1
|
Sharfuddin N, Mathura P, Mac A, Ling E, Tan M, Khatib E, Suranyi Y, Kassam N. Advancing language concordant care: a multimodal medical interpretation intervention. BMJ Open Qual 2024; 13:e002511. [PMID: 38232982 PMCID: PMC10806550 DOI: 10.1136/bmjoq-2023-002511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Ensuring language concordant care through medical interpretation services (MIS) allows for accurate information sharing and positive healthcare experiences. The COVID-19 pandemic led to a regional halt of in-person interpreters, leaving only digital MIS options, such as phone and video. Due to longstanding institutional practices, and lack of accessibility and awareness of these options, digital MIS remained underused. A Multimodal Medical Interpretation Intervention (MMII) was developed and piloted to increase digital MIS usage by 25% over an 18-month intervention period for patients with limited English proficiency. METHODS Applying quality improvement methodology, an intervention comprised digital MIS technology and education was trialled for 18 months. To assess intervention impact, the number of digital MIS minutes was measured monthly and compared before and after implementation. A questionnaire was developed and administered to determine healthcare providers' awareness, technology accessibility and perception of MIS integration in the clinical workflow. RESULTS Digital MIS was used consistently from the beginning of the COVID-19 pandemic (March 2020) and over the subsequent 18 months. The total number of minutes of MIS use per month increased by 44% following implementation of our intervention. Healthcare providers indicated that digital MIS was vital in facilitating transparent communication with patients, and the MMII ensured awareness of and accessibility to the various MIS modalities. CONCLUSION Implementation of the MMII allowed for an increase in digital MIS use in a hospital setting. Providing digital MIS access, education and training is a means to advance patient-centred and equitable care by improving accuracy of clinical assessments and communication.
Collapse
Affiliation(s)
- Nazia Sharfuddin
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Harvard Medical School, Boston, Massachusetts, USA
| | - Pamela Mathura
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Amanda Mac
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Emily Ling
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Merve Tan
- Medicine, Koc Universitesi, Istanbul, Turkey
| | - Emad Khatib
- Inonu University School of Medicine, Malatya, Turkey
| | | | - Narmin Kassam
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| |
Collapse
|
2
|
Hayba N, Cheek C, Austin E, Testa L, Richardson L, Safi M, Ransolin N, Carrigan A, Harrison R, Francis-Auton E, Clay-Williams R. Strategies to Improve Care in the Emergency Department for Culturally and Linguistically Diverse Adults: a Systematic Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01876-z. [PMID: 38117444 DOI: 10.1007/s40615-023-01876-z] [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: 07/13/2023] [Revised: 11/01/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The emergency department (ED) is an important gateway into the health system for people from culturally and linguistically diverse (CALD) backgrounds; their experience in the ED is likely to impact the way they access care in the future. Our review aimed to describe interventions used to improve ED health care delivery for adults from a CALD background. METHODS An electronic search of four databases was conducted to identify empirical studies that reported interventions with a primary focus of improving ED care for CALD adults (aged ≥ 18 years), with measures relating to ED system performance, patient outcomes, patient experience, or staff experience. Studies published from inception to November 2022 were included. We excluded non-empirical studies, studies where an intervention was not provided in ED, papers where the full text was unavailable, or papers published in a language other than English. The intervention strategies were categorised thematically, and measures were tabulated. RESULTS Following the screening of 3654 abstracts, 89 articles underwent full text review; 16 articles met the inclusion criteria. Four clear strategies for targeting action tailored to the CALD population of interest were identified: improving self-management of health issues, improving communication between patients and providers, adhering to good clinical practice, and building health workforce capacity. CONCLUSIONS The four strategies identified provide a useful framework for targeted action tailored to the population and outcome of interest. These detailed examples show how intervention design must consider intersecting socio-economic barriers, so as not to perpetuate existing disparity. REGISTRATION PROSPERO registration number: CRD42022379584.
Collapse
Affiliation(s)
- Nematullah Hayba
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Colleen Cheek
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia.
