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Kelleher DP, Barwise AK, Robbins KA, Borah BJ. Examining the association between professional language interpreter services and intensive care unit utilization among patients with non-English language preference: Evidence from a large U.S. hospital. PATIENT EDUCATION AND COUNSELING 2024; 128:108375. [PMID: 39079432 DOI: 10.1016/j.pec.2024.108375] [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: 05/06/2024] [Revised: 07/11/2024] [Accepted: 07/20/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE To examine the healthcare utilization of patients with non-English language preference (NELP) who utilized a professional language interpreter (PLI) in the intensive care unit (ICU) compared to similar patients with NELP who did not utilize a PLI in the ICU. METHODS Single center cohort study of patients with NELP with at least one ICU admission a large academic medical center in the U.S. Midwest (1/1/2008-12/31/2022). The first model examined ICU length-of-stay (LOS) using a negative binomial and the second model examined whether a patient was readmitted to the ICU using a logistic regression with each model controlling for PLI utilization and covariates. RESULTS Patients with NELP who utilized a PLI in the ICU had 0.87-days longer in the ICU (p < 0.01) and had a 46 % decreased odds of being readmitted to the ICU (p < 0.01) than a comparable patient with NELP who did not utilize a PLI in the ICU. CONCLUSION Providing patients with NELP with access to a PLI in the ICU can improve patient outcomes and reduce language barriers. PRACTICE IMPLICATIONS These results can provide the justification to potentially increase PLI staffing levels or increase the access to existing PLIs for more patients with NELP in ICUs.
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Affiliation(s)
- Dan P Kelleher
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA; Bioethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Kellie A Robbins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bijan J Borah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
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2
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Gimeno A, Krause K, D’Souza S, Walsh CG. Completeness and readability of GPT-4-generated multilingual discharge instructions in the pediatric emergency department. JAMIA Open 2024; 7:ooae050. [PMID: 38957592 PMCID: PMC11216721 DOI: 10.1093/jamiaopen/ooae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 05/16/2024] [Accepted: 05/28/2024] [Indexed: 07/04/2024] Open
Abstract
Objectives The aim of this study was to assess the completeness and readability of generative pre-trained transformer-4 (GPT-4)-generated discharge instructions at prespecified reading levels for common pediatric emergency room complaints. Materials and Methods The outputs for 6 discharge scenarios stratified by reading level (fifth or eighth grade) and language (English, Spanish) were generated fivefold using GPT-4. Specifically, 120 discharge instructions were produced and analyzed (6 scenarios: 60 in English, 60 in Spanish; 60 at a fifth-grade reading level, 60 at an eighth-grade reading level) and compared for completeness and readability (between language, between reading level, and stratified by group and reading level). Completeness was defined as the proportion of literature-derived key points included in discharge instructions. Readability was quantified using Flesch-Kincaid (English) and Fernandez-Huerta (Spanish) readability scores. Results English-language GPT-generated discharge instructions contained a significantly higher proportion of must-include discharge instructions than those in Spanish (English: mean (standard error of the mean) = 62% (3%), Spanish: 53% (3%), P = .02). In the fifth-grade and eighth-grade level conditions, there was no significant difference between English and Spanish outputs in completeness. Readability did not differ across languages. Discussion GPT-4 produced readable discharge instructions in English and Spanish while modulating document reading level. Discharge instructions in English tended to have higher completeness than those in Spanish. Conclusion Future research in prompt engineering and GPT-4 performance, both generally and in multiple languages, is needed to reduce potential for health disparities by language and reading level.
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Affiliation(s)
- Alex Gimeno
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN 37232, United States
| | - Kevin Krause
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Starina D’Souza
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN 37232, United States
| | - Colin G Walsh
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN 37232, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN 37203, United States
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Verkhovsky SB, Kong L, Oliver BJ. Comparing Hospital Length of Stay Between Persons With LEP and English-Speaking Patients in a Large Rural Academic Medical Center. Perm J 2024; 28:270-277. [PMID: 38916447 PMCID: PMC11404650 DOI: 10.7812/tpp/23.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND Patients with limited English proficiency that are hospitalized without regular access to professional medical interpreters have a longer length of stay (LOS).1 The authors studied the difference in LOS between English-speaking patients and patients with limited English proficiency in New Hampshire's only academic trauma medical center. The authors also examined race, ethnicity, and distance of residence from hospital. METHODS Retrospective data were queried from EPIC, the electronic medical record system used by the authors. Queried data focused on inpatient hospitalizations between January 1, 2019, and December 31, 2021. Patient primary language was grouped into English, Spanish, and other non-English language. RESULTS Spanish-speaking patients live on average 39.6 miles farther from a hospital than English-speaking patients and have a 0.34 lower case mix index. After English, Spanish is the second-most frequently spoken language. Regression analyses found language to be a significant factor in LOS, LOS variance, and case mix index. DISCUSSION A 2.34-day longer LOS for Spanish-speaking patients demonstrates an important health care disparity warranting further attention.
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Affiliation(s)
- Samuel B Verkhovsky
- Office of Care Experience, the Value Institute, Dartmouth Health, Lebanon, NH, USA
| | - Lixi Kong
- Analytics Institute, Dartmouth Health, Lebanon, NH, USA
| | - Brant J Oliver
- Office of Care Experience, the Value Institute, Dartmouth Health, Lebanon, NH, USA
- Chronic Health Improvement Research Program, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Schwei RJ, Geiger G, Mirrielees J, Center A, Enemuoh A, Portillo Recinos A, Arias F, Lor M, Shah MN, Wiegmann D, Pulia MS. Characterizing Spanish-speaking patients' patient-centered care experiences in the emergency department. Acad Emerg Med 2024. [PMID: 39248362 DOI: 10.1111/acem.15011] [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] [Received: 03/29/2024] [Revised: 08/06/2024] [Accepted: 08/20/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Patient-centered care (PCC) is an essential component of high-quality health, yet patients with non-English language preferences (NELP) experience worse PCC outcomes. Additionally, there are likely unique aspects to PCC for patients with NELP in the emergency department (ED). To inform the development of strategies to improve PCC for NELP in the ED, we sought to understand how Spanish-speaking ED patients experience care and the factors that influenced their perceptions of the patient-centeredness of that care. METHODS We conducted a single-center qualitative study using semistructured interviews with adult, Spanish-speaking patients who had been discharged home from the ED. Interviews were conducted using an interview guide, recorded, transcribed, and analyzed iteratively in Spanish using inductive and deductive thematic analysis. RESULTS We conducted 19 interviews with participants from 24 to 72 years old. Participants were born in seven different Spanish-speaking countries. Participants identified three domains of PCC: patient, medical team's skills, and system. Several of the identified themes such as shared decision making, open communication, compassionate care, and coordination of follow-up care are often incorporated into PCC definitions. However, other themes, including uncertainty leading to fear, use of professional interpreters to promote understanding, receiving equitable care, technical proficiency, and efficiency of care expand upon existing domains in PCC definitions. CONCLUSIONS We now have a more nuanced understanding of how Spanish-speaking patients with NELP experience PCC in the ED and what matters to them. Several of the themes identified in this analysis add details about what matters to patients within the domains of previous PCC definitions. This suggests that the conceptualization of PCC may vary based on the setting where care is provided and the population who is receiving this care. Future work should consider patient population and setting when conceptualizing PCC.
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Affiliation(s)
- Rebecca J Schwei
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Gabriella Geiger
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jenn Mirrielees
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Alexandra Center
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Alyana Enemuoh
- University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ashley Portillo Recinos
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Franchesca Arias
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
- 1FLADRC, Gainesville, Florida, USA
- UF Center for Health Equity and Engagement Research (CHEER), Gainesville, Florida, USA
| | - Maichou Lor
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medicine (Geriatrics and Gerontology), School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Douglas Wiegmann
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michael S Pulia
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Truong NM, Stroud SG, Zhuang T, Fernandez A, Kamal RN, Shapiro LM. The Association Between Social Determinants of Health and Distal Radius Fracture Outcomes. J Hand Surg Am 2024; 49:875-884. [PMID: 38934997 DOI: 10.1016/j.jhsa.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 03/25/2024] [Accepted: 04/10/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE The purpose of this study was to determine if adverse social determinants of health (SDOH) are associated with differential complication rates following surgical fixation of distal radius fractures and assess which SDOH domain (economic, educational, social, health care, or environmental) is most associated with postoperative complications. METHODS Using a national administrative claims database, we conducted a retrospective cohort analysis of patients undergoing open treatment for an isolated distal radius fracture between 2010 and 2020. Patients were stratified based on the presence/absence of at least one SDOH code and propensity score matched to create two cohorts balanced by age, sex (male or female), insurance type, and comorbidities. Social determinants of health examined included economic, educational, social, health care, and environmental factors. Multivariable logistic regression analyses were performed to assess the isolated effect of SDOH on 90-day and 1-year complication rates. RESULTS After propensity matching, 57,025 patients in the adverse SDOH cohort and 57,025 patients in the control cohort were included. Patients facing an adverse SDOH were significantly more likely to experience 90-day complications, including emergency department visits (Odds ratio (OR): 3.18 [95% confidence interval (CI): 3.07-3.29]), infection (OR: 2.37 [95% CI: 2.12-2.66]), wound dehiscence (OR: 2.06 [95% CI: 1.72-2.49]), and 1-year complications, including complex regional pain syndrome (OR: 1.35 [95% CI: 1.15-1.58]), malunion/nonunion (OR: 1.18 [95% CI: 1.08-1.29]), and hardware removal (OR: 1.13 [95% CI: 1.07-1.20]). Additionally, patients facing an adverse SDOH had a significantly increased risk of 90-day complications, regardless of fracture severity, and patients with economic and social challenges had the highest odds of both 90-day and 1-year postoperative complications. CONCLUSIONS Social determinants of health are associated with increased complications following distal radius fracture fixation, even when controlling for demographic and clinical factors. We recommend routine screening for adverse SDOH and inclusion of SDOH data into health records to not only inform quality improvement initiatives and risk adjustment for outcome-based quality measurements but also to allow providers to begin to discuss and address such barriers during the perioperative period. TYPE OF STUDY/LEVEL OF EVIDENCE Prognosis II.
