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Feister J, Razdan S, Sharp D, Punjabi S, Blecharczyk E, Escobar V, Gay PM, Scala M, Bonifacio S. Increasing in-person medical interpreter utilization in the NICU through a bundle of interventions. J Perinatol 2024:10.1038/s41372-024-01915-5. [PMID: 38424233 DOI: 10.1038/s41372-024-01915-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND In-person medical interpretation improves communication with patients who have preferred language other than English (PLOE). Multi-dimensional barriers to use of medical interpreters limit their use in the NICU. LOCAL PROBLEM Medical teams in our NICU were not consistently using in-person medical interpreters, leading to ineffective communication with families with PLOE. METHODS/INTERVENTIONS Interventions included staff educational sessions and grand rounds regarding equitable language access, distribution of interpreter request cards to families, and allocation of dedicated in-person interpreters for NICU rounds. Interpreter utilization was calculated by total requests per Spanish-speaking person day in the NICU. RESULTS Interpreter utilization increased five-fold during the intervention period (from 0.2 to 1.0 requests per Spanish-speaking person day). CONCLUSIONS We substantially increased our unit in-person interpreter utilization through a bundle of multifaceted interventions, many of which were low-cost. NICUs should regard dedicated medical interpreters as a critical part of the care team.
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Affiliation(s)
- John Feister
- Stanford University School of Medicine, Department of Pediatrics, Stanford, CA, USA.
- Lucile Packard Children's Hospital Stanford, Stanford, CA, USA.
- University of Cincinnati College of Medicine, Department of Pediatrics & Cincinnati Children's Hospital Medical Center Division of Neonatology, Cincinnati, OH, USA.
| | - Sheila Razdan
- Stanford University School of Medicine, Department of Pediatrics, Stanford, CA, USA
- Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Danielle Sharp
- Stanford University School of Medicine, Department of Pediatrics, Stanford, CA, USA
- Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Shamita Punjabi
- Stanford University School of Medicine, Department of Pediatrics, Stanford, CA, USA
- Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Elizabeth Blecharczyk
- Stanford University School of Medicine, Department of Pediatrics, Stanford, CA, USA
- Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | | | - Paw Mar Gay
- Stanford University School of Medicine, Department of Pediatrics, Stanford, CA, USA
| | - Melissa Scala
- Stanford University School of Medicine, Department of Pediatrics, Stanford, CA, USA
- Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Sonia Bonifacio
- Stanford University School of Medicine, Department of Pediatrics, Stanford, CA, USA
- Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
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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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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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4
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Chicas VM, Tung WC, Chicas KA, Donnelly M, Dawkins D, Hampton MD. Ensuring equitable quality care through accessible language services. Nurs Manag (Harrow) 2023; 54:8-14. [PMID: 37647555 DOI: 10.1097/nmg.0000000000000045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Vanessa Michelle Chicas
- Vanessa Michelle Chicas is a clinical nurse III at Stanford Health Care in Palo Alto, Calif., and was a clinical instructor for graduate nursing students at the University of San Francisco. Wei-Chen Tung is a professor at the School of Nursing, San Jose State University in San Jose, Calif. Karena Alexandra Chicas is a senior emergency medicine trauma technician at California State University in Davis, Calif. Mary Donnelly is director of the Post-Baccalaureate Registered Nurse Residency Program at VA Northern California Health Care System in Mather, Calif. Denise Dawkins is an assistant professor at the School of Nursing, San Jose State University in San Jose, Calif. Michelle DeCoux Hampton is the director of Academic Nursing and Patient Care Research at Stanford Health Care in Palo Alto, Calif
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5
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Rosenberg J, Chelemedos K, Luna L, Khan A. Gaps in Clinical Care and Research Inclusion for Families Speaking Languages Other Than English. Hosp Pediatr 2023; 13:e144-e146. [PMID: 37125492 PMCID: PMC10233731 DOI: 10.1542/hpeds.2023-007248] [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: 05/02/2023]
Affiliation(s)
- Julia Rosenberg
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Kasey Chelemedos
- Department of Pediatrics, St Christopher’s Hospital for Children, Philadelphia, Pennsylvania
| | - Luis Luna
- HUSKY (Medicaid) 4 Immigrants, Hartford, Connecticut
| | - Alisa Khan
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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6
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Rojas CR, Coffin A, Taylor A, Ortiz P, Jenicek G, Hart J, Callahan JM, Shaw KN. Resident Communication With Patients and Families Preferring Languages Other Than English. Hosp Pediatr 2023:191228. [PMID: 37125495 DOI: 10.1542/hpeds.2022-007003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Patients and families preferring languages other than English (LOE) often experience inequitable communication with their health care providers, including the underutilization of professional interpretation. This study had 2 aims: to characterize resident-perceived communication with families preferring LOE and to evaluate the impact of language preference on frequency of resident interactions with hospitalized patients and families. METHODS This was a cross-sectional study at a quaternary care children's hospital. We developed a questionnaire for residents regarding their interactions with patients preferring LOE. We