD This analysis uses reports from a patient safety event reporting system. Reports contain information regarding no-harm (near miss) events and events where harm may have reached the patient. Reports occurring with patients with a preferred language other than English were extracted and analyzed to determine whether the language barrier contributed to the safety event, the language barrier was mentioned in the resolution, and themes were mentioned for addressing language barriers. RESULTS A subset of 1553 events pertaining to non-English-speaking patients were first categorized as "likely" (3%), "plausibly" (10%), or "unlikely" (87%) related to the patient's language barrier. Second, events related to the patient's language barrier were categorized as directly addressing (19%), indirectly addressing (3%), not mentioning (69%) the language barrier, or containing insufficient information to determine whether the language barrier was addressed (7%). Third, thematic analysis revealed that the most common methods for addressing language barriers included presenting issues to interpreter services and subsequent use of interpreter services. CONCLUSIONS This study found that it is challenging to determine the direct role of certain social determinants of health (e.g., language barriers) in safety events. In many cases, the language barrier was not addressed in the event report. Furthermore, when the language barrier was addressed, solution themes typically involved weaker, less sustainable suggested actions.
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Affiliation(s)
| | | | - Matthew Nare
- Department of Psychology, California State, Long Beach, California
| | - Allan Fong
- From the National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia
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Ndukwe T, Cole E, Scanzera AC, Chervinko MA, Chiang MF, Campbell JP, Chan RVP. Health Equity and Disparities in ROP Care: A Need for Systematic Evaluation. Front Pediatr 2022; 10:806691. [PMID: 35433564 PMCID: PMC9010777 DOI: 10.3389/fped.2022.806691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/03/2022] [Indexed: 12/04/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that can have devastating visual sequelae if not managed appropriately. From an ophthalmology standpoint, ROP care is complex, since it spans multiple care settings and providers, including those in the neonatal intensive care unit (NICU), step down nurseries, and the outpatient clinic setting. This requires coordination and communication between providers, ancillary staff, and most importantly, effective communication with the patient's family members and caregivers. Often, factors related to the social determinants of health play a significant role in effective communication and care coordination with the family, and it is important for ophthalmologists to recognize these risk factors. The aim of this article is to (1) review the literature related to disparities in preterm birth outcomes and infants at risk for ROP; (2) identify barriers to ROP care and appropriate follow up, and (3) describe patient-oriented solutions and future directions for improving ROP care through a health equity lens.
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Affiliation(s)
- Tochukwu Ndukwe
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Emily Cole
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Angelica C Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Margaret A Chervinko
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Michael F Chiang
- National Institutes of Health, National Eye Institute, Bethesda, MD, United States
| | - John Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, United States
| | - Robison Vernon Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
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Schulson L, Lin MY, Paasche-Orlow MK, Hanchate AD. Limited English Proficient Patient Visits and Emergency Department Admission Rates for Ambulatory Care Sensitive Conditions in California: a Retrospective Cohort Study. J Gen Intern Med 2021; 36:2683-2691. [PMID: 33528781 PMCID: PMC8390610 DOI: 10.1007/s11606-020-06523-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the risk of admission for emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) by limited English proficient (LEP) patients. OBJECTIVE Estimate admission rates from ED for ACSCs comparing LEP and English proficient (EP) patients and examine how these rates vary at hospitals with a high versus low proportion of LEP patients. DESIGN Retrospective cohort study of California's 2017 inpatient and ED administrative data PARTICIPANTS: Community-dwelling individuals ≥ 18 years without a primary diagnosis of pregnancy or childbirth. LEP patients had a principal language other than English. MAIN MEASURES We used a series of linear probability models with incremental sets of covariates, including patient demographics, primary diagnosis, and Elixhauser comorbidities, to examine admission rate for visits of LEP versus EP patients. We then added an interaction covariate for high versus low LEP-serving hospital. We estimated models with and without hospital-level random effects. KEY RESULTS These analyses included 9,641,689 ED visits; 14.7% were for LEP patients. . Observed rate of admission for all ACSC ED visits was higher for LEP than for EP patients (26.2% vs. 25.2; p value < .001). Adjusted rate of admission was not statistically significant (27.3% [95% CI 25.4-29.3%] vs. 26.2% [95% CI 24.3-28.1%]). For COPD, the difference was significant (36.8% [95% CI 35.0-38.6%] vs. 33.3% [95% CI 31.7-34.9%]). Difference in adjusted admission rate for LEP versus EP visits did not differ in high versus low LEP-serving hospitals. CONCLUSIONS In adjusted analyses, LEP was not a risk factor for admission for most ACSCs. This finding was observed in both high and low LEP-serving hospitals.