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Affiliation(s)
- Nicole M Truong
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Sarah G Stroud
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Thompson Zhuang
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Alicia Fernandez
- Department of Internal Medicine, University of California, San Francisco, CA
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California, San Francisco, CA.
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Schippert AC, Grov EK, Dahl-Michelsen T, Silvola J, Sparboe-Nilsen B, Danielsen SO, Lie I, Aaland M, Bjørnnes AK. Preventing retraumatisation in torture survivors during surgical care: results of a guideline-development project and qualitative study exploring healthcare providers' experiences. BMJ Open 2024; 14:e083388. [PMID: 39179277 PMCID: PMC11344513 DOI: 10.1136/bmjopen-2023-083388] [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: 12/18/2023] [Accepted: 08/01/2024] [Indexed: 08/26/2024] Open
Abstract
OBJECTIVES Insufficient training and the absence of guidelines increase the risk of retraumatisation in torture survivors during surgical procedures. This study aims to develop guidelines to mitigate this risk and gather healthcare professionals' experiences treating torture survivors and insights on the guideline's feasibility and acceptability. DESIGN The study was conducted in two phases. Phase 'a' involved developing guidelines based on reviews of torture survivors' encounters in somatic care and potential retraumatisation triggers, as well as a qualitative study on survivors' experiences during surgical interventions. The development process adhered to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles and the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument for methodological rigour. Phase 'b' involved focus groups and individual interviews with healthcare professionals to explore challenges in caring for torture survivors and to evaluate the guidelines. SETTING The study, conducted from May to August 2023, involved participants from surgical departments in three hospitals in southern and southeastern Norway. PARTICIPANTS Twenty-one healthcare professionals, including surgeons, anaesthesiologists, nurses and a dentist, participated in the study. Both focus group interviews and individual interviews were conducted. RESULTS Phase 'a': guidelines comprising six sections were developed: an introduction, general guidelines and four sections covering the preoperative, perioperative and postoperative surgical stages. Phase 'b': healthcare professionals struggled to understand torture's complexities and identify survivors' unique needs. They faced challenges using interpreters and assisting patients with strong reactions. While the guidelines were viewed as practical and useful for raising awareness, their length was questioned. CONCLUSIONS We provide recommendations for preventing retraumatisation in torture survivors undergoing surgical treatment. The guidelines may serve as a starting point for offering safe and individualised care to torture survivors. Teaching institutions and hospitals may incorporate the guidelines into healthcare professionals' education.
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Affiliation(s)
- Ana Carla Schippert
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Akershus University Hospital, Lorenskog, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Tone Dahl-Michelsen
- Institute of Physiotherapy, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Juha Silvola
- ENT, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo Faculty of Medicine, Lorenskog, Norway
| | - Bente Sparboe-Nilsen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Hospitality, Culinary Arts and Meal Science, Örebro Universitet-Campus Grythyttan, Grythyttan, Sweden
| | - Stein Ove Danielsen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Irene Lie
- Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
- Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Center for Patient-Centered Heart and Lung Research, Oslo University Hospital, Oslo, Norway
| | | | - Ann Kristin Bjørnnes
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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Amobi A. Upholding Standards for Qualified Bilingual Staff. JAMA 2024; 332:101-102. [PMID: 38869875 DOI: 10.1001/jama.2024.8896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
This Viewpoint discusses ways to ensure the proficiency of bilingual communication among health care staff in patient-clinician encounters, such as language testing and use of professional interpreters.
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Affiliation(s)
- Adaugo Amobi
- Massachusetts General Hospital, Harvard Medical School, Boston
- Public Voices Fellow, The Op-Ed Project, Boston, 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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Silva-Rudberg JA, Carrión CI, Pérez-Palmer N, Li J, Mehta SK, Diab NS, Mecca AP, O'Dell RS. Assessment of disparities in timely diagnosis and comprehensive workup of cognitive impairment between English and Spanish speakers. Am J Geriatr Psychiatry 2024; 32:773-786. [PMID: 38336573 PMCID: PMC11162952 DOI: 10.1016/j.jagp.2024.01.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 01/13/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Previous studies have examined disparities in dementia care that affect the U.S. Hispanic/Latino population, including clinician bias, lack of cultural responsiveness, and less access to health care. However, there is limited research that specifically investigates the impact of language barriers to health disparities in dementia diagnosis. METHODS In this retrospective cross-sectional study, 12,080 English- or Spanish- speaking patients who received an initial diagnosis of mild cognitive impairment (MCI) or dementia between July 2017 and June 2019 were identified in the Yale New Haven Health (YNHH) electronic medical record. To evaluate the timeliness of diagnosis, an initial diagnosis of MCI was classified as "timely", while an initial diagnosis of dementia was considered "delayed." Comprehensiveness of diagnosis was assessed by measuring the presence of laboratory studies, neuroimaging, specialist evaluation, and advanced diagnostics six months before or after diagnosis. Binomial logistic regressions were calculated with and without adjustment for age, legal sex, ethnicity, neighborhood disadvantage, and medical comorbidities. RESULTS Spanish speakers were less likely to receive a timely diagnosis when compared with English speakers both before (unadjusted OR, 0.65; 95% CI, 0.53-0.80, p <0.0001) and after adjusting for covariates (adjusted OR, 0.55; 95% CI, 0.40-0.75, p = 0.0001). Diagnostic services were provided equally between groups, except for referrals to geriatrics, which were more frequent among Spanish-speaking patients. A subgroup analysis revealed that Spanish-speaking Hispanic/Latino patients were less likely to receive a timely diagnosis compared to English-speaking Hispanic/Latino patients (adjusted OR, 0.53; 95% CI, 0.38-0.73, p = 0.0001). CONCLUSIONS Non-English language preference is likely to be a contributing factor to timely diagnosis of cognitive impairment. In this study, Spanish language preference rather than Hispanic/Latino ethnicity was a significant predictor of a less timely diagnosis of cognitive impairment. Policy changes are needed to reduce barriers in cognitive disorders care for Spanish-speaking patients.
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Affiliation(s)
- Jason A Silva-Rudberg
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Medicine (JAS-R,), University of California, San Francisco, San Francisco, CA
| | - Carmen I Carrión
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Neurology (CIC), Yale University School of Medicine, New Haven, CT
| | - Nicolás Pérez-Palmer
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (NP-P), Veteran's Affairs Connecticut Healthcare System, West Haven, CT
| | - Judy Li
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Sumarth K Mehta
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Nicholas S Diab
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Adam P Mecca
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Ryan S O'Dell
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT.
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Chu JN, Wong J, Bardach NS, Allen IE, Barr-Walker J, Sierra M, Sarkar U, Khoong EC. Association between language discordance and unplanned hospital readmissions or emergency department revisits: a systematic review and meta-analysis. BMJ Qual Saf 2024; 33:456-469. [PMID: 38160059 PMCID: PMC11186734 DOI: 10.1136/bmjqs-2023-016295] [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: 04/28/2023] [Accepted: 10/25/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND OBJECTIVE Studies conflict about whether language discordance increases rates of hospital readmissions or emergency department (ED) revisits for adult and paediatric patients. The literature was systematically reviewed to investigate the association between language discordance and hospital readmission and ED revisit rates. DATA SOURCES Searches were performed in PubMed, Embase and Google Scholar on 21 January 2021, and updated on 27 October 2022. No date or language limits were used. STUDY SELECTION Articles that (1) were peer-reviewed publications; (2) contained data about patient or parental language skills and (3) included either unplanned hospital readmission or ED revisit as one of the outcomes, were screened for inclusion. Articles were excluded if: unavailable in English; contained no primary data or inaccessible in a full-text form (eg, abstract only). DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data using Preferred Reporting Items for Systematic Reviews and Meta-Analyses-extension for scoping reviews guidelines. We used the Newcastle-Ottawa Scale to assess data quality. Data were pooled using DerSimonian and Laird random-effects models. We performed a meta-analysis of 18 adult studies for 28-day or 30-day hospital readmission; 7 adult studies of 30-day ED revisits and 5 paediatric studies of 72-hour or 7-day ED revisits. We also conducted a stratified analysis by whether access to interpretation services was verified/provided for the adult readmission analysis. MAIN OUTCOMES AND MEASURES Odds of hospital readmissions within a 28-day or 30-day period and ED revisits within a 7-day period. RESULTS We generated 4830 citations from all data sources, of which 49 (12 paediatric; 36 adult; 1 with both adult and paediatric) were included. In our meta-analysis, language discordant adult patients had increased odds of hospital readmissions (OR 1.11, 95% CI 1.04 to 1.18). Among the 4 studies that verified interpretation services for language discordant patient-clinician interactions, there was no difference in readmission (OR 0.90, 95% CI 0.77 to 1.05), while studies that did not specify interpretation service access/use found higher odds of readmission (OR 1.14, 95% CI 1.06 to 1.22). Adult patients with a non-dominant language preference had higher odds of ED revisits (OR 1.07, 95% CI 1.004 to 1.152) compared with adults with a dominant language preference. In 5 paediatric studies, children of parents language discordant with providers had higher odds of ED revisits at 72 hours (OR 1.12, 95% CI 1.05 to 1.19) and 7 days (OR 1.02, 95% CI 1.01 to 1.03) compared with patients whose parents had language concordant communications. DISCUSSION Adult patients with a non-dominant language preference have more hospital readmissions and ED revisits, and children with parents who have a non-dominant language preference have more ED revisits. Providing interpretation services may mitigate the impact of language discordance and reduce hospital readmissions among adult patients. PROSPERO REGISTRATION NUMBER CRD42022302871.