concurrently developed a communication tracking tool to measure the frequency of resident communication events with hospitalized patients. Data were analyzed with logistic and Poisson regression models. RESULTS Questionnaire results demonstrated a high level of resident comfort with interpretation, though more than 30% of residents reported "sometimes" or "usually" communicating with families preferring LOE without appropriate interpretation (response rate, 47%). The communication tracking tool was completed by 36 unique residents regarding 151 patients, with a 95% completion rate. Results demonstrated that patients and families preferring LOE were less likely to be present on rounds compared with their counterparts preferring English (adjusted odds ratio, 0.17; 95% confidence interval [CI], 0.07-0.39). Similarly, patients and families preferring LOE were less likely to receive a resident update after rounds (adjusted odds ratio, 0.29; 95% CI, 0.13-0.62) and received fewer resident updates overall (incidence rate ratio, 0.45; 95% CI, 0.30-0.69). CONCLUSIONS Hospitalized patients and families preferring LOE experience significant communication-related inequities. Ongoing efforts are needed to promote equitable communication with this population and should consider the unique role of residents.
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Affiliation(s)
- Christina R Rojas
- Department of Pediatrics
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia; and
| | | | | | | | | | - Jessica Hart
- Department of Pediatrics
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James M Callahan
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathy N Shaw
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Smith CJ, Raval MV, Simon MA, Henry MCW. Addressing pediatric surgical health inequities through quality improvement efforts. Semin Pediatr Surg 2023; 32:151280. [PMID: 37147217 DOI: 10.1016/j.sempedsurg.2023.151280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Concepts of healthcare quality and health equity should be inextricably linked but are often pursued separately. Quality improvement (QI) can serve as a powerful means to eliminate health inequities by adopting an equity-focused lens to diagnose and address baseline disparities among pediatric populations using targeted interventions. QI and pediatric surgery practitioners should integrate concepts of equity at every stage of formulating a QI project including conceptualization, planning, and execution. Early adaptation of an equity conscious perspective using QI methodology can prevent exacerbation of preexisting disparities while improving overall outcomes.
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Affiliation(s)
- Charesa J Smith
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA; Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA; Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Marion C W Henry
- Division of Pediatric Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
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Lion KC, Zhou C, Fishman P, Senturia K, Cole A, Sherr K, Opel DJ, Stout J, Hazim CE, Warren L, Rains BH, Lewis CC. A sequential, multiple assignment randomized trial comparing web-based education to mobile video interpreter access for improving provider interpreter use in primary care clinics: the mVOCAL hybrid type 3 study protocol. Implement Sci 2023; 18:8. [PMID: 36915138 PMCID: PMC10012737 DOI: 10.1186/s13012-023-01263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/12/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Individuals who use a language other than English for medical care are at risk for disparities related to healthcare safety, patient-centered care, and quality. Professional interpreter use decreases these disparities but remains underutilized, despite widespread access and legal mandates. In this study, we compare two discrete implementation strategies for improving interpreter use: (1) enhanced education targeting intrapersonal barriers to use delivered in a scalable format (interactive web-based educational modules) and (2) a strategy targeting system barriers to use in which mobile video interpreting is enabled on providers' own mobile devices. METHODS We will conduct a type 3 hybrid implementation-effectiveness study in 3-5 primary care organizations, using a sequential multiple assignment randomized trial (SMART) design. Our primary implementation outcome is interpreter use, calculated by matching clinic visits to interpreter invoices. Our secondary effectiveness outcome is patient comprehension, determined by comparing patient-reported to provider-documented visit diagnosis. Enrolled providers (n = 55) will be randomized to mobile video interpreting or educational modules, plus standard interpreter access. After 9 months, providers with high interpreter use will continue as assigned; those with lower use will be randomized to continue as before or add the alternative strategy. After another 9 months, both strategies will be available to enrolled providers for 9 more months. Providers will complete 2 surveys (beginning and end) and 3 in-depth interviews (beginning, middle, and end) to understand barriers to interpreter use, based on the Theoretical Domains Framework. Patients who use a language other than English will be surveyed (n = 648) and interviewed (n = 75) following visits with enrolled providers to understand their experiences with communication. Visits will be video recorded (n = 100) to assess fidelity to assigned strategies. We will explore strategy mechanism activation to refine causal pathway models using a quantitative plus qualitative approach. We will also determine the incremental cost-effectiveness of each implementation strategy from a healthcare organization perspective, using administrative and provider survey data. DISCUSSION Determining how these two scalable strategies, alone and in sequence, perform for improving interpreter use, the mechanisms by which they do so, and at what cost, will provide critical insights for addressing a persistent cause of healthcare disparities. TRIAL REGISTRATION NCT05591586.