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Affiliation(s)
- Lucy Schulson
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. .,RAND Corporation, 20 Park Plaza #920, Boston, MA, 02116, USA.
| | - Meng-Yun Lin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael K Paasche-Orlow
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Amresh D Hanchate
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Mirza M, Harrison EA, Miller KA, Jacobs EA. Indicators of Quality Rehabilitation Services for Individuals with Limited English Proficiency: A 3-Round Delphi Study. Arch Phys Med Rehabil 2021; 102:2125-2133. [PMID: 34052214 DOI: 10.1016/j.apmr.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/09/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To obtain expert consensus on indicators of quality rehabilitation services for individuals with limited English proficiency (LEP). DESIGN Three-round Delphi study. SETTING Delphi survey conducted online with 30 experts. Most experts worked in adult physical rehabilitation settings and were from Illinois (n=16), and the remaining participants were from 8 other US states or Canadian provinces. PARTICIPANTS Experts (N=30) had a minimum of 2 publications on health care services for patients with LEP and/or a minimum of 5 years clinical experience in physical rehabilitation. Of 43 experts (11 researchers, 32 clinicians) who received the round 1 survey by e-mail, 30 returned complete responses (70% response rate). Of those, 25 completed round 2 and 24 completed round 3. Of round 1 participants, most (n =21) identified their primary professional activity as clinical, whereas the others worked in research (n =5) or education (n =4). Twenty-four were women. The median age was 43 years (range, 27-67y). Disciplines included occupational therapy (n =14), physical therapy (n =13), psychology (n=1), nursing (n=1), and medicine (n=1). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Indicators were rated on a 7-point Likert scale for importance and feasibility. Interquartile range (IQR) and 95% confidence intervals were calculated for importance and feasibility ratings. Indicators with an IQR <2 and a median importance score ≥6 were accepted as reaching consensus for importance. RESULTS Round 1 responses were categorized into 15 structural, 13 process, and 18 outcome indicators. All 15 structural indicators reached consensus for importance; 8 were rated as feasible. All 13 process indicators reached consensus, of which 8 were deemed feasible. Sixteen outcome indicators reached consensus, of which 7 were deemed feasible. CONCLUSIONS This Delphi study identified structural, process, and outcome indicators that can inform delivery and assessment of quality rehabilitation services for individuals with LEP. Future research should operationalize and measure these quality indicators in clinical practice.
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Affiliation(s)
- Mansha Mirza
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL.
| | - Elizabeth A Harrison
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL
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Suarez NRE, Urtecho M, Jubran S, Yeow ME, Wilson ME, Boehmer KR, Barwise AK. The Roles of medical interpreters in intensive care unit communication: A qualitative study. PATIENT EDUCATION AND COUNSELING 2021; 104:1100-1108. [PMID: 33168459 PMCID: PMC8068732 DOI: 10.1016/j.pec.2020.10.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To understand healthcare team perceptions of the role of professional interpreters and interpretation modalities during end of life and critical illness discussions with patients and families who have limited English proficiency in the intensive care unit (ICU). METHODS We did a secondary analysis of data from a qualitative study with semi-structured interviews of 16 physicians, 12 nurses, and 12 professional interpreters from 3 ICUs at Mayo Clinic, Rochester. RESULTS We identified 3 main role descriptions for professional interpreters: 1) Verbatim interpretation; interpreters use literal interpretation; 2) Health Literacy Guardian; interpreters integrate advocacy into their role; 3) Cultural Brokers; interpreters transmit information incorporating cultural nuances. Clinicians expressed advantages and disadvantages of different interpretation modalities on the professional interpreter's role in the ICU. CONCLUSION Our study illuminates different professional interpreters' roles. Furthermore, we describe the perceived relationship between interpretation modalities and the interpreter's roles and influence on communication dynamics in the ICU for patients with LEP. PRACTICE IMPLICATIONS Patients benefit from having an interpreter, who can function as a cultural broker or literacy guardian during communication in the ICU setting where care is especially complex, good communication is vital, and decision making is challenging.