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Affiliation(s)
- Janet N Chu
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jeanette Wong
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Naomi S Bardach
- Pediatrics, University of California San Francisco, San Francisco, California, USA
- Philip R Lee Institute for Health Policy Studies, San Francisco, California, USA
| | - Isabel Elaine Allen
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Jill Barr-Walker
- Zuckerberg San Francisco General Hospital and Trauma Center Library, San Francisco, California, USA
| | - Maribel Sierra
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
- Tendo, San Francisco, California, USA
| | - Urmimala Sarkar
- Medicine, University of California San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Elaine C Khoong
- Medicine, University of California San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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11
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Reppas-Rindlisbacher C, Rawal S. Understanding linguistic inequities in healthcare: moving from the technical to the social. BMJ Qual Saf 2024; 33:416-418. [PMID: 38609172 DOI: 10.1136/bmjqs-2023-016873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Christina Reppas-Rindlisbacher
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, Ontario, Canada
| | - Shail Rawal
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, Ontario, Canada
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12
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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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13
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Schweiberger K, Patel M, Ragavan MI. Promoting Equity in Pediatric Health Care Through Language Services Reimbursement. Pediatrics 2024; 153:e2023064214. [PMID: 38567419 PMCID: PMC11035156 DOI: 10.1542/peds.2023-064214] [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] [Accepted: 11/28/2023] [Indexed: 04/04/2024] Open
Affiliation(s)
- Kelsey Schweiberger
- Division of General Academic Pediatrics, University of Pittsburgh and UPMC Children’s Hospital of Pittsburgh, Pennsylvania
| | - Mona Patel
- Department of Pediatrics, Children’s Hospital Los Angeles, California
| | - Maya I. Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh and UPMC Children’s Hospital of Pittsburgh, Pennsylvania
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14
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Uveges MK, Milliken A. Nurses' Ethical Obligations When Caring for Patients With Limited English Proficiency. AACN Adv Crit Care 2024; 35:66-74. [PMID: 38457613 DOI: 10.4037/aacnacc2024319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Affiliation(s)
- Melissa Kurtz Uveges
- Melissa Kurtz Uveges is Assistant Professor, Boston College, William F. Connell School of Nursing, 140 Commonwealth Avenue, Maloney Hall 375, Chestnut Hill, MA 02467
| | - Aimee Milliken
- Aimee Milliken is Associate Professor of the Practice, Boston College, William F. Connell School of Nursing Chestnut Hill, Massachusetts
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15
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Dube AR, Ortega P, Hardin DM, Hardin K, Martinez F, Shah M, Naimi BR, Esteban-González AI, Dickmeyer J, Ruggiero D, Abraham V, Diamond LC, Cowden JD. Improving Assessment and Learning Environments for Graduate Medical Trainees to Advance Healthcare Language Equity. J Gen Intern Med 2024; 39:696-705. [PMID: 38093027 PMCID: PMC10973305 DOI: 10.1007/s11606-023-08527-3] [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: 06/20/2023] [Accepted: 11/02/2023] [Indexed: 03/28/2024]
Abstract
Language-appropriate care is critical for equitable, high-quality health care, but educational standards to assure graduate medical trainees are prepared to give such care are lacking. Detailed guidance for graduate medical education is provided by the Accreditation Council for Graduate Medical Education through the following: (1) an assessment framework for competencies, subcompetencies, and milestones for trainees and (2) the Clinical Learning Environment Review (CLER) Pathways for assessment of trainees' learning environments. These tools do not include a robust framework to evaluate trainees' abilities to offer language-appropriate care. They also do not address the learning environment's potential to support such care. A multidisciplinary group of linguistic, medical, and educational experts drafted a new subcompetency with milestones and an expanded CLER Pathway to highlight the importance of equitable care for patients who prefer languages other than English. These resources offer residency and fellowship programs tools to guide assessment, curriculum development, and learning-environment improvements related to language-appropriate care. Recognizing that programs have unique needs and resources, we propose a range of initial actions to address language equity. A focus on language diversity in the learning environment can have a broad and lasting impact on care quality, patient safety, and health equity.
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Affiliation(s)
- Amanda R Dube
- Rady Children's Hospital-San Diego, San Diego, CA, USA
| | - Pilar Ortega
- Accreditation Council for Graduate Medical Education, Chicago, IL, USA
- University of Illinois College of Medicine, Chicago, IL, USA
| | | | | | - Francisco Martinez
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Madhura Shah
- Boston University School of Medicine, Boston, MA, USA
| | | | | | - Jodi Dickmeyer
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Veronica Abraham
- F Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Lisa C Diamond
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John D Cowden
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
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16
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Gonzalez C, Graves JM, Ramos J, Vavilala MS, Moore M. Language access research for community health: provider perspectives on language access techniques and the role of communication technology. JOURNAL OF COMMUNICATION IN HEALTHCARE 2024; 17:7-14. [PMID: 37470760 DOI: 10.1080/17538068.2023.2237351] [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: 07/21/2023]
Abstract
BACKGROUND In the United States, 66 million people speak a language other than English at home. Patients with diverse language needs often face significant health disparities. Information and communication technologies have expanded the realm of modalities for patient-provider communication. However, the extent to which digital language access tools are utilized by healthcare providers is unknown. This research examines provider perspectives on language assistance techniques and the role of communication technology when serving patients with non-English language preference (NELP). METHODS Between April and July 2019, an online survey was administered to 3,033 healthcare providers (doctors, nurse practitioners, pharmacists, and dentists) in Washington State. Providers reported on their language access practices and perspectives on communication technology. RESULTS Most providers reported using ad hoc language access techniques when engaging patients with NELP, such as a patient's family member or friend (75.8%), a patient's child specifically (61.9%), or a bilingual staff member (64.3%). Professional techniques, such as in-person interpretation (53.5%), phone interpretation (57%), and video remote interpretation (38.8%), were used less often. Dissatisfaction with the language access processes of healthcare providers' place of work was associated with a higher reliance on a patient's family or friend for language interpretation. CONCLUSIONS Findings suggest that providers might be under-utilizing professional and digital interpreter services while relying on ad hoc techniques. Such practices reveal systemic constraints on language access that might make it difficult for providers to access timely and reliable options for professional language interpretation, despite federal regulations that mandate such services for patients with NELP.
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Affiliation(s)
- Carmen Gonzalez
- Department of Communication, University of Washington, Seattle, Washington, USA
| | - Janessa M Graves
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Joana Ramos
- Washington State Coalition for Language Access (WASCLA), Seattle, Washington, USA
| | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine and Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Megan Moore
- School of Social Work, University of Washington, Seattle, Washington, USA
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17
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Barwise AK, Curtis S, Diedrich DA, Pickering BW. Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives. J Am Med Inform Assoc 2024; 31:611-621. [PMID: 38099504 PMCID: PMC10873784 DOI: 10.1093/jamia/ocad224] [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: 06/23/2023] [Accepted: 11/14/2023] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVES Inpatients with language barriers and complex medical needs suffer disparities in quality of care, safety, and health outcomes. Although in-person interpreters are particularly beneficial for these patients, they are underused. We plan to use machine learning predictive analytics to reliably identify patients with language barriers and complex medical needs to prioritize them for in-person interpreters. MATERIALS AND METHODS This qualitative study used stakeholder engagement through semi-structured interviews to understand the perceived risks and benefits of artificial intelligence (AI) in this domain. Stakeholders included clinicians, interpreters, and personnel involved in caring for these patients or for organizing interpreters. Data were coded and analyzed using NVIVO software. RESULTS We completed 49 interviews. Key perceived risks included concerns about transparency, accuracy, redundancy, privacy, perceived stigmatization among patients, alert fatigue, and supply-demand issues. Key perceived benefits included increased awareness of in-person interpreters, improved standard of care and prioritization for interpreter utilization; a streamlined process for accessing interpreters, empowered clinicians, and potential to overcome clinician bias. DISCUSSION This is the first study that elicits stakeholder perspectives on the use of AI with the goal of improved clinical care for patients with language barriers. Perceived benefits and risks related to the use of AI in this domain, overlapped with known hazards and values of AI but some benefits were unique for addressing challenges with providing interpreter services to patients with language barriers. CONCLUSION Artificial intelligence to identify and prioritize patients for interpreter services has the potential to improve standard of care and address healthcare disparities among patients with language barriers.
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Affiliation(s)
- Amelia K Barwise
- Biomedical Ethics Research Program, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Susan Curtis
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55902, United States
| | - Daniel A Diedrich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55902, United States
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18
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Dagher O, Passos-Castilho AM, Sareen V, Labbé AC, Barkati S, Luong ML, Rousseau C, Benedetti A, Azoulay L, Greenaway C. Impact of Language Barriers on Outcomes and Experience of COVID-19 Patients Hospitalized in Quebec, Canada, During the First Wave of the Pandemic. J Immigr Minor Health 2024; 26:3-14. [PMID: 37902902 DOI: 10.1007/s10903-023-01561-7] [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] [Accepted: 10/13/2023] [Indexed: 11/01/2023]
Abstract
Language barriers (LB) contribute to coronavirus disease 2019 (COVID-19) health inequities. People with LB were more likely to be SARS-CoV-2 positive despite lower testing and had higher rates of hospitalization. Data on hospital outcomes among immigrants with LB, however, are limited. We aimed to investigate the clinical outcomes of hospitalized COVID-19 cases by LB, immigration status, ethnicity, and access to COVID-19 health information and services prior to admission. Adults with laboratory-confirmed community-acquired COVID-19 hospitalized from March 1 to June 30, 2020, at four tertiary-care hospitals in Montréal, Quebec, Canada were included. Demographics, comorbidities, immigration status, country of birth, ethnicity, presence of LB, and hospital outcomes (ICU admission and death) were obtained through a chart review. Additional socio-economic and access to care questions were obtained through a phone survey. A Fine-Gray competing risk subdistribution hazards model was used to estimate the risk of ICU admission and in-hospital death by immigrant status, region of birth and LB Among 1093 patients, 622 (56.9%) were immigrants and 101 (16.2%) of them had a LB. One third (36%) of immigrants with LB did not have access to an interpreter during hospitalization. Admission to ICU and in-hospital mortality were not significantly different between groups. Prior to admission, one third (14/41) of immigrants with LB had difficulties accessing COVID-19 information in their mother tongue and one third (9/27) of non-white immigrants with a LB had difficulties accessing COVID-19 services. Immigrants with LB were inequitably affected by the first wave of the pandemic in Quebec, Canada. In our study, a large proportion had difficulties accessing information and services related to COVID-19 prior to admission, which may have increased SARS-CoV-2 exposure and hospitalizations. After hospitalization, a large proportion did not have access to interpreters. Providing medical information and care in the language of preference of increasing diverse populations in Canada is important for promoting health equity.