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Affiliation(s)
- K Casey Lion
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, 98145-5005, USA.
| | - Chuan Zhou
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, 98145-5005, USA
| | - Paul Fishman
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Kirsten Senturia
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Allison Cole
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
- Department of Industrial & Systems Engineering, University of Washington, Seattle, WA, USA
| | - Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - James Stout
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Carmen E Hazim
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
| | - Louise Warren
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Bonnie H Rains
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Cara C Lewis
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Knighton AJ, Bass EJ, McLaurin EJ, Anderson M, Baird JD, Cray S, Destino L, Khan A, Liss I, Markle P, O’Toole JK, Patel A, Srivastava R, Landrigan CP, Spector ND, Patel SJ. Intervention, individual, and contextual determinants to high adherence to structured family-centered rounds: a national multi-site mixed methods study. Implement Sci Commun 2022; 3:74. [PMID: 35842692 PMCID: PMC9287702 DOI: 10.1186/s43058-022-00322-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Effective communication in transitions between healthcare team members is associated with improved patient safety and experience through a clinically meaningful reduction in serious safety events. Family-centered rounds (FCR) can serve a critical role in interprofessional and patient-family communication. Despite widespread support, FCRs are not utilized consistently in many institutions. Structured FCR approaches may prove beneficial in increasing FCR use but should address organizational challenges. The purpose of this study was to identify intervention, individual, and contextual determinants of high adherence to common elements of structured FCR in pediatric inpatient units during the implementation phase of a large multi-site study implementing a structured FCR approach.
Methods
We performed an explanatory sequential mixed methods study from September 2019 to October 2020 to evaluate the variation in structured FCR adherence across 21 pediatric inpatient units. We analyzed 24 key informant interviews of supervising physician faculty, physician learners, nurses, site administrators, and project leaders at 3 sites using a qualitative content analysis paradigm to investigate site variation in FCR use. We classified implementation determinants based on the Consolidated Framework for Implementation Research.
Results
Provisional measurements of adherence demonstrated considerable variation in structured FCR use across sites at a median time of 5 months into the implementation. Consistent findings across all three sites included generally positive clinician beliefs regarding the use of FCR and structured rounding approaches, benefits to learner self-efficacy, and potential efficiency gains derived through greater rounds standardization, as well as persistent challenges with nurse engagement and interaction on rounds and coordination and use of resources for families with limited English proficiency.
Conclusions
Studies during implementation to identify determinants to high adherence can provide generalizable knowledge regarding implementation determinants that may be difficult to predict prior to implementation, guide adaptation during the implementation, and inform sustainment strategies.
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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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Schlange SA, Palmer-Wackerly AL, Chaidez V. A Narrative Review of Medical Interpretation Services and their Effect on the Quality of Health Care. South Med J 2022; 115:317-321. [PMID: 35504613 DOI: 10.14423/smj.0000000000001392] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Half of the foreign-born population in the United States speaks English "less than very well." The extant literature suggests that low-English-proficient (LEP) patients experience poorer healthcare outcomes than do language-concordant patients. It remains unclear which methods of interpreter services are best for communicating effectively and achieving positive health outcomes for LEP patients. This review examines interpretation methods to compare their effectiveness and frequency of use and identifies the remaining gaps in our knowledge. The evidence suggests that any type of professional language service is superior to untrained interpreting and vastly better than not using an interpreter at all. Even with this knowledge, use of interpreter services is unacceptably low and gaps remain. Further research is needed to isolate and examine different methods of interpretation and measure objective health outcomes. In addition, education is needed for interpreters and healthcare providers to ensure the most effective communicative strategies for LEP patients.