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Luke Testa
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Lieke Richardson
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Mariam Safi
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Internal Medicine Research Unit, Department of Regional Health Research, University Hospital of Southern Denmark, Aabenraa, University of Southern Denmark, Odense, Denmark
| | - Natália Ransolin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Emilie Francis-Auton
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Robyn Clay-Williams
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| |
Collapse
|
3
|
Yang C, Prokop L, Barwise A. Strategies Used by Healthcare Systems to Communicate with Hospitalized Patients and Families with Limited English Proficiency During the COVID-19 Pandemic: A Narrative Review. J Immigr Minor Health 2023; 25:1393-1401. [PMID: 36821068 PMCID: PMC9948796 DOI: 10.1007/s10903-023-01453-w] [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] [Accepted: 01/17/2023] [Indexed: 02/24/2023]
Abstract
The COVID-19 pandemic disproportionately affected racial and ethnic minorities in the United States, including many with limited English proficiency (LEP). These patients face various communication barriers, including a shortage of available interpreters and the need for masks that exacerbated communication barriers. It is not known how hospitals responded to these unique challenges to providing language services for the large number of patients with LEP during COVID-19. This narrative review assessed literature and lay media to identify strategies utilized by hospitals to communicate with patients with LEP hospitalized during the COVID-19 pandemic. A search of APA PsychInfo, EBM Reviews, Embase, Ovid MEDLINE, Epub Ahead of Print, and Ebsco Megafile initially yielded 61 articles, 6 of which were ultimately included after reviewing abstracts and full texts. The identified interventions, which sought to increase accessibility of language-concordant care, increase accessibility of professional interpretation, and improve family communication and understanding, were described positively, though only one was tested for effectiveness.
Collapse
Affiliation(s)
- Catherine Yang
- Mayo Clinic Alix School of Medicine, 200 First St SW, Rochester, MN, 55905, USA.
| | - Larry Prokop
- Department of Library Services, Mayo Clinic, Rochester, MN, USA
| | - Amelia Barwise
- Bioethics Research Program, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
4
|
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.
Collapse
Affiliation(s)
- Emily Ahrens
- University of Washington School of Nursing, USA.
| | - Maya Elias
- University of Washington School of Nursing, USA
| |
Collapse
|
5
|
Chipman SA, Meagher K, Barwise AK. A Public Health Ethics Framework for Populations with Limited English Proficiency. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023:1-16. [PMID: 37379053 DOI: 10.1080/15265161.2023.2224263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
25.6 Million people in the United States have Limited English Proficiency (LEP), defined as insufficient ability to read, write, or understand English. We will (1) Delineate the merits of approaching language as a social determinant of health, (2) highlight pertinent public health values and guidelines which are most relevant to the plight of populations with LEP and (3) Use the COVID-19 pandemic as an example of how a breakdown in public health ethics values created harm for populations and patients with LEP. We define a framework to tease out public health responsibilities given some populations' limited proficiency in a society's predominant language. The American Public Health Association (APHA) public health ethics core values serve as a framework to interrogate current practices. We use the COVID-19 case to illustrate gaps between health policy and healthcare disparities experienced by populations with LEP.
Collapse
|
6
|
Mudie LI, Patnaik JL, Gill Z, Wagner M, Christopher KL, Seibold LK, Ifantides C. Disparities in eye clinic patient encounters among patients requiring language interpreter services. BMC Ophthalmol 2023; 23:82. [PMID: 36864395 PMCID: PMC9978272 DOI: 10.1186/s12886-022-02756-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/23/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Communication barriers are a major cause of health disparities for patients with limited English proficiency (LEP). Medical interpreters play an important role in bridging this gap, however the impact of interpreters on outpatient eye center visits has not been studied. We aimed to evaluate the differences in length of eyecare visits between LEP patients self-identifying as requiring a medical interpreter and English speakers at a tertiary, safety-net hospital in the United States. METHODS A retrospective review of patient encounter metrics collected by our electronic medical record was conducted for all visits between January 1, 2016 and March 13, 2020. Patient demographics, primary language spoken, self-identified need for interpreter and encounter characteristics including new patient status, patient time waiting for providers and time in room were collected. We compared visit times by patient's self-identification of need for an interpreter, with our main outcomes being time spent with ophthalmic technician, time spent with eyecare provider, and time waiting for eyecare provider. Interpreter services at our hospital are typically remote (via phone or video). RESULTS A total of 87,157 patient encounters were analyzed, of which 26,443 (30.3%) involved LEP patients identifying as requiring an interpreter. After adjusting for patient age at visit, new patient status, physician status (attending or resident), and repeated patient visits, there was no difference in the length of time spent with technician or physician, or time spent waiting for physician, between English speakers and patients identifying as needing an interpreter. Patients who self-identified as requiring an interpreter were more likely to have an after-visit summary printed for them, and were also more likely to keep their appointment once it was made when compared to English speakers. CONCLUSIONS Encounters with LEP patients who identify as requiring an interpreter were expected to be longer than those who did not indicate need for an interpreter, however we found that there was no difference in the length of time spent with technician or physician. This suggests providers may adjust their communication strategy during encounters with LEP patients identifying as needing an interpreter. Eyecare providers must be aware of this to prevent negative impacts on patient care. Equally important, healthcare systems should consider ways to prevent unreimbursed extra time from being a financial disincentive for seeing patients who request interpreter services.