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Affiliation(s)
- Olina Dagher
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Ana Maria Passos-Castilho
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Vasu Sareen
- Department of Internal Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Annie-Claude Labbé
- Division of Infectious Diseases, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'Île-de-Montréal, Montreal, QC, Canada
- Department of Microbiology, Infectiology and Immunology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Sapha Barkati
- Division of Infectious Diseases, McGill University Health Center (MUHC), McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Me-Linh Luong
- Department of Microbiology, Infectiology and Immunology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Microbiology and Infectiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Cecile Rousseau
- Department of Psychiatry, McGill University Health Center, McGill University, Montreal, QC, Canada
- SHERPA University Institute, CIUSSS du Centre-Ouest-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Andrea Benedetti
- Departments of Medicine and Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Laurent Azoulay
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Departments of Medicine and Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Christina Greenaway
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.
- Departments of Medicine and Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
- Division of Infectious Disease, Jewish General Hospital, Montreal, QC, Canada.
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19
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Lowe JT, Leonard J, Dominguez F, Widmer K, Deakyne Davies SJ, Wiersma AJ, Mendenhall M, Grubenhoff JA. Preferred language and diagnostic errors in the pediatric emergency department. Diagnosis (Berl) 2024; 11:49-53. [PMID: 37795819 DOI: 10.1515/dx-2023-0079] [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: 06/29/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES To investigate the relationship between language and diagnostic errors (DxE) in the pediatric emergency department (ED). METHODS Electronic trigger identified ED encounters resulting in unplanned hospital admission that occurred within 10 days of an index visit from January 2018 through February 2022. Manual screening of each triggered encounter identified cases where the index visit diagnosis and hospitalization discharge diagnosis differed, and these were screened in for review using the Revised Safer Dx instrument to determine if a diagnostic error (DxE) occurred. Non-English primary language (NEPL) and English-proficient (EP) groups were established based on caregiver language. The primary outcome was the proportion of DxE each group. Data were analyzed using univariate analysis and multivariable logistic regression to identify independent predictors of DxE. RESULTS Electronic trigger identified 3,551 patients, of which 806 (22.7 %) screened in for Safer Dx review. 172 (21.3 %) experienced DxE. The proportion of DxE was similar between EP and NEPL groups (21.5 vs. 21.7 %; p=0.97). Age≥12 years and fewer prior admissions in the preceding 6 months predicted higher odds of DxE. NEPL did not predict higher odds of DxE. CONCLUSIONS NEPL was not associated with increased odds DxE resulting in unplanned admission.
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Affiliation(s)
| | - Jan Leonard
- Children's Hospital of Philadelphia, Philadelphia, PN, USA
| | | | - Kaitlin Widmer
- University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | | | - Alexandria J Wiersma
- University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | - Marcela Mendenhall
- University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | - Joseph A Grubenhoff
- University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
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20
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Twersky SE, Jefferson R, Garcia-Ortiz L, Williams E, Pina C. The Impact of Limited English Proficiency on Healthcare Access and Outcomes in the U.S.: A Scoping Review. Healthcare (Basel) 2024; 12:364. [PMID: 38338249 PMCID: PMC10855368 DOI: 10.3390/healthcare12030364] [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: 12/29/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
A majority of individuals with limited English proficiency (LEP) in the U.S. are foreign-born, creating a complex intersection of language, socio-economic, and policy barriers to healthcare access and achieving good outcomes. Mapping the research literature is key to addressing how LEP intersects with healthcare. This scoping review followed PRISMA-ScR guidelines and included PubMed/MEDLINE, CINAHL, Sociological Abstracts, EconLit, and Academic Search Premier. Study selection included quantitative studies since 2000 with outcomes specified for adults with LEP residing in the U.S. related to healthcare service access or defined health outcomes, including healthcare costs. A total of 137 articles met the inclusion criteria. Major outcomes included ambulatory care, hospitalization, screening, specific conditions, and general health. Overall, the literature identified differential access to and utilization of healthcare across multiple modalities with poorer outcomes among LEP populations compared with English-proficient populations. Current research includes inconsistent definitions for LEP populations, primarily cross-sectional studies, small sample sizes, and homogeneous language and regional samples. Current regulations and practices are insufficient to address the barriers that LEP individuals face to healthcare access and outcomes. Changes to EMRs and other data collection to consistently include LEP status and more methodologically rigorous studies are needed to address healthcare disparities for LEP individuals.
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Affiliation(s)
- Sylvia E. Twersky
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
| | - Rebeca Jefferson
- R. Barbara Gitenstein Library, The College of New Jersey, Ewing Township, NJ 08618, USA;
| | - Lisbet Garcia-Ortiz
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
| | - Erin Williams
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
| | - Carol Pina
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
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21
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Gmünder M, Gessler N, Buser S, Feuz U, Fayyaz J, Jachmann A, Keitel K, Brandenberger J. Caregivers with limited language proficiency and their satisfaction with paediatric emergency care related to the use of professional interpreters: a mixed methods study. BMJ Open 2024; 14:e077716. [PMID: 38216184 PMCID: PMC10806666 DOI: 10.1136/bmjopen-2023-077716] [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: 07/12/2023] [Accepted: 12/14/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES Communication is a main challenge in migrant health and essential for patient safety. The aim of this study was to describe the satisfaction of caregivers with limited language proficiency (LLP) with care related to the use of interpreters and to explore underlying and interacting factors influencing satisfaction and self-advocacy. DESIGN A mixed-methods study. SETTING Paediatric emergency department (PED) at a tertiary care hospital in Bern, Switzerland. PARTICIPANTS AND METHODS Caregivers visiting the PED were systematically screened for their language proficiency. Semistructured interviews were conducted with all LLP-caregivers agreeing to participate and their administrative data were extracted. RESULTS The study included 181 caregivers, 14 of whom received professional language interpretation. Caregivers who were assisted by professional interpretation services were more satisfied than those without (5.5 (SD)±1.4 vs 4.8 (SD)±1.6). Satisfaction was influenced by five main factors (relationship with health workers, patient management, alignment of health concepts, personal expectations, health outcome of the patient) which were modulated by communication. Of all LLP-caregivers without professional interpretation, 44.9% were satisfied with communication due to low expectations regarding the quality of communication, unawareness of the availability of professional interpretation and overestimation of own language skills, resulting in low self-advocacy. CONCLUSION The use of professional interpreters had a positive impact on the overall satisfaction of LLP-caregivers with emergency care. LLP-caregivers were not well-positioned to advocate for language interpretation. Healthcare providers must be aware of their responsibility to guarantee good-quality communication to ensure equitable quality of care and patient safety.
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Affiliation(s)
- Myriam Gmünder
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Noemi Gessler
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Sina Buser
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Ursula Feuz
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Jabeen Fayyaz
- Emergency Department, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne Jachmann
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kristina Keitel
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Julia Brandenberger
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
- Emergency Department, The Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S. H. Leong Centre for Healthy Children, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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Limaye NP, Matias WR, Rozansky H, Neville BA, Vise A, McEvoy DS, Dutta S, Gershanik E. Limited English Proficiency and Sepsis Mortality by Race and Ethnicity. JAMA Netw Open 2024; 7:e2350373. [PMID: 38175644 PMCID: PMC10767592 DOI: 10.1001/jamanetworkopen.2023.50373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
Importance Patients with limited English proficiency (LEP) face multiple barriers and are at risk for worse health outcomes compared with patients with English proficiency (EP). In sepsis, a major cause of mortality in the US, the association of LEP with health outcomes is not widely explored. Objective To assess the association between LEP and inpatient mortality among patients with sepsis and test the hypothesis that LEP would be associated with higher mortality rates. Design, Setting, and Participants This retrospective cohort study of hospitalized patients with sepsis included those who met the Centers for Disease Control and Prevention's sepsis criteria, received antibiotics within 24 hours, and were admitted through the emergency department. Data were collected from the electronic medical records of a large New England tertiary care center from January 1, 2016, to December 31, 2019. Data were analyzed from January 8, 2021, to March 2, 2023. Exposures Limited English proficiency, gathered via self-reported language preference in electronic medical records. Main Outcomes and Measures The primary outcome was inpatient mortality. The analysis used multivariable generalized estimating equation models with propensity score adjustment and analysis of covariance to analyze the association between LEP and inpatient mortality due to sepsis. Results A total of 2709 patients met the inclusion criteria, with a mean (SD) age of 65.0 (16.2) years; 1523 (56.2%) were men and 327 (12.1%) had LEP. Nine patients (0.3%) were American Indian or Alaska Native, 101 (3.7%) were Asian, 314 (11.6%) were Black, 226 (8.3%) were Hispanic, 38 (1.4%) were Native Hawaiian or Other Pacific Islander or of other race or ethnicity, 1968 (72.6%) were White, and 6 (0.2%) were multiracial. Unadjusted mortality included 466 of 2382 patients with EP (19.6%) and 69 of 327 with LEP (21.1%). No significant difference was found in mortality odds for the LEP compared with EP groups (odds ratio [OR], 1.12 [95% CI, 0.88-1.42]). When stratified by race and ethnicity, odds of inpatient mortality for patients with LEP were significantly higher among the non-Hispanic White subgroup (OR, 1.76 [95% CI, 1.41-2.21]). This significant difference was also present in adjusted analyses (adjusted OR, 1.56 [95% CI, 1.02-2.39]). No significant differences were found in inpatient mortality between LEP and EP in the racial and ethnic minority subgroup (OR, 0.99 [95% CI, 0.63-1.58]; adjusted OR, 0.91 [95% CI, 0.56-1.48]). Conclusions and Relevance In a large diverse academic medical center, LEP had no significant association overall with sepsis mortality. In a subgroup analysis, LEP was associated with increased mortality among individuals identifying as non-Hispanic White. This finding highlights a potential language-based inequity in sepsis care. Further studies are needed to understand drivers of this inequity, how it may manifest in other diverse health systems, and to inform equitable care models for patients with LEP.