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Affiliation(s)
- Stacie A Schlange
- From Nutrition and Health Sciences and Communication Studies, University of Nebraska-Lincoln, Lincoln
| | - Angela L Palmer-Wackerly
- From Nutrition and Health Sciences and Communication Studies, University of Nebraska-Lincoln, Lincoln
| | - Virginia Chaidez
- From Nutrition and Health Sciences and Communication Studies, University of Nebraska-Lincoln, Lincoln
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Rajbhandari P, Keith MF, Braidy R, Gunkelman SM, Smith E. Interpreter Use for Limited English Proficiency Patients/Families: A QI Study. Hosp Pediatr 2021; 11:718-726. [PMID: 34583318 DOI: 10.1542/hpeds.2020-003889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Communication is fundamental to high-quality health care. Despite federal requirements to provide interpreters and growing evidence favoring the benefits of interpreter use, providers' use of interpreters remains suboptimal. In acute care settings, where decisions need to be made rapidly on the basis of changing clinical circumstances, this has proven to be challenging. METHODS We designed a quality improvement project using the model for improvement methodology for patients admitted to the pediatric hospital medicine service. A multidisciplinary team developed interventions focused on provider education and leveraging health information technology (IT). We used health IT to improve the identification of families with limited English proficiency, improve access to various modalities of interpreting, standardize workflow to request face-to-face (F2F) interpreters, and create a designated place in the electronic health record for interpreter use documentation. The use of all forms (telephone, video, and F2F) of interpreter service, documentation of interpreter uses, and F2F interpreter overload were tracked monthly for 3 years. RESULTS The baseline use of interpreter services for the pediatric hospital medicine inpatient service was 64%. After starting the project, the use of interpreter service increased to 97% and has sustained for more than a year since the project's completion. The use of F2F interpreters also increased from a baseline of 20% to 54% post intervention. CONCLUSIONS We successfully achieved and sustained our goals of improving interpreter use through supportive leadership and a multidisciplinary approach using quality improvement methodology. Future efforts should be focused on defining and standardizing metrics for families with limited English proficiency across institutions and using health IT to improve care.
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Mitchell HK, Reddy A, Perry MA, Gathers CA, Fowler JC, Yehya N. Racial, ethnic, and socioeconomic disparities in paediatric critical care in the USA. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:739-750. [PMID: 34370979 DOI: 10.1016/s2352-4642(21)00161-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022]
Abstract
In an era of tremendous medical advancements, it is important to characterise and address inequities in the provision of health care and in outcomes. There is a large body of evidence describing such disparities by race or ethnicity and socioeconomic position in critically ill adults; however, this important issue has received less attention in children and adolescents (aged ≤21 years). This Review presents a summary of the available evidence on disparities in outcomes in paediatric critical illness in the USA as a result of racism and socioeconomic privilege. The majority of evidence of racial and socioeconomic disparities in paediatric critical care originates from the USA and is retrospective, with only one prospective intervention-based study. Although there is mixed evidence of disparities by race or ethnicity and socioeconomic position in general paediatric intensive care unit admissions and outcomes in the USA, there are striking trends within some disease processes. Notably, there is evidence of disparities in management and outcomes for out-of-hospital cardiac arrest, asthma, severe trauma, sepsis, and oncology, and in families' perceptions of care. Furthermore, there is clear evidence that critical care research is limited by under-enrolment of participants from minority race or ethnicity groups. We advocate for rigorous research standards and increases in the recruitment and enrolment of a diverse range of participants in paediatric critical care research to better understand the disparities observed, including the effects of racism and poverty. A clearer understanding of when, where, and how such disparities affect patients will better enable the development of effective strategies to inform practice, interventions, and policy.