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Affiliation(s)
| | - Meritxell Urtecho
- Knowledge and Evaluation Research Unit (KER), Mayo Clinic, Rochester, Minnesota, USA.
| | - Samira Jubran
- Language Services, Mayo Clinic, Rochester, Minnesota, USA.
| | - Mei-Ean Yeow
- Center For Palliative Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Michael E Wilson
- Knowledge and Evaluation Research Unit (KER), Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Kasey R Boehmer
- Knowledge and Evaluation Research Unit (KER), Mayo Clinic, Rochester, Minnesota, USA.
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA; Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA.
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Noack EM, Schulze J, Müller F. Designing an App to Overcome Language Barriers in the Delivery of Emergency Medical Services: Participatory Development Process. JMIR Mhealth Uhealth 2021; 9:e21586. [PMID: 33851933 PMCID: PMC8082383 DOI: 10.2196/21586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/29/2020] [Accepted: 02/06/2021] [Indexed: 12/14/2022] Open
Abstract
Background In emergencies, language barriers may have dangerous consequences for the patients. There have been some technical approaches to overcome language barriers in medical care but not yet in the prehospital emergency care setting. The use of digital technologies in health care is expanding rapidly. Involving end users at all stages of the development process may help to ensure such technologies are usable and can be implemented. Objective We aimed to develop a digital communication tool that addresses paramedic needs in the specific circumstances of prehospital emergency care and helps paramedics to overcome language barriers when providing care to foreign-language patients. Methods We actively engaged paramedics and software designers in an action-oriented, participatory, iterative development process, which included field observations, workshops, background conversations, questionnaires on rescue missions, studying the literature, and preliminary testing in the field. Results With input from paramedics, we created an app with 600 fixed phrases supporting 18 languages. The app includes medical history–taking questions, phrases asking for consent, and phrases providing specific additional information. Children as patients, as well as their carers and other third parties, can be addressed with appropriate wording. All phrases can be played back audibly or displayed as text. The comprehensive content is grouped into categories and adapted to diverse scenarios, which makes the tool rapidly usable. The app includes a function to document patient responses and the conversation history. For evaluation in a clinical study, the app is run on a smartphone with extra speakers to be of use in noisy environments. The use of prototypes proved valuable to verify that the content, structure, and functions discussed in theory were of value and genuinely needed in practice and that the various device control elements were intuitive. Conclusions The nature of the paramedic work environment places specific demands on the communication options used and need for such devices. The active involvement of paramedics in the development process allowed us to understand and subsequently consider their experience-based knowledge. Software designers could understand the paramedics’ work environment and consider respective needs in the menu navigation and design principles of the app. We argue that the development of any medical software product should actively involve both end users and developers in all phases of the development process. Providing the users with the opportunity to influence technology development ensures that the result is closer to their needs, which can be seen as crucial for successful implementation and sustainable use. Trial Registration German Clinical Trials Register DRKS00016719; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016719 International Registered Report Identifier (IRRID) RR2-10.1186/s12913-020-05098-5
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Affiliation(s)
- Eva Maria Noack
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Jennifer Schulze
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