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Affiliation(s)
- Neha P. Limaye
- Department of Medicine, Mount Sinai Hospital, New York, New York
- Department of Pediatrics, Mount Sinai Hospital, New York, New York
- Arnhold Institute for Global Health, Icahn School of Medicine, New York, New York
| | - Wilfredo R. Matias
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Global Health, Massachusetts General Hospital, Boston
| | - Hallie Rozansky
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
- Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts
| | - Bridget A. Neville
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Allison Vise
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Health Sciences and Technology, Harvard Medical School, Boston, Massachusetts
| | | | - Sayon Dutta
- Mass General Brigham Digital, Boston, Massachusetts
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Esteban Gershanik
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Deparment of Medicine, Harvard Medical School, Boston, Massachusetts
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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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Dutta PA, Flynn SJ, Oreper S, Kantor MA, Mourad M. Across race, ethnicity, and language: An intervention to improve advance care planning documentation unmasks health disparities. J Hosp Med 2024; 19:5-12. [PMID: 38041530 DOI: 10.1002/jhm.13248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/10/2023] [Accepted: 11/19/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Racial and ethnic minority groups are less likely to have advance directives and living wills, despite the importance of advanced care planning (ACP) in end-of-life care. We aimed to understand the impact of an intervention to improve ACP documentation across race, ethnicity, and language on hospitalized patients at our institution. METHODS We launched an intervention to improve the rates of ACP documentation for hospitalized patients aged >75 or with advanced illness defined by the International Classification of Diseases 10th Revision codes. We analyzed ACP completion rates, preintervention, and intervention, and used interrupted time-series analyses to measure the differential impact of the intervention across race, ethnicity, and language. KEY RESULTS A total of 10,220 patients met the inclusion criteria. Overall rates of ACP documentation improved from 13.9% to 43.7% in the intervention period, with a 2.47% monthly increase in ACP documentation compared to baseline (p < .001). During the intervention period, the rate of ACP documentation increased by 2.72% per month for non-Hispanic White patients (p < .001), by 1.84% per month for Latinx patients (p < .001), and by 1.9% per month for Black patients (p < .001). Differences in the intervention trends between non-Hispanic White and Latinx patients (p = .04) and Black patients (p = .04) were significant. CONCLUSIONS An intervention designed to improve ACP documentation in hospitalized patients widened a disparity across race and ethnicity with Latinx and Black patients having lower rates of improvement. Our findings reinforce the need to measure the impact of quality improvement interventions on existing health disparities and to implement specific strategies to prevent worsening disparities.
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Affiliation(s)
- Priyanka A Dutta
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sarah J Flynn
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sandra Oreper
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Molly A Kantor
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Michelle Mourad
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
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25
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Shin TM, Dodenhoff KA, Pardy M, Wehner AS, Rafla S, McDowell LD, Denizard-Thompson NM. Providing Equitable Care for Patients With Non-English Language Preference in Telemedicine: Training on Working With Interpreters in Telehealth. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11367. [PMID: 38098759 PMCID: PMC10719426 DOI: 10.15766/mep_2374-8265.11367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/18/2023] [Indexed: 12/17/2023]
Abstract
Introduction The COVID-19 pandemic has led to a large increase in telemedicine encounters. Despite this rise in virtual visits, patients who speak non-English languages have experienced challenges accessing telemedicine. To improve health equity, medical education on telehealth delivery should include instruction on working with interpreters in telehealth. Methods We developed a 25-minute self-directed module with collective expertise of faculty with experience in medical education, interpreter training, and communication training. The module was delivered online as part of a longitudinal health equity curriculum for third-year medical students. In addition to didactic information, the module contained video examples of interpreter interactions in telehealth. Results Sixty-four third-year medical students participated in the study, and 60 completed a postmodule survey. Students were satisfied with the content of the module, as well as the duration of time required to complete the tasks. Approximately 90% would recommend it to future students. Nearly 80% of students rated the module as being quite effective or extremely effective at increasing their comfort level with visits with patients with non-English language preference. Discussion Our module provides a basic framework for medical students on how to successfully work with interpreters during a language-discordant virtual visit. This format of asynchronous learning could also be easily expanded to resident physicians and faculty seeking more resources around working with interpreters in telemedicine.
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Affiliation(s)
- Tiffany M. Shin
- Assistant Professor, Department of Pediatrics, Wake Forest University School of Medicine
| | - Kristen A. Dodenhoff
- Second-Year Resident, Department of Family and Community Medicine, Wake Forest University School of Medicine
| | - Mariana Pardy
- Project Manager, Department of Social Sciences and Health Policy, Wake Forest University
| | - Abigail Smith Wehner
- Third-Year Resident, Department of Emergency Medicine, Wake Forest University School of Medicine
| | - Samuel Rafla
- Third-Year Resident, Department of Anesthesiology, Icahn School of Medicine at Mount Sinai
| | - Leslie Doroski McDowell
- Quality Improvement Specialist and Curriculum Developer, Northwest Area Health Education Center
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Barry M, Gozali A, Vu L. Impact of Social Vulnerability on Long-Term Growth Outcomes in Sutureless Versus Sutured Repair of Gastroschisis. Eur J Pediatr Surg 2023; 33:477-484. [PMID: 36720245 DOI: 10.1055/s-0043-1761921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study is to describe the long-term growth and nutrition outcomes of sutureless versus sutured gastroschisis repair. We hypothesized that weight z-score at 1 year would be affected by social determinants of health measured by the U.S. Centers for Disease Control Social Vulnerability Index (SVI). MATERIALS AND METHODS We conducted a single-center retrospective review of patients who underwent gastroschisis repair (n = 97) from 2007 to 2018. Growth z-scores collected through 5 years of age and long-term clinical outcomes were compared based on the closure method and the type of gastroschisis (simple vs. complicated). Multiple regression analysis was performed to identify the impact of SVI themes and other covariates on weight for age z-score at 1 year. RESULTS In total, 46 patients underwent sutureless repair and 51 underwent sutured repair with median follow-up duration of 2.5 and 1.9 years, respectively. Weight and length z-scores decreased after birth but normalized within the first year of life. Growth and long-term clinical outcomes were similar regardless of the closure method, while patients with complicated gastroschisis had higher rates of hospitalizations, small bowel obstructions, and additional abdominal surgeries. Using multiple regression, both low discharge weight and high SVI in the "minority status and language" theme were associated with lower weight for age z-scores at 1 year (p = 0.003 and p = 0.03). CONCLUSION Sutureless and sutured gastroschisis repairs result in similar growth and long-term outcomes. Patients living in areas with greater social vulnerability may be at increased risk of poor weight gain. Patients should be followed at least through their first year to ensure appropriate growth.
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Affiliation(s)
- Mark Barry
- Department of Surgery, University of California San Francisco, San Francisco, California, United States
| | - Aileen Gozali
- School of Medicine, University of California San Francisco, San Francisco, California, United States
| | - Lan Vu
- Division of Pediatric Surgery, University of California San Francisco, San Francisco, California, United States
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Tomkow L, Prager G, Drinkwater J, Morris RL, Farrington R. 'That's how we got around it': a qualitative exploration of healthcare professionals' experiences of care provision for asylum applicants' with limited English proficiency in UK contingency accommodation. BMJ Open 2023; 13:e074824. [PMID: 37996230 PMCID: PMC10668227 DOI: 10.1136/bmjopen-2023-074824] [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: 04/18/2023] [Accepted: 10/11/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES The inadequate provision of language interpretation for people with limited English proficiency (LEP) is a determinant of poor health, yet interpreters are underused. This research explores the experiences of National Health Service (NHS) staff providing primary care for people seeking asylum, housed in contingency accommodation during COVID-19. This group often have LEP and face multiple additional barriers to healthcare access. Language discrimination is used as a theoretical framework. The potential utility of this concept is explored as a way of understanding and addressing inequities in care. DESIGN Qualitative research using semistructured interviews and inductive thematic analysis. SETTING An NHS primary care service for people seeking asylum based in contingency accommodation during COVID-19 housing superdiverse residents speaking a wide spectrum of languages. PARTICIPANTS Ten staff including doctors, nurses, mental health practitioners, healthcare assistants and students participated in semistructured online interviews. Some staff were redeployed to this work due to the pandemic. RESULTS All interviewees described patients' LEP as significant. Inadequate provision of interpretation services impacted the staff's ability to provide care and compromised patient safety. Discrimination, such as that based on migration status, was recognised and challenged by staff. However, inequity based on language was not articulated as discrimination. Instead, insufficient and substandard interpretation was accepted as the status quo and workarounds used, such as gesticulating or translation phone apps. The theoretical lens of language discrimination shows how this propagates existing social hierarchies and further disadvantages those with LEP. CONCLUSIONS This research provides empirical evidence of how the inadequate provision of interpreters forces the hand of healthcare staff to use shortcuts. Although this innovative 'tinkering' allows staff to get the job done, it risks normalising structural gaps in care provision for people with LEP. Policy-makers must rethink their approach to interpretation provision which prioritises costs over quality. We assert that the concept of language discrimination is a valuable framework for clinicians to better identify and articulate unfair treatment on the grounds of LEP.
