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Le D, Mullen MT, Lin W, Katz PM, Hellerslia V. Comparison of stroke process measures and clinical outcomes between English and Non-English preferring patients. J Stroke Cerebrovasc Dis 2024; 33:107880. [PMID: 39038629 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107880] [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: 06/07/2024] [Revised: 07/12/2024] [Accepted: 07/18/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND In the United States, limited English proficiency may reduce the quality of care and worsen outcomes after stroke. The aim was to compare stroke process measures and clinical outcomes between English preferring and non-English preferring stroke patients. METHODS/MATERIALS This single-center retrospective cohort study evaluated patients from one United States hospital with acute ischemic stroke between July 2013 and June 2022. The primary outcomes were defect-free care, a composite of 7 stroke process measures, and independent ambulation at hospital discharge. Multivariate logistic regression models quantified the association between language preference and outcomes. Secondary outcomes included individual components of defect-free care, discharge modified Rankin scale, and discharge disposition. RESULTS There were 4,030 patients with acute ischemic stroke identified, of which 2,965 were matched with language data from the electronic medical record. There were 373 non-English preferring patients, among which 76.9% preferred Spanish and 23.1% were non-English, non-Spanish preferring. In the multivariable model, there was no significant association between non-English preference and defect-free care (OR=0.64, 95% CI=0.26-1.59) or independent ambulation at discharge (OR=0.89, 95% CI=0.67-1.17). When compared to Spanish preferring patients, non-English, non-Spanish preferring patients had more severe strokes (P<0.001) but there was no difference in defect-free care or independent ambulation after adjustment. CONCLUSION Our results suggest that process and clinical outcomes are similar regardless of language preference; although, our data are limited by small numbers of non-English, non-Spanish preferring patients. Additional research is needed among this population.
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Affiliation(s)
- Dianne Le
- College of Public Health, Temple University, United States
| | - Michael T Mullen
- Department of Neurology, Lewis Katz School of Medicine at Temple University, United States
| | - Wenxue Lin
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, United States
| | - Paul M Katz
- Department of Neurology, Lewis Katz School of Medicine at Temple University, United States
| | - Van Hellerslia
- Department of Neurology, Lewis Katz School of Medicine at Temple University, United States; Department of Pharmacy Practice, Temple University School of Pharmacy, 3307 North Broad Street, Philadelphia 19001, PA, United States.
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Bakillah E, Moneme A, Brown D, Sharpe J, McGarvey ML, Kelz RR. The influence of primary language on postoperative stroke outcomes. Am J Surg 2024; 234:150-155. [PMID: 38688813 DOI: 10.1016/j.amjsurg.2024.04.023] [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: 01/30/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Language barriers have the potential to influence acute stroke outcomes. Thus, we examined postoperative stroke outcomes among non-English primary language speakers. METHODS Utilizing the Healthcare Cost and Utilization Project State Inpatient Database (2016-2019), we conducted a retrospective cohort study of adults diagnosed with a postoperative stroke in Michigan, Maryland, and New Jersey. Patients were classified by primary language spoken: English (EPL) or non-English (n-EPL). The primary outcome was hospital length-of-stay. Secondary outcomes included stroke intervention, feeding tube, tracheostomy, mortality, cost, disposition, and readmission. Propensity-score matching and post-match regression were used to quantify outcomes. RESULTS Among 3078 postoperative stroke patients, 6.2 % were n-EPL. There were no differences in length-of-stay or secondary outcomes, except for higher odds of feeding tube placement (OR 1.95, 95 % CI 1.10-3.47, p = 0.0227) in n-EPL. CONCLUSIONS Postoperative stroke outcomes were comparable by primary language spoken. However, higher odds of feeding tube placement in n-EPL may suggest differences in patient-provider communication.