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Chong EY, Jacob SA, Ramadas A, Goh PH, Palanisamy UD. Assessment of community pharmacists' communication and comfort levels when interacting with Deaf and hard of hearing patients. Pharm Pract (Granada) 2021; 19:2274. [PMID: 34221194 PMCID: PMC8216707 DOI: 10.18549/pharmpract.2021.2.2274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/25/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Deaf and hard of hearing patients who use sign language face considerable communication barriers while accessing pharmacy services. Low comfort-levels between community pharmacists and Deaf and hard of hearing patients result in poor interactions and increase patient safety risks. OBJECTIVE 1) To examine the way community pharmacists interact with Deaf and hard of hearing patients in Malaysia, and their level of comfort in such interactions. 2) To examine how comfort-levels vary by the preferred communication methods, resources and employer support. METHODS This cross-sectional study was conducted among registered community pharmacists practicing in Malaysia. Questionnaire items included comfort-levels of community pharmacists when interacting with Deaf and hard of hearing patients, used and preferred communication methods, necessary resources, and perceived employer's level of support. Based on the list of registered pharmacies, the questionnaire with a pre-paid return envelope was mailed out while pharmacies close to the university were approached in person. This questionnaire was distributed online using Google Form. Comparisons between comfort-levels and study parameters were analyzed using independent t-tests and ANOVA. RESULTS A total of 297 community pharmacists responded (response rate 29.2%). Higher comfort-levels were reported in those who had received between 1 to 5 prescriptions as compared to those who did not receive prescriptions from Deaf and hard of hearing patients (MD= -0.257, SD=0.104, p=0.042). More than 80% used written information and only 3.4% had used the services of a qualified sign language interpreter throughout their community pharmacist career. Significantly lower comfort-levels (p=0.0004) were reported in community pharmacists who perceived training in sign language as a necessity to interact with Deaf and hard of hearing patients (M=3.6, SD=0.9) versus those who were not interested in sign language training (M=3.8, SD=0.6). CONCLUSIONS The results suggest that community pharmacists were neither extremely comfortable nor averse when interacting with Deaf and hard of hearing patients. The lack of significant findings in terms of comfort-levels may indicate other potential drivers for their choice of communication method when interacting with Deaf and hard of hearing patients.
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Affiliation(s)
- Elizabeth Y Chong
- BPharm (Hons). Research Assistant. Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia. Jalan Lagoon Selatan, Selangor (Malaysia).
| | - Sabrina A Jacob
- MPharm, PhD. Research Associate. Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde. Glasgow (United Kingdom).
| | - Amutha Ramadas
- MSc, PhD. Senior Lecturer. Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia. Jalan Lagoon Selatan, Selangor (Malaysia).
| | - Pei H Goh
- PhD. Lecturer. Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia. Jalan Lagoon Selatan, Selangor (Malaysia).
| | - Uma D Palanisamy
- MPhil, PhD. Associate Professor. Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia. Jalan Lagoon Selatan, Selangor (Malaysia).
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Krystallidou D, Langewitz W, van den Muijsenbergh M. Multilingual healthcare communication: Stumbling blocks, solutions, recommendations. PATIENT EDUCATION AND COUNSELING 2021; 104:512-516. [PMID: 32988684 DOI: 10.1016/j.pec.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/04/2020] [Accepted: 09/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To provide guidance on multilingual and language discordant healthcare communication. DISCUSSION We provide a critical reflection on common stumbling blocks to securing (professional) language support, as well as on the currently available solutions to language discordance in healthcare. We discuss issues pertaining to i) the assessment of the patient and healthcare professional's language proficiency, ii) the decision making on whether to seek language support, iii) the currently available options of language support and the development of skills that ensure their effective use, iv) the inclusion of professional interpreters in the interprofessional healthcare team, and v) the transition from single- to integrated language support solutions that allow for a more comprehensive approach to multilingual healthcare communication. We present a set of recommendations for good practice. CONCLUSION Understanding the needs, capabilities and shortcoming of the available language- support solutions and the implications arising from them can enable decision makers to make informed decisions that ensure the quality of communication and care. The integrated use of language-support solutions at different stages of care can create the conditions for effective communication, while promoting patient and family participation in the decision making process. Evidence-based interventions that can inform the implementation of solutions are required.