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Affiliation(s)
| | | | - Jessica Drinkwater
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Rebecca L Morris
- Centre for Primary Care, The University of Manchester, Manchester, UK
| | - Rebecca Farrington
- Division of Medical Education, University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
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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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Segal KR, Gomez JA, Schulz JF, Alvandi LM, Fornari ED. The Impact of Standardized Recovery Pathways on Language Barriers and Inpatient Pain Management. Hosp Pediatr 2023; 13:1001-1009. [PMID: 37850258 DOI: 10.1542/hpeds.2023-007232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Inpatient postoperative care is reliant upon clear, open communication between providers and patient-families, and thus is particularly vulnerable to disparities when discordant languages exist. It is not yet understood how standardized postoperative protocols may mitigate disparities related to language discordance. METHODS This is a retrospective cohort study among adolescent idiopathic scoliosis patients who underwent posterior spinal fusion at a tertiary care children's hospital in Bronx, New York after implementation of a postoperative pathway in 2017. Outcomes reliant upon communication between patient-families and providers were measured, including measures of pain management (number and type of pain medications requested, daily pain assessments, total opioids consumed), as well as outpatient pain scores. RESULTS A total of 160 patients were included (39 language other than English [LOE]). Between patient cohorts, there were no significant differences in demographic or operative characteristics. On univariate analyses, LOE patients were more likely to be given a basal dosing of patient-controlled analgesia or additional boluses (26% vs 12%, P = .03), consumed 0.53 fewer benzodiazepine medications per day (P = .01), and were more likely to have pain at outpatient follow-up (67% vs 43%, P = .03). On multivariate analyses, LOE patients were more likely to be placed on basally dosed or receive additional boluses of patient-controlled analgesia (odds ratio 3.19, 95% confidence interval 1.15-8.85). CONCLUSIONS As standardized pathways become more common in health care, it is critical to monitor for components of these protocols that may be vulnerable to language-related disparities, such as therapies reliant on symptom description and outpatient follow-up.
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Prochaska EC, Caballero TM, Fabre V, Milstone AM. Infection prevention requires attention to patient and caregiver language: Removing language barriers from infection prevention education. Infect Control Hosp Epidemiol 2023; 44:1707-1710. [PMID: 37039600 PMCID: PMC10691433 DOI: 10.1017/ice.2023.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Affiliation(s)
- Erica C. Prochaska
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Hospital Epidemiology and Infection Control, Johns Hopkins Health System, Baltimore, MD, USA
| | - Tania Maria Caballero
- Department of Pediatrics, Division of General Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valeria Fabre
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron M. Milstone
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Hospital Epidemiology and Infection Control, Johns Hopkins Health System, Baltimore, MD, USA
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Ahrens E, Elias M. Effective communication with linguistically diverse patients: A concept analysis. PATIENT EDUCATION AND COUNSELING 2023; 115:107868. [PMID: 37480794 DOI: 10.1016/j.pec.2023.107868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE Effective communication is essential to providing high-quality healthcare. For linguistically diverse patients, communication remains a barrier to receiving equitable healthcare throughout the globe. It is necessary to examine the concept of effective communication with linguistically diverse patients. METHODS The Walker and Avant method was used to analyze the concept. RESULTS We define effective communication with linguistically diverse patients as any verbal or written communication between two or more individuals who do not speak the same language that utilizes accurate translation techniques to reach a shared message or understanding, where all parties involved are listened to and actively engaged. The antecedents, attributes, consequences, and empirical referents are mapped. CONCLUSION Effective communication with linguistically diverse patients is limited by a lack of access to professional language assistance, structural racism/discrimination, and policy barriers. PRACTICE IMPLICATIONS Healthcare workers hold the power to provide language assistance to patients and should therefore receive training in cultural competency, cultural humility, and how to work with professional medical interpreters and language access programs. Institutions should invest in multimodal approaches to provide equitable healthcare to linguistically diverse patients.
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Affiliation(s)
- Emily Ahrens
- University of Washington School of Nursing, USA.
| | - Maya Elias
- University of Washington School of Nursing, USA
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Brumbaugh JE, Tschida‐Reuter DJ, Barwise AK. Meeting the needs of the patient with non-English language preference in the hospital setting. Health Serv Res 2023; 58:965-969. [PMID: 37580055 PMCID: PMC10480083 DOI: 10.1111/1475-6773.14217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Affiliation(s)
- Jane E. Brumbaugh
- Department of Pediatric and Adolescent MedicineMayo ClinicRochesterMinnesotaUSA
| | | | - Amelia K. Barwise
- Program in Biomedical Ethics Research and Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterMinnesotaUSA
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Squires A, Engel P, Ma C, Miner S, Feldman PH, McDonald MV, Jones S. Continuity of Care Versus Language Concordance as an Intervention to Reduce Hospital Readmissions From Home Health Care. Med Care 2023; 61:605-610. [PMID: 37561604 PMCID: PMC10421624 DOI: 10.1097/mlr.0000000000001884] [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: 08/12/2023]
Abstract
BACKGROUND Language concordance between health care practitioners and patients have recently been shown to lower the risk of adverse health events. Continuity of care also been shown to have the same impact. OBJECTIVE The purpose of this paper is to examine the relative effectiveness of both continuity of care and language concordance as alternative or complementary interventions to improve health outcomes of people with limited English proficiency. DESIGN A multivariable logistic regression model using rehospitalization as the dependent variable was built. The variable of interest was created to compare language concordance and continuity of care. PARTICIPANTS The final sample included 22,103 patients from the New York City area between 2010 and 2015 who were non-English-speaking and admitted to their home health site following hospital discharge. MEASURES The odds ratio (OR) average marginal effect (AME) of each included variable was calculated for model analysis. RESULTS When compared with low continuity of care and high language concordance, high continuity of care and high language concordance significantly decreased readmissions (OR=0.71, 95% CI: 0.62-0.80, P<0.001, AME=-4.95%), along with high continuity of care and low language concordance (OR=0.80, 95% CI: 0.74-0.86, P<0.001, AME=-3.26%). Low continuity of care and high language concordance did not significantly impact readmissions (OR=1.04, 95% CI: 0.86-1.26, P=0.672, AME=0.64%). CONCLUSION In the US home health system, enhancing continuity of care for those with language barriers may be helpful to address disparities and reduce hospital readmission rates.
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Affiliation(s)
| | | | - Chenjuan Ma
- Rory Meyers College of Nursing, New York University
| | - Sarah Miner
- Wegman’s School of Nursing, New York University
| | | | | | - Simon Jones
- Director of Analytics, Center for Delivery Systems Science Department of Population Health, Grossman School of Medicine, New York University
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Sharma RK, Cowan A, Gill H, Miyagawa LA. Understanding the Role of Caseworker-Cultural Mediators in Addressing Healthcare Inequities for Patients with Limited-English Proficiency: a Qualitative Study. J Gen Intern Med 2023; 38:1190-1199. [PMID: 36192577 PMCID: PMC10110807 DOI: 10.1007/s11606-022-07816-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients with limited-English proficiency (LEP) face multiple barriers to equitable healthcare. Interventions that go beyond interpretation, such as the use of bicultural-bilingual patient navigators, hold promise for addressing multi-level barriers. However, data about how to operationalize the tasks that are key to such interventions across diverse LEP communities are lacking. OBJECTIVE Using our health system's bicultural-bilingual caseworker-cultural mediator (CCM) program serving Amharic-, Cambodian/Khmer-, Somali-, Spanish-, and Vietnamese-speaking patients, we sought to understand the key tasks that comprise the CCMs' role and how these tasks enable them to address barriers to healthcare for patients with LEP. DESIGN Semi-structured interviews were conducted in 2019 with a purposive sample (n=23) of clinicians, CCMs, and patients with LEP or their family members from all language groups. PARTICIPANTS Patients or family members receiving CCM services, CCMs, and clinicians who referred patients to the program. APPROACH Content analysis consisting of a hybrid deductive-inductive qualitative approach. KEY RESULTS Seven CCM tasks were identified: advocacy, care coordination, navigation, interpretation, education, mediation, and emotional support. Additionally, four key impacts emerged that described the ways in which these tasks enabled the CCMs to facilitate equitable care: bridging the patient, family, community, clinical team, and healthcare system; impacting knowledge of cultural issues and of the healthcare system; troubleshooting cultural barriers and problem solving; and enhancing relationship building. CONCLUSIONS We identified several tasks and impacts that enabled CCMs to address multi-level barriers to care experienced by patients with LEP and their families across diverse cultural and linguistic groups. Findings suggest opportunities for the generalizability of programs such as ours for multiple LEP populations. Additionally, interventions having a greater scope than interpretation and including relationships with communities may be more successful in addressing barriers to equitable care at the individual, system, and community levels.
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Affiliation(s)
- Rashmi K Sharma
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA.
| | - Anna Cowan
- Interpreter Services Department, Harborview Medical Center, Seattle, WA, USA
| | - Harsimrat Gill
- University of Washington School of Medicine, Seattle, WA, USA
| | - Lea Ann Miyagawa
- Interpreter Services Department, Harborview Medical Center, Seattle, WA, USA
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Kwan M, Jeemi Z, Norman R, Dantas JAR. Professional Interpreter Services and the Impact on Hospital Care Outcomes: An Integrative Review of Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5165. [PMID: 36982073 PMCID: PMC10048935 DOI: 10.3390/ijerph20065165] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
Migration patterns have rapidly changed in Australia and elsewhere, which have contributed to increasingly culturally and linguistically diverse societies. This requires healthcare sectors to provide professional interpreter services for patients with a language barrier to eliminate healthcare disparities. This integrative review aimed to investigate the impact of professional interpreter services on hospital care outcomes and the associated cost of service provision. A systematic search of five databases was conducted for peer-reviewed articles from January 1996 to December 2020. Data were extracted for the hospital setting, intervention, population, study design, outcomes and key findings. Following the PRISMA guidelines, full-text screening identified 37 articles that were analysed and included. Communication quality, hospital care outcomes and hospital costs were the three main themes identified. Closing the language gap should be a primary consideration to prevent adverse events that affect patient safety and the standard of care in hospitals. The findings of this review indicate the provision of professional interpreter services can enhance hospital care for linguistically diverse patients by improving patient-provider communication. To gain insight into the changing patterns on the outcomes of medical care, further research requires efforts by the hospital administrative system to document complete records of service usage.