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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.
| | - Adora Moneme
- 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
| | - Danielle Brown
- 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
| | - 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
| | - Michael L McGarvey
- Department of Neurology, Perelman School of Medicine of the 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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Bell F, Crabtree R, Wilson C, Miller E, Byrne R. Ambulance service recognition of health inequalities and activities for reduction: An evidence and gap map of the published literature. Br Paramed J 2024; 9:47-57. [PMID: 38946737 PMCID: PMC11210581 DOI: 10.29045/14784726.2024.6.9.1.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Background Emergency medical services (EMS) are often patients' first point of contact for urgent and emergency care needs. Patients are triaged over the phone and may receive an ambulance response, with potential conveyance to the hospital. A recent scoping review suggested disparities in EMS patient care in the United States. However, it is unknown how health inequalities impact EMS care in other developed countries and how inequalities are being addressed. Objectives This rapid evidence map of published literature aims to map known health inequalities in EMS patients and describe interventions reducing health inequalities in EMS patient care. Methods The search strategy consisted of EMS synonyms and health inequality synonyms. The MEDLINE/PubMed database was searched from 1 January 2010 to 26 July 2022. Studies were included if they described empirical research exploring health inequalities within ambulance service patient care. Studies were mapped on to the EMS care interventions framework and Core20PLUS5 framework. Studies evaluating interventions were synthesised using the United Kingdom Allied Health Professions Public Health Strategic Framework. Results The search strategy yielded 771 articles, excluding duplicates, with two more studies added from hand searches. One hundred studies met the inclusion criteria after full-text review. Inequalities in EMS patient care were predominantly situated in assessment, treatment and conveyance, although triage and response performance were also represented. Studies mostly explored EMS health inequalities within ethnic minority populations, populations with protected characteristics and the core issue of social deprivation. Studies evaluating interventions reducing health inequalities (n = 5) were from outside the United Kingdom and focused on older patients, ethnic minorities and those with limited English proficiency. Interventions included community paramedics, awareness campaigns, dedicated language lines and changes to EMS protocols. Conclusions Further UK-based research exploring health inequalities of EMS patients would support ambulance service policy and intervention development to reduce health inequality in urgent and emergency care delivery.
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Affiliation(s)
- Fiona Bell
- Yorkshire Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0003-4503-1903
| | | | - Caitlin Wilson
- Yorkshire Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0002-9854-4289
| | - Elisha Miller
- NIHR Coordinating Centre ORCID iD: https://orcid.org/0000-0003-4729-8572
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Melgoza E, Cardenas V, Enguídanos S, Bustamante AV, Beltrán-Sánchez H. A Systematic Literature Review of Hispanic Adults' Experiences With the Emergency Medical Services System in the United States Between 2000 and 2021. Med Care 2023; 61:150-156. [PMID: 36598888 PMCID: PMC9931647 DOI: 10.1097/mlr.0000000000001817] [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: 01/05/2023]
Abstract
OBJECTIVE This systematic literature review presents an overview of studies that assess the experiences of Hispanic adults with (1) activation of emergency medical services (EMS); (2) on-scene care provided by EMS personnel; (3) mode of transport (EMS vs. non-EMS) to an emergency department (ED); and (4) experiences with EMS before and during the COVID-19 pandemic. METHODS A bibliographic database search was conducted to identify relevant studies on Ovid MEDLINE (PubMed), Web of Science, EMBASE, and CINAHL. Quantitative, mixed methods, and qualitative studies published in English or Spanish were included if they discussed Hispanic adults' experiences with EMS in the US between January 1, 2000 and December 31, 2021. The Hawker and colleagues quality assessment instrument was used to evaluate the quality of studies. RESULTS Of the 43 included studies, 13 examined EMS activation, 13 assessed on-scene care, 22 discussed the mode of transport to an ED, and 4 described Hispanic adults' experiences with EMS during the COVID-19 pandemic. Hispanics were less likely to activate EMS (N=7), less likely to receive certain types of on-scene care (N=6), and less likely to use EMS as the mode of transport to an ED (N=13), compared with non-Hispanic Whites. During the early COVID-19 pandemic period (March to May 2020), EMS use decreased by 26.5% compared with the same months during the previous 4 years. CONCLUSIONS The contribution of this study is its attention to Hispanic adults' experiences with the different phases of the US EMS system.