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Affiliation(s)
- Demi Krystallidou
- University of Surrey, Centre for Translation Studies, School of Literature and Languages, Guildford, Surrey, GU2 7XH, UK; KU Leuven, Faculty of Arts, Sint Andries Campus, B-2000 Antwerp, Belgium.
| | - Wolf Langewitz
- University and University Hospital Basel, Dept. Psychosomatic Medicine, Clinical Communication, Switzerland.
| | - Maria van den Muijsenbergh
- Radboud University Medical Centre Department of Primary and Community Care Nijmegen, the Netherlands; Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht the Netherlands.
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Lion KC, Gritton J, Scannell J, Brown JC, Ebel BE, Klein EJ, Mangione-Smith R. Patterns and Predictors of Professional Interpreter Use in the Pediatric Emergency Department. Pediatrics 2021; 147:peds.2019-3312. [PMID: 33468598 PMCID: PMC7906072 DOI: 10.1542/peds.2019-3312] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Professional interpretation for patients with limited English proficiency remains underused. Understanding predictors of use is crucial for intervention. We sought to identify factors associated with professional interpreter use during pediatric emergency department (ED) visits. METHODS We video recorded ED visits for a subset of participants (n = 50; 20% of the total sample) in a randomized trial of telephone versus video interpretation for Spanish-speaking limited English proficiency families. Medical communication events were coded for duration, health professional type, interpreter (none, ad hoc, or professional), and content. With communication event as the unit of analysis, associations between professional interpreter use and assigned interpreter modality, health professional type, and communication content were assessed with multivariate random-effects logistic regression, clustered on the patient. RESULTS We analyzed 312 communication events from 50 ED visits (28 telephone arm, 22 video arm). Professional interpretation was used for 36% of communications overall, most often for detailed histories (89%) and least often for procedures (11%) and medication administrations (8%). Speaker type, communication content, and duration were all significantly associated with professional interpreter use. Assignment to video interpretation was associated with significantly increased use of professional interpretation for communication with providers (adjusted odds ratio 2.7; 95% confidence interval: 1.1-7.0). CONCLUSIONS Professional interpreter use was inconsistent over the course of an ED visit, even for patients enrolled in an interpretation study. Assignment to video rather than telephone interpretation led to greater use of professional interpretation among physicians and nurse practitioners but not nurses and other staff.
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Affiliation(s)
- K. Casey Lion
- Department of Pediatrics and,Center for Child Health, Behavior and Development and
| | - Jesse Gritton
- Center for Child Health, Behavior and Development and
| | - Jack Scannell
- Center for Child Health, Behavior and Development and
| | - Julie C. Brown
- Department of Pediatrics and,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Beth E. Ebel
- Department of Pediatrics and,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; and,Center for Child Health, Behavior and Development and
| | - Eileen J. Klein
- Department of Pediatrics and,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Rita Mangione-Smith
- Department of Pediatrics and,Center for Child Health, Behavior and Development and
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Le Neveu M, Berger Z, Gross M. Lost in Translation: The Role of Interpreters on Labor and Delivery. Health Equity 2020; 4:406-409. [PMID: 33015520 PMCID: PMC7526727 DOI: 10.1089/heq.2020.0016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2020] [Indexed: 11/30/2022] Open
Abstract
During the Coronavirus (COVID-19) pandemic, in-person interpreters have been deemed “nonessential,” and thus eliminated to minimize viral exposure and conserve personal protective equipment. Considering alarming patterns of interpreter underuse, we evaluate how substitution for remote modalities (telephone or video) may exacerbate existing inequalities for patients with limited English proficiency. The inherent intimacy, dynamic physicality, and cultural nuances of labor and delivery pose unique communication challenges. Using clinical scenarios, we illustrate the vital role interpreters have in providing accessible obstetric care. We argue that eliminating in-person interpreters in this setting is not justified by COVID-related harms given the potential to exacerbate underlying health disparities.