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Affiliation(s)
| | | | | | - Jaya A. R. Dantas
- Curtin School of Population Health, Curtin University, Perth 6102, Australia
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Olszewski AE, Bogetz J, Mercer A, Bradford MC, Scott M, Fields B, Williams K, Rosenberg AR, Trowbridge A. Empathy Expression in Interpreted and Noninterpreted Care Conferences of Seriously Ill Children. Pediatrics 2023; 151:e2022059447. [PMID: 36785992 PMCID: PMC9986854 DOI: 10.1542/peds.2022-059447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Clinician empathy is associated with improved communication and clinical outcomes. We hypothesized that, when clinicians express empathy, families are more likely to deepen discussions, and that clinicians express less empathy in care conferences with language interpretation. METHODS Prospective, mixed methods cohort study of English and interpreted audio-recorded transcripts of care conferences for pediatric patients with serious illness hospitalized at a single urban, quaternary medical institution between January 2018 and January 2021. Directed content analysis identified empathic opportunities, clinician empathetic statements or missed opportunities, and family responses. Clinician empathic statements were "buried" if immediately followed by more clinician medical talk. Descriptive analyses summarized demographics and codes. χ2 analyses summarized differences among language interpretation and family responses. RESULTS Twenty-nine patient-family dyads participated. Twenty-two (81%) family members were female. Eleven (39%) used language interpretation (8 Spanish, 2 Vietnamese, 1 Somali). Families created 210 empathic opportunities. Clinicians responded with unburied empathy 80 times (38%, no differences for English versus interpreted care conferences, P = .88). When clinicians buried empathy or missed empathic opportunities, families responded with alliance (agreement, gratitude, or emotional deepening) 14% and 15% of the time, respectively. When clinicians responded with unburied empathy, families responded with alliance 83% of the time (P < .01). CONCLUSIONS Our study suggests that clinician empathic expression does not differ when language interpretation is used in pediatric care conferences. Clinicians often miss opportunities to express empathy, or they bury it by medical talk. Although unburied empathy created opportunities for relationship-building and family-sharing, buried empathy negatively impacted these domains similarly to no empathic expression.
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Affiliation(s)
- Aleksandra E. Olszewski
- Divisions of Bioethics and Palliative Care
- Division of Critical Care Medicine, Department of Pediatrics, Lurie Children’s Hospital and Northwestern University, Chicago, Illinois
| | - Jori Bogetz
- Divisions of Bioethics and Palliative Care
- Palliative Care and Resilience Program
| | | | - Miranda C. Bradford
- Palliative Care and Resilience Program
- Core for Biostatistics, Epidemiology and Analytics in Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Maya Scott
- Divisions of Bioethics and Palliative Care
- Center for Diversity and Health Equity
| | | | - Kelli Williams
- Parent Advisory Council, Seattle Children’s Hospital, Seattle, Washington
| | - Abby R. Rosenberg
- Hematology and Oncology, Department of Pediatrics, University of Washington and Seattle Children’s Hospital, Seattle, Washington
- Palliative Care and Resilience Program
| | - Amy Trowbridge
- Divisions of Bioethics and Palliative Care
- Palliative Care and Resilience Program
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Keller MS, Carrascoza-Bolanos J. Pharmacists, nurses, and physicians' perspectives and use of formal and informal interpreters during medication management in the inpatient setting. PATIENT EDUCATION AND COUNSELING 2023; 108:107607. [PMID: 36566119 PMCID: PMC9877185 DOI: 10.1016/j.pec.2022.107607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Language barriers during inpatient medication management can occur during medication reconciliation on admission and discharge, and during the hospitalization. Understanding inpatient clinicians' experiences with language barriers and use of interpreters can help inform interventions aimed at improving medication management with Limited English Proficient (LEP) patients. Our objective was to examine clinicians' experiences with language barriers around inpatient medication management. METHODS We used semi-structured interviews with pharmacist technicians, pharmacists, nurses, and physicians working in a tertiary care hospital. We used the constant comparison method to guide data collection and analysis. RESULTS We interviewed 14 providers. Nurses and physicians perceived lack of time to use formal interpreters, particularly during busy or night shifts. Clinicians strongly preferred virtual and in-person interpreter services over telephonic services, and highlighted communication challenges with patients with low health literacy, concerns about the quality of interpretation, and inconsistencies in the use of translated materials. CONCLUSIONS Ensuring access to formal interpreters during all shifts, translation of materials into the patient/caregiver's language, and access to in-person/virtual services would improve quality of care for LEP patients. PRACTICE IMPLICATIONS Current laws require use of interpreters, but do not provide for their reimbursement, resulting in suboptimal use. Reimbursement for interpreter services may increase their availability.
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Affiliation(s)
- Michelle S Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA; Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, USA; Department of Health Policy and Management, University of California-Los Angeles, Los Angeles, USA.
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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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Azua E, Fortier LM, Carroll M, Martin A, Mayorga S, Albino A, Lopez S, Chahla J. Spanish-Speaking Patients Have Limited Access Scheduling Outpatient Orthopaedic Appointments Compared With English-Speaking Patients Across the United States. Arthrosc Sports Med Rehabil 2023; 5:e465-e471. [PMID: 37101862 PMCID: PMC10123429 DOI: 10.1016/j.asmr.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/31/2023] [Indexed: 02/27/2023] Open
Abstract
Purpose To evaluate whether Spanish-speaking patients can obtain appointments to outpatient orthopaedic surgery clinics across the United States at a similar rate as English-speaking patients and to examine the language interpretation services available at those clinics. Methods Orthopaedic offices nationwide were called by a bilingual investigator to request an appointment with a pre-established script. The investigators called in English asking for an appointment for an English-speaking patient (English-English), called in English requesting an appointment for a Spanish-speaking patient (English-Spanish), and called in Spanish asking for an appointment for a Spanish-speaking patient (Spanish-Spanish) in a random order. During each call whether an appointment was given, the number of days to the offered appointment, the mechanism of interpretation available in clinic, and whether the patient's citizenship or insurance information was requested was collected. Results A total of 78 clinics included in the analysis. There was a statistically significant decrease in access to scheduling an orthopaedic appointment in the Spanish-Spanish group (26.3%) compared with English-English (61.3%) or English-Spanish (58.8%) groups (P < .001). There was no significant difference in access to appointment between rural and urban areas. Patients in the Spanish-Spanish group who made an appointment were offered in-person interpretation 55% of the time. There was no statistically significant difference in time from call to offered appointment or the request for citizenship status between the 3 groups. Conclusions This study detected a considerable disparity regarding access to orthopaedic clinics nationwide in the individuals who called to establish an appointment in Spanish. Patients in the Spanish-Spanish group were able to make an appointment less often but had in-person interpreters available for interpretation services. Clinical Relevance With a large Spanish-speaking population in the United States, it is important to understand how lack of proficiency with the English language may affect access to orthopaedic care. This study uncovers variables associated with difficulties scheduling appointments for Spanish-speaking patients.
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Bavarian R, Harris R, Holland N. Language Access and Orofacial Pain. Dent Clin North Am 2023; 67:187-198. [PMID: 36404078 DOI: 10.1016/j.cden.2022.07.014] [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: 11/07/2022]
Abstract
Clear and effective communication is vital to quality patient care. More than 66 million Americans (21.5%) speak a language other than English at home, with more than 25 million (8.2%) speaking English "less than very well." Addressing language differences in the orofacial pain setting is of utmost importance to care quality, treatment outcomes, and overall health equity. In the case presented, language-related communication challenges affect the diagnosis and management of a patient with orofacial pain. This case highlights the significance of language discordance in the clinical setting and demonstrates the need for greater language access in the orofacial pain field.
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Affiliation(s)
- Roxanne Bavarian
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
| | - Rachel Harris
- Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
| | - Nicole Holland
- Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA.
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Barwise AK, Moriarty JP, Rosedahl JK, Soleimani J, Marquez A, Weister TJ, Gajic O, Borah BJ. Comparative costs for critically ill patients with limited English proficiency versus English proficiency. PLoS One 2023; 18:e0279126. [PMID: 37186248 PMCID: PMC10132690 DOI: 10.1371/journal.pone.0279126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 11/30/2022] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES To conduct comparative cost analysis of hospital care for critically ill patients with Limited English Proficiency (LEP) versus patients with English proficiency (controls). PATIENTS AND METHODS We conducted a historical cohort study using propensity matching at Mayo Clinic Rochester, a quaternary care academic center. We included hospitalized patients who had at least one admission to ICU during a 10-year period between 1/1/2008-12/31/2017. RESULTS Due to substantial differences in baseline characteristics of the groups, propensity matching for the covariates age, sex, race, ethnicity, APACHE 3 score, and Charlson Comorbidity score was used, and we achieved the intended balance. The final cohort included 80,404 patients, 4,246 with LEP and 76,158 controls. Patients with LEP had higher costs during hospital admission to discharge, with a mean cost difference of $3861 (95% CI $822 to $6900, p = 0.013) and also higher costs during index ICU admission to hospital discharge, with a mean cost difference of $3166 (95% CI $231 to $6101, p = 0.035). A propensity matched cohort including only those that survived showed those with LEP had significantly greater mean costs for all outcomes. Sensitivity analysis revealed that international patients with LEP had significantly greater overall hospital costs of $9,240 than patients with LEP who resided in the US (95% CI $3341 to $15,140, p = 0.002). CONCLUSION This is the first study to demonstrate significantly higher costs for patients with LEP experiencing a critical illness. The causes for this may be increased healthcare utilization secondary to communication deficiencies that impede timely decision making about care.