Collapse
Affiliation(s)
- Lucy I Mudie
- Department of Ophthalmology, University of Colorado, 1675 Aurora Court F731, Aurora, CO, 80045, USA
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado, 1675 Aurora Court F731, Aurora, CO, 80045, USA
| | - Zafar Gill
- Department of Ophthalmology, University of Colorado, 1675 Aurora Court F731, Aurora, CO, 80045, USA
| | - Marissa Wagner
- Department of Ophthalmology, University of Colorado, 1675 Aurora Court F731, Aurora, CO, 80045, USA
| | - Karen L Christopher
- Department of Ophthalmology, University of Colorado, 1675 Aurora Court F731, Aurora, CO, 80045, USA
| | - Leonard K Seibold
- Department of Ophthalmology, University of Colorado, 1675 Aurora Court F731, Aurora, CO, 80045, USA
| | - Cristos Ifantides
- Department of Ophthalmology, University of Colorado, 1675 Aurora Court F731, Aurora, CO, 80045, USA. .,Department of Surgery, Denver Health Medical Center, 660 Bannock Street, Denver, CO, 80204, USA.
| |
Collapse
|
7
|
Kwok MMK, Sandarage R, Kahlon M. Observational study on resource utilisation of patients with limited English proficiency (LEP) at a high-LEP serving community hospital emergency department. BMJ Open Qual 2023; 12:bmjoq-2022-002053. [PMID: 36657957 PMCID: PMC9853255 DOI: 10.1136/bmjoq-2022-002053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023] Open
Abstract
Communication barriers often result in healthcare disparities. Language barriers in patients with limited English proficiency (LEP) frequently results in higher healthcare expenditures and potentially poorer patient-centred outcomes. Therefore, we decided to assess resource utilisation of patients with LEP at our high-LEP serving community hospital emergency department (ED) in Canada. Specifically, we examined whether LEP patients have a higher rate of CT utilisation and/or a higher rate of hospital admission from the ED.We enrolled 100 patients who presented to the ED in our study. Each patient's English proficiency was rated. We classified 31 patients as LEP patients and 69 patients as non-LEP patients. Within the LEP patients' group, 13 out of 31 patients (42%) received a CT scan, while in the non-LEP patients' group, 30 out of 69 patients (43%) received a CT scan. In addition, 28 out of 31 patients (90%) from the LEP patients' group were admitted to the hospital after the initial ED consultation, while in the non-LEP patients' group, 51 out of 69 patients (74%) were admitted.We did not find a difference in CT scan utilisation between LEP and non-LEP patients (p=0.89). Although there is a trend towards a higher hospital admission rate in LEP patients, our finding was not statistically significant (p=0.062).