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Affiliation(s)
- Margot Le Neveu
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Zackary Berger
- Johns Hopkins University Berman Institute of Ethics, Baltimore, Maryland, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Marielle Gross
- Johns Hopkins University Berman Institute of Ethics, Baltimore, Maryland, USA.,Department of Obstetrics and Gynecology, Greater Baltimore Medical Center, Baltimore, Maryland, USA
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Gutman CK, Klein EJ, Follmer K, Brown JC, Ebel BE, Lion KC. Deficiencies in Provider-Reported Interpreter Use in a Clinical Trial Comparing Telephonic and Video Interpretation in a Pediatric Emergency Department. Jt Comm J Qual Patient Saf 2020; 46:573-580. [PMID: 32888814 DOI: 10.1016/j.jcjq.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/22/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Professional interpretation improves health care quality and outcomes for limited English proficient (LEP) patients, yet interpreter use remains low even when interpretation is available remotely. The researchers analyzed the effect of remote interpretation (telephone or video) on pediatric emergency provider attitudes and behaviors around professional interpretation. METHODS A cross-sectional questionnaire of pediatric emergency providers was conducted as part of a randomized trial of telephone vs. video interpretation with Spanish speaking LEP families. Providers recalled lapses of professional interpretation for medical communication (use of an ad hoc or no interpreter), if they had delayed or deferred communication due to the need for professional interpretation, and were asked about their satisfaction with the interpretation modality. Bivariate and multivariate analysis of professional interpreter use and communication behaviors were analyzed by self-report of study group assignment. RESULTS One third of providers reported lapses of professional interpretation and many reported less frequent (45.6%) and deferred (34.6%) communication due to the need for interpretation. There was no significant difference in these outcomes between telephone and video assignment. Interpreter skill and technical difficulties were similar between groups. Providers assigned to telephone, compared to video, were more likely to be dissatisfied (p < 0.001) and to report that interpretation was ineffective (p = 0.002). CONCLUSION Despite access to interpretation, providers caring for patients enrolled in a study of professional interpreter modalities reported frequent lapses in professional interpretation and deferring or delaying communication because an interpreter was needed. Addressing barriers to remote interpreter use will improve quality of care and health equity for LEP patients.
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Nurses' Perceptions of Technology Used in Language Interpretation for Patients with Limited English Proficiency. Am J Nurs 2020; 120:48-58. [DOI: 10.1097/01.naj.0000697652.73975.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Morris D, Lambert K, Vellar L, Mastroianni F, Krizanac J, Lago L, Mullan J. Factors associated with utilisation of health care interpreting services and the impact on length of stay and cost: A retrospective cohort analysis of audit data. Health Promot J Austr 2020; 32:425-432. [PMID: 32542897 DOI: 10.1002/hpja.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/11/2020] [Indexed: 11/10/2022] Open
Abstract
ISSUE ADDRESSED Utilisation of professional health care interpreting services improves the quality and safety of health care among patients with limited English proficiency. Health care interpreter service utilisation is inconsistent and suboptimal in Australia. Evidence of the impact of interpreter service use on patient outcomes and costs is limited. This study aimed to identify the proportion of hospitalised patients who received a health care interpreter during admission and describe the characteristics and outcomes for those requiring interpreter services. METHODS A retrospective cohort analysis of linked admitted patient data with internal interpreter audit data. This study included all inpatients in a health district-wide clinical audit of interpreter service use conducted between July 2016 and March 2018. The dataset comprised 74 patients (including 79 unique hospital stays and 90 episodes) from eight hospitals in one regional health district in New South Wales, Australia. RESULTS Interpreting services were utilised at least once for 54.4% (n = 43) of admissions. Females were more likely to receive an interpreter (65.1% vs 47.1%, P = .04). Age, preferred language, hospital, Diagnosis-Related Group partition and comorbidities were not associated with interpreter service utilisation. Differences in length of stay and cost associated with use of interpreter services were not statistically significant after casemix adjustment. CONCLUSIONS Approximately half of those who required an interpreter received one during their hospital stay. Further investigation is needed to establish whether regular clinical audits contributed to this rate of utilisation, which is higher than reported elsewhere in the literature. SO WHAT?: A detailed understanding of regional interpreting service use with evidence from the literature provides compelling and contextual evidence for change, at the level at which the service is delivered. This supports meaningful action to increase utilisation, and improve the quality and safety of health care delivered to patients with limited English proficiency.