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Affiliation(s)
- Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Bioethics Research Program, Mayo Clinic, Rochester, Minnesota, United States of America
| | - James P Moriarty
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jordan K Rosedahl
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jalal Soleimani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Alberto Marquez
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Timothy J Weister
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Bijan J Borah
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
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Jorge S. Health Equity in Gynecologic Oncology: Focus on Limited English Proficiency. Gynecol Oncol 2022; 167:414-416. [PMID: 36273924 DOI: 10.1016/j.ygyno.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Soledad Jorge
- University of Washington, Seattle, WA, United States of America.
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Sina B, Noemi G, Myriam G, Ursula F, Anne J, Jabeen F, Kristina K, Julia B. The use of intercultural interpreter services at a pediatric emergency department in Switzerland. BMC Health Serv Res 2022; 22:1365. [DOI: 10.1186/s12913-022-08771-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
AbstractThe aim of our study was to analyze the use of interpreter services and improve communication during health encounters with families with limited language proficiency (LLP) at the pediatric emergency department (ED) of the University Hospital of Bern.This study is a pre- and post-intervention study analyzing the use of interpreter services for LLP families. All families originating from a country with a native language other than German, English or French presenting to the ED were eligible to participate in the study. If they agreed to participate, the language proficiency of the caregiver present during the health encounter was systematically assessed during a phone interview within a few days after the consultation, using a standardized screening tool. If screened positive (relevant LLP), a second phone interview with an interpreter was conducted. Further variables were extracted including nationality, age, gender and date of visit using administrative health records. To increase the use of interpreter services, a package of interventions was implemented at the department during 3 months. It consisted of: i) in person and online transcultural teaching ii) awareness raising through the regular information channels and iii) the introduction of a pathway to systematically identify and manage LLP families.The proportion of LLP families who received an interpreter was 11.0% (14/127) in the pre-intervention period compared to 14.8% (20/135) in the post-intervention period. The interpreter use was therefore increased by 3.8% (95% CI − 0.43 to 0.21; p = 0.36).The assessed level of language proficiency of caregivers differed from the self-reported level of language proficiency. Of the study participants in the interview whose language proficiency was screened as limited, 77.1% estimated their language proficiency level as intermediate. More than half of the LLP families who did not receive an interpreter and participated in the interview reported, that they would have liked an interpreter during the consultation.Conclusions: Interpreter services are largely underused during health encounters with LLP families. Relying on caregivers´ self-assessed language proficiency and their active request for an interpreter is not sufficient to ensure safe communication during health encounters. Systematic screening of language proficiency and standardized management of LLP families is feasible and needed at health care facilities to ensure equitable care. Further studies are needed to analyze personal and institutional barriers to interpreter use and find interventions to sustainably increase the use of interpreter services for LLP families.
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Schwartz H, Menza R, Lindquist K, Mackersie R, Fernández A, Stein D, Bongiovanni T. Limited English Proficiency Associated With Suboptimal Pain Assessment in Hospitalized Trauma Patients. J Surg Res 2022; 278:169-178. [DOI: 10.1016/j.jss.2022.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/22/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
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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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Duraiswamy S, Rubin SJ, Kim Y, Mur T, Edwards HA. Limited English proficiency and head and neck cancer outcomes. Am J Otolaryngol 2022; 43:103470. [PMID: 35427938 DOI: 10.1016/j.amjoto.2022.103470] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Limited English proficiency (LEP) is common among hospitalized patients and may impact clinical care and outcomes. This study aimed to examine the relationship between LEP and clinical oncological outcomes for patients with head and neck cancer (HNC). MATERIALS AND METHODS A single center retrospective review was conducted including adult patients with squamous cell carcinoma of the head and neck who received treatment with curative intent between January 1, 2014 and July 1, 2019. Clinical data collected included patient demographics and clinical variables. Univariate and multivariate analysis was performed to determine whether there was an association between LEP and demographic and clinical factors. RESULTS There were 477 patients included in the study; 426 (81%) were English proficient (EP) while 51 (10.7%) were LEP. The LEP patients were diagnosed with cancer at a later overall stage (p = 0.03) and less frequently treated with surgery alone compared to English speaking patients (p < 0.001). After adjusting for overall stage and primary site, LEP patients were significantly more likely to receive primary surgical management compared to primary non-surgical management [OR = 2.29 95% CI (0.93, 5.58), p = 0.008]. There was also a significant association between LEP and primary site of tumor (p < 0.01). Kaplan-Meyer curves for overall survival and disease specific survival showed no significant differences between the two cohorts (p = 0.8063 and p = 0.4986, respectively). CONCLUSIONS LEP may impact access to care resulting in more advanced overall tumor stage at presentation and treatment with primary surgery compared to non-surgical management after adjusting for tumor stage and primary site. Interventions to provide better access to care, awareness of HNC in the LEP populations, and earlier detection may improve outcomes for LEP patients.
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Affiliation(s)
- Swetha Duraiswamy
- Department of Otolaryngology, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America.
| | - Samuel J Rubin
- Department of Otolaryngology, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America.
| | - Yeahan Kim
- Department of Otolaryngology, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America.
| | - Taha Mur
- Department of Otolaryngology, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America.
| | - Heather A Edwards
- Department of Otolaryngology, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America.
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Ortega P, Avila S, Park YS. Patient-Reported Quality of Communication Skills in the Clinical Workplace for Clinicians Learning Medical Spanish. Cureus 2022; 14:e22222. [PMID: 35340494 PMCID: PMC8930460 DOI: 10.7759/cureus.22222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/14/2022] [Indexed: 11/05/2022] Open
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Diallo MS, Tan JM, Heitmiller ES, Vetter TR. Achieving Greater Health Equity: An Opportunity for Anesthesiology. Anesth Analg 2022; 134:1175-1184. [PMID: 35110516 DOI: 10.1213/ane.0000000000005937] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anesthesiology and anesthesiologists have a tremendous opportunity and responsibility to eliminate health disparities and to achieve health equity. We thus examine health disparity and health equity through the lens of anesthesiology and the perspective of anesthesiologists. In this paper, we define health disparity and health care disparities and provide tangible, representative examples of the latter in the practice of anesthesiology. We define health equity, primarily as the desired antithesis of health disparity. Finally, we propose a framework for anesthesiologists, working toward mitigating health disparity and health care disparities, advancing health equity, and documenting improvements in health care access and health outcomes. This multilevel and interdependent framework includes the perspectives of the patient, clinician, group or department, health care system, and professional societies, including medical journals. We specifically focus on the interrelated roles of social identity and social determinants of health in health outcomes. We explore the foundational role that clinical informatics and valid data collection on race and ethnicity have in achieving health equity. Our ability to ensure patient safety by considering these additional patient-specific factors that affect clinical outcomes throughout the perioperative period could substantially reduce health disparities. Finally, we explore the role of medical journals and their editorial boards in ameliorating health disparities and advancing health equity.
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Affiliation(s)
- Mofya S Diallo
- From the Division of Anesthesiology, Sedation and Perioperative Medicine, Children's National Hospital-George Washington University, Washington, DC
| | - Jonathan M Tan
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine at the University of Southern California, Spatial Sciences Institute at the University of Southern California, Los Angeles, California
| | - Eugenie S Heitmiller
- Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital-George Washington University, Washington, DC
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
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McDade JE, Olszewski AE, Qu P, Ramos J, Bell S, Adiele A, Roberts J, Coker TR. Association Between Language Use and ICU Transfer and Serious Adverse Events in Hospitalized Pediatric Patients Who Experience Rapid Response Activation. Front Pediatr 2022; 10:872060. [PMID: 35865710 PMCID: PMC9295993 DOI: 10.3389/fped.2022.872060] [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: 02/09/2022] [Accepted: 06/13/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hospitalized patients and caregivers who use a language other than English have worse health outcomes, including longer length of stay, more frequent readmissions, and increased rates of in-hospital adverse events. Children who experience clinical deterioration (as measured by a Rapid Response Team event) during a hospitalization are at increased risk for adverse events and mortality. METHODS We describe the results of a retrospective cohort study using hospital records at a free-standing, quaternary children's hospital, to examine the association of language of care with outcomes (transfer to intensive care, adverse event, mortality prior to discharge) following Rapid Response Team event, and whether increased interpreter use among patients who use a language other than English is associated with improved outcomes following Rapid Response Team event. RESULTS In adjusted models, Rapid Response Team events for patients who use a language other than English were associated with higher transfer rates to intensive care (RR 1.1, 95% CI 1.01, 1.21), but not with adverse event or mortality. Among patients who use a language other than English, use of 1-2 interpreted sessions per day was associated with lower transfer rates to intensive care compared to use of less than one interpreted session per day (RR 0.79, 95% 0.66, 0.95). CONCLUSION Rapid Response Team events for hospitalized children of families who use a language other than English are more often followed by transfer to intensive care, compared with Rapid Response Team events for children of families who use English. Improved communication with increased interpreter use for hospitalized children who use a language other than English may lead to improvements in Rapid Response Team outcomes.
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Affiliation(s)
- Jessica E McDade
- Division of Critical Care, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA, United States
| | - Aleksandra E Olszewski
- Division of Critical Care, Department of Pediatrics, McGaw Medical Center of Northwestern University, Chicago, IL, United States.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Pingping Qu
- Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, WA, United States
| | - Jessica Ramos
- Center for Diversity and Health Equity, Seattle Children's Hospital, Seattle, WA, United States
| | - Shaquita Bell
- Center for Diversity and Health Equity, Seattle Children's Hospital, Seattle, WA, United States
| | - Alicia Adiele
- Center for Diversity and Health Equity, Seattle Children's Hospital, Seattle, WA, United States
| | - Joan Roberts
- Division of Critical Care, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA, United States
| | - Tumaini R Coker
- Center for Diversity and Health Equity, Seattle Children's Hospital, Seattle, WA, United States
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