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Affiliation(s)
- Esmeralda Melgoza
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Valeria Cardenas
- Leonard Davis School of Gerontology, University of Southern California (USC), Los Angeles, CA
| | - Susan Enguídanos
- Leonard Davis School of Gerontology, University of Southern California (USC), Los Angeles, CA
| | - Arturo Vargas Bustamante
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Hiram Beltrán-Sánchez
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA
- California Center for Population Research, UCLA
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Zachrison KS, Samuels‐Kalow ME, Li S, Yan Z, Reeves MJ, Hsia RY, Schwamm LH, Camargo CA. The relationship between stroke system organization and disparities in access to stroke center care in California. J Am Coll Emerg Physicians Open 2022; 3:e12706. [PMID: 35316966 PMCID: PMC8921441 DOI: 10.1002/emp2.12706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/08/2022] Open
Abstract
Background There are significant racial and ethnic disparities in receipt of reperfusion interventions for acute ischemic stroke. Our objective was to determine whether there are disparities in access to stroke center care by race or ethnicity that help explain differences in reperfusion therapy and to understand whether interhospital patient transfer plays a role in improving access. Methods Using statewide administrating data including all emergency department and hospital discharges in California from 2010 to 2017, we identified all acute ischemic stroke patients. Primary outcomes of interest included presentation to primary or comprehensive stroke center (PSC or CSC), interhospital transfer, discharge from PSC or CSC, and discharge from CSC alone. We used hierarchical logistic regression modeling to identify the relationship between patient- and hospital-level characteristics and outcomes of interest. Results Of 336,247 ischemic stroke patients, 55.4% were non-Hispanic White, 19.6% Hispanic, 10.6% non-Hispanic Asian/Pacific Islander, and 10.3% non-Hispanic Black. There was no difference in initial presentation to stroke center hospitals between groups. However, adjusted odds of reperfusion intervention, interhospital transfer and discharge from CSC did vary by race and ethnicity. Adjusted odds of interhospital transfer were lower among Hispanic (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.89 to 0.98) and non-Hispanic Asian/Pacific Islander patients (OR 0.84, 95% CI 0.79 to 0.90) and odds of discharge from a CSC were lower for Hispanic (OR 0.91, 95% CI 0.85 to 0.97) and non-Hispanic Black patients (OR 0.74, 95% CI 0.67 to 0.81). Conclusions There are racial and ethnic disparities in reperfusion intervention receipt among stroke patients in California. Stroke system of care design, hospital resources, and transfer patterns may contribute to this disparity.
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Affiliation(s)
- Kori S. Zachrison
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | | | - Sijia Li
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Zhiyu Yan
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Mathew J. Reeves
- Department of Epidemiology and BiostatisticsMichigan State UniversityEast LansingMichiganUSA
| | - Renee Y. Hsia
- Department of Emergency MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Philip R. Lee Institute for Health Policy StudiesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lee H. Schwamm
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Carlos A. Camargo
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
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Clark JR, Shlobin NA, Batra A, Liotta EM. The Relationship Between Limited English Proficiency and Outcomes in Stroke Prevention, Management, and Rehabilitation: A Systematic Review. Front Neurol 2022; 13:790553. [PMID: 35185760 PMCID: PMC8850381 DOI: 10.3389/fneur.2022.790553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/11/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Individuals with limited English proficiency (LEP) face structural challenges to communication in English-speaking healthcare environments. We performed a systematic review to characterize the relationship between LEP and outcomes in stroke prevention, management, and recovery. Methods A systematic review was conducted using the PubMed, Embase, Scopus, and Web of Science databases. Titles and abstracts from articles identified were read and selected for full text review. Studies meeting inclusion criteria were reviewed in full for study design, aim, and outcomes. Results Of 891 unique articles, 20 were included. Eleven articles did not provide information about interpreter availability or usage, limiting the ability to draw conclusions about the effect of LEP on measured outcomes in these studies. Overall, studies demonstrated that English proficiency is associated with better outcomes in preventive aspects of stroke care such as stroke symptom awareness, anticoagulation maintenance, and knowledge of warfarin indication. Some acute stroke care metrics were independent of English proficiency in seven studies while other evidence showed associations between interpreter requirement and quality of inpatient care received. LEP and English-proficient groups show similar mortality despite greater lengths of stay and greater proportions of care in dedicated stroke units for LEP patients. Post-stroke quality of life can be worse for those with LEP, and language barriers can negatively impact patient and provider experiences of rehabilitation. Conclusions Stroke patients with LEP face barriers to equitable care at multiple stages. While some studies demonstrate worse outcomes for LEP patients, equitable care was shown in multiple studies frequently in the setting of a high degree of interpreter availability. Patients with LEP will benefit from tailored education regarding stroke symptom recognition and medication regimens, and from provision of translated written educational material. Inequities in inpatient care and rehabilitation exist despite similar mortality rates in four studies. Future studies should report interpreter availability and usage within LEP groups and whether patient interactions were language-concordant or discordant in order to allow for more generalizable and reliable conclusions.
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