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Affiliation(s)
- Darcy Morris
- Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Kelly Lambert
- Centre for Health Research Illawarra Shoalhaven Population, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Lucia Vellar
- Clinical Governance Unit, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Fiorina Mastroianni
- Clinical Governance Unit, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Josipa Krizanac
- Health Care Interpreter Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Luise Lago
- Centre for Health Research Illawarra Shoalhaven Population, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Judy Mullan
- Centre for Health Research Illawarra Shoalhaven Population, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
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Pines RL, Jones L, Sheeran N. Using Family Members as Medical Interpreters: An Explanation of Healthcare Practitioners' Normative Practices in Pediatric and Neonatal Departments in Australia. HEALTH COMMUNICATION 2020; 35:902-909. [PMID: 30947559 DOI: 10.1080/10410236.2019.1598740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Both international tourism and migration of people with low English proficiency (LEP) to Australia are increasing. Thus, health-care practitioners (HPs) increasingly use interpreters to communicate with patients with LEP. Although qualified interpreters are the most suggested and policy-endorsed mechanism for communicating with patients with LEP, family members (FMIs) are also used as interpreters. This study investigated (a) when do health professionals consider it appropriate to use FMIs and (b) what characteristics of family members health professionals believe make them suitable to act as FMIs. As part of a larger project examining the decision-making processes of HPs regarding interpreter use, 69 HPs from neonatal and pediatric departments in one hospital in Queensland Australia were interviewed. Results indicated HPs thought the appropriateness of using FMIs depended on the type of information, such that it was either completely acceptable (e.g., explaining some basic or non-medical information) or completely unacceptable (e.g., confidential information or consent). However, in an emergency, when no other options were available, FMIs were used. The characteristics of suitable FMIs included age, level of English proficiency and medical understanding, and the relationship between patient and FMI. Results were to some extent consistent with Queensland government policies but there were notable differences, including using children and regarding FMIs as first preference. Improving HP's knowledge of policies may increase their confidence in their practice and appropriate use of FMIs, thereby improving their care delivery to patients and families with LEP.
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Affiliation(s)
| | - Liz Jones
- School of Applied Psychology, Griffith University
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Mirza M, Harrison EA, Roman M, Miller KA, Jacobs EA. Walking the talk: understanding how language barriers affect the delivery of rehabilitation services. Disabil Rehabil 2020; 44:301-314. [DOI: 10.1080/09638288.2020.1767219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mansha Mirza
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Elizabeth A. Harrison
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Marissa Roman
- Rehabilitation Sciences Program, University of Illinois at Chicago, Chicago, IL, USA
| | - Kathryn A. Miller
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Elizabeth A. Jacobs
- Departments of Population Health and Internal Medicine, University of Texas, Austin, TX, USA
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Kleinert E, Müller F, Kruse S, Furaijat G, Simmenroth A. [Usability and Efficiency of a Digital Communication Assistance Tool to Obtain Medical History from Non-German-Speaking Patients]. DAS GESUNDHEITSWESEN 2020; 83:531-537. [PMID: 32413911 DOI: 10.1055/a-1144-2848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM In the DICTUM-Friedland study, a medical history-taking app was implemented in an initial reception facility for refugees and asylum seekers. This app can be used to obtain from patients information about the most frequent general medical complaints and risk factors in 13 different languages or dialects. A report (synopsis) is generated, based on each patient's given data, in the German language. Usability and efficiency of obtaining medical history were the criteria evaluated in order to test and optimize the app for use in a broader general medical setting. METHODS From May to December 2018, the app was tested in the waiting room of the general medical ward in the refugee camp in Friedland in southern Lower Saxony, Germany. Patients were asked to complete a short digital questionnaire about the usability of the app immediately after finishing the query. Sociodemographic data were partly collected with the same questionnaire and partly extracted from patient records. The efficiency was evaluated on the basis of the correspondence between the entered complaints (ICPC-2) and the diagnoses of the doctors (ICD-10). RESULTS In total, the app was used 353 times, and based on these, 283 medical histories were taken. The median time for entering the complaints was 10:27 minutes. The use of the audio output (60% of patients used this option) did not influence the usability. The majority of the users (76%) rated the app as easy to use and 65% of the users stated that they were able to enter their main complaints. Both assessments were independent of the age and sex of the users, but the educational level had a slightly more positive influence. The efficiency test showed that 51% (n=144) of the synopses matched fully and 28% (n=79) of the synopses matched partially with the medical diagnoses. CONCLUSION The systematic survey of the most frequent general medical complaints enables a more precise medical history taking in patients with whom a normal interview is not possible due to language barriers. Thus it serves as a support for the medical history taking. The app is easy to use and not prone to the errors of online translations.