Collapse
Affiliation(s)
- Matthew Mo Kin Kwok
- The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada .,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Ryan Sandarage
- The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Manjot Kahlon
- The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| |
Collapse
|
8
|
Muacevic A, Adler JR, Walker M. Interpretation Services in a Canadian Emergency Department: How Often Are They Utilized for Patients With Limited English Proficiency? Cureus 2022; 14:e32288. [PMID: 36628037 PMCID: PMC9818050 DOI: 10.7759/cureus.32288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Patients with limited English proficiency (LEP) face barriers to communication leading to inferior health outcomes when compared with English-proficient patients. Professional interpretation services have been shown to improve healthcare outcomes for patients with LEP but are often underutilized. Methods We conducted a retrospective chart review of all patients who visited the Kingston Health Sciences Centre's ED and urgent care centre between July 2015 and August 2021 and identified as having a non-English preferred language. The demographic and visit information of LEP patients who used LanguageLine (Monterey, CA) were compared to LEP patients who did not use the service. Variables were analysed using t-tests and chi-squared tests. A survey distributed to ED physicians and residents collected perspectives on the facilitators/barriers to LanguageLine use. Results Of the 37,500 visits from LEP patients between 2015 and 2021, 118 (0.31%) used LanguageLine. LEP patients were more likely to access LanguageLine if they were younger (p < 0.001), had a more acute Canadian Triage Acuity Scale (CTAS) score (p < 0.001), and spoke Arabic (p<0.001). All 16 staff/residents who responded to the survey (30% response rate) had at least one LEP patient in the preceding month, and 3/16 (19%) accessed LanguageLine for these patients. Further, 5/16 (31%) reported never using the service, with 4/5 (80%) unaware the service existed. Among those aware of LanguageLine, 7/12 (58%) reported the availability of an ad-hoc interpreter as a reason for not accessing the service. Conclusion Interpretation services are underutilized for LEP patients in the ED, with less than 1% of these patients accessing LanguageLine. Patients were more likely to access LanguageLine if they were younger, spoke Arabic, and had a more acute triage score. Most ED physicians were either unaware of or not accessing LanguageLine despite seeing LEP patients. Future work should aim to improve the use of language services and patient-centred care for LEP patients in the ED.
Collapse
|
9
|
Rivas Velarde M, Jagoe C, Cuculick J. Video Relay Interpretation and Overcoming Barriers in Health Care for Deaf Users: Scoping Review. J Med Internet Res 2022; 24:e32439. [PMID: 35679099 PMCID: PMC9227653 DOI: 10.2196/32439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/21/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Persons who are deaf are more likely to avoid health care providers than those who can hear, partially because of the lack of means of communication with these providers and the dearth of available interpreters. The use of video remote interpretation, namely the video camera on an electronic device, to connect deaf patients and health providers has rapidly expanded owing to its flexibility and advantageous cost compared with in-person sign language interpretation. Thus, we need to learn more about how this technology could effectively engage with and respond to the priorities of its users. OBJECTIVE We aimed to identify existing evidence regarding the use of video remote interpretation (VRI) in health care settings and to assess whether VRI technology can enable deaf users to overcome barriers to interpretation and improve communication outcomes between them and health care personnel. METHODS We conducted a search in 7 medical research databases (including MEDLINE, Web of Science, Embase, and Google Scholar) from 2006 including bibliographies and citations of relevant papers. The searches included articles in English, Spanish, and French. The eligibility criteria for study selection included original articles on the use of VRI for deaf or hard of hearing (DHH) sign language users for, or within, health care. RESULTS From the original 176 articles identified, 120 were eliminated after reading the article title and abstract, and 41 articles were excluded after they were fully read. In total, 15 articles were included in this study: 4 studies were literature reviews, 4 were surveys, 3 were qualitative studies, and 1 was a mixed methods study that combined qualitative and quantitative data, 1 brief communication, 1 quality improvement report, and 1 secondary analysis. In this scoping review, we identified a knowledge gap regarding the quality of interpretation and training in sign language interpretation for health care. It also shows that this area is underresearched, and evidence is scant. All evidence came from high-income countries, which is particularly problematic given that most DHH persons live in low- and middle-income countries. CONCLUSIONS Furthering our understanding of the use of VRI technology is pertinent and relevant. The available literature shows that VRI may enable deaf users to overcome interpretation barriers and can potentially improve communication outcomes between them and health personnel within health care services. For VRI to be acceptable, sign language users require a VRI system supported by devices with large screens and a reliable internet connection, as well as qualified interpreters trained on medical interpretation.
Collapse
Affiliation(s)
- Minerva Rivas Velarde
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneve, Switzerland
| | - Caroline Jagoe
- Department of Clinical Speech & Language Studies, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Jessica Cuculick
- Department of Liberal Studies, National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY, United States
| |
Collapse
|