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Affiliation(s)
- Evelyn Kleinert
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen Abteilung Allgemeinmedizin, Gottingen
| | - Frank Müller
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen Abteilung Allgemeinmedizin, Gottingen
| | - Stefan Kruse
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen Abteilung Allgemeinmedizin, Gottingen
| | - Ghefar Furaijat
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen Abteilung Allgemeinmedizin, Gottingen
| | - Anne Simmenroth
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen Abteilung Allgemeinmedizin, Gottingen.,Institut für Allgemeinmedizin, Universitätsklinikum Würzburg, Wurzburg
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Woll A, Quick KK, Mazzei C, Selameab T, Miller JL. Working With Interpreters as a Team in Health Care (WITH Care) Curriculum Tool Kit for Oral Health Professions. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10894. [PMID: 32352031 PMCID: PMC7187915 DOI: 10.15766/mep_2374-8265.10894] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/25/2019] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Limited English proficiency (LEP) patients face multiple care barriers and disproportionate risks for communication errors. Working with trained interpreters as a health care team can improve communication and drive high-quality care for LEP patients. Simulation and interprofessional education provide key strategies to address the critical training gap that exists at the intersection of patient safety, interprofessional practice, and cultural competence. METHODS Using action research principles across 16 months, we created a 3.5-hour simulation-based training for oral health and interpreting learners. The curriculum included profession-specific orientations with didactic and experiential content, three immersive simulations using start-stop-rewind methodology, virtual scenarios, and summary reflection discussions. A comprehensive tool kit facilitated curriculum implementation and standardization. RESULTS Forty-nine students from dentistry (first- through third-year predoctoral), dental hygiene, and dental therapy participated in this elective training during the 2017-2018 academic year; as required training, 126 third-year dental students participated in fall 2018. Students' familiarity with provider and interpreter best practices, appreciation of challenges faced by LEP patients, and confidence in skills working with spoken language interpreters increased. For all evaluation parameters, pre- and postsurvey ratings were statistically significant (chi-square tests, p < .001). DISCUSSION The curriculum efficiently and effectively develops oral health and interpreting learners' abilities to work as a team with LEP patients. Curriculum design and resources address key barriers to feasibility and sustainability. The curriculum informs communication across all patient populations, revealing that getting by with partial understanding can be insufficient for any patient and any health care team.
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Affiliation(s)
- Anne Woll
- Associate Director, Interprofessional Education and Resource Center, University of Minnesota
- Associate Director, Academic Health Center Simulation Center, University of Minnesota
| | - Karin K. Quick
- Associate Professor, Department of Primary Dental Care, University of Minnesota School of Dentistry
- Director, Division of Dental Public Health, Department of Primary Dental Care, University of Minnesota School of Dentistry
- Director, Global Programs, Department of Primary Dental Care, University of Minnesota School of Dentistry
| | - Cristiano Mazzei
- Director, Translator and Interpreter Training, Department of Languages, Literatures, and Cultures, University of Massachusetts Amherst
| | | | - Jane L. Miller
- Clinical Associate Professor, Department of Family Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine
- Director, Office of Consultation and Research in Medical Education, University of Iowa Roy J. and Lucille A. Carver College of Medicine
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