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Affiliation(s)
- Hannah K Mitchell
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Anireddy Reddy
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, PA, USA
| | - Mallory A Perry
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cody-Aaron Gathers
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jessica C Fowler
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nadir Yehya
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, PA, USA
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Flower KB, Wurzelmann S, Tucker C, Rojas C, Díaz-González de Ferris ME, Sylvester F. Spanish-Speaking Parents' Experiences Accessing Academic Medical Center Care: Barriers, Facilitators and Technology Use. Acad Pediatr 2021; 21:793-801. [PMID: 33096286 PMCID: PMC7573670 DOI: 10.1016/j.acap.2020.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/11/2020] [Accepted: 10/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Children of Spanish-speaking caregivers face multiple barriers to care in academic medical centers. This study identified barriers and facilitators of health care and described use of health information technology in order to guide interventions and optimize services. METHODS In-depth, audiotaped interviews were conducted with monolingual Spanish-speaking caregivers (N = 28) of children receiving care in academic medical center clinics using a structured interview guide. Interviews were transcribed in Spanish, and key themes were identified using thematic analysis. Illustrative quotes for each theme were translated into English. RESULTS Language-specific barriers included arrival/registration occurring in English, lack of bilingual personnel, heavy reliance on interpreters, long wait times, and challenging phone communication. Non-language-specific barriers included medical center size and complexity, distance to services, lack of convenient and coordinated appointments, missing work/school, and financial barriers including insurance coverage or lack of citizenship. Caregivers identified interpreters, bilingual physicians and staff, and written materials in Spanish as facilitators of care. Most caregivers had internet access and expressed interest in health information technology, including patient portals, to communicate about their children's health. CONCLUSIONS Caregivers of Spanish-speaking children encounter many language-specific barriers, which are compounded by non-language-specific barriers arising from complex health systems and social needs. Caregivers with limited resources described working hard to meet children's complex health care needs despite these barriers. Most caregivers had internet access and interest in patient portals. Academic medical centers may need multifaceted interventions that improve the availability of bilingual staff and interpreters and also address caregivers' social and informational needs.
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Affiliation(s)
- Kori B Flower
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics (KB Flower, ME Díaz-González de Ferris), University of North Carolina at Chapel Hill.
| | - Samuel Wurzelmann
- School of Medicine, University of North Carolina at Chapel Hill (S Wurzelmann)
| | - Christine Tucker
- Department of Maternal and Child Health (C Tucker), Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Claudia Rojas
- Center for Latino Health and Division of General Internal Medicine, Department of Internal Medicine (C Rojas), University of North Carolina at Chapel Hill
| | - Maria E Díaz-González de Ferris
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics (KB Flower, ME Díaz-González de Ferris), University of North Carolina at Chapel Hill
| | - Francisco Sylvester
- Division of Pediatric Gastroenterology, Department of Pediatrics (F Sylvester), University of North Carolina at Chapel Hill
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Mirza M, Harrison EA, Miller KA, Jacobs EA. Indicators of Quality Rehabilitation Services for Individuals with Limited English Proficiency: A 3-Round Delphi Study. Arch Phys Med Rehabil 2021; 102:2125-2133. [PMID: 34052214 DOI: 10.1016/j.apmr.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/09/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To obtain expert consensus on indicators of quality rehabilitation services for individuals with limited English proficiency (LEP). DESIGN Three-round Delphi study. SETTING Delphi survey conducted online with 30 experts. Most experts worked in adult physical rehabilitation settings and were from Illinois (n=16), and the remaining participants were from 8 other US states or Canadian provinces. PARTICIPANTS Experts (N=30) had a minimum of 2 publications on health care services for patients with LEP and/or a minimum of 5 years clinical experience in physical rehabilitation. Of 43 experts (11 researchers, 32 clinicians) who received the round 1 survey by e-mail, 30 returned complete responses (70% response rate). Of those, 25 completed round 2 and 24 completed round 3. Of round 1 participants, most (n =21) identified their primary professional activity as clinical, whereas the others worked in research (n =5) or education (n =4). Twenty-four were women. The median age was 43 years (range, 27-67y). Disciplines included occupational therapy (n =14), physical therapy (n =13), psychology (n=1), nursing (n=1), and medicine (n=1). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Indicators were rated on a 7-point Likert scale for importance and feasibility. Interquartile range (IQR) and 95% confidence intervals were calculated for importance and feasibility ratings. Indicators with an IQR <2 and a median importance score ≥6 were accepted as reaching consensus for importance. RESULTS Round 1 responses were categorized into 15 structural, 13 process, and 18 outcome indicators. All 15 structural indicators reached consensus for importance; 8 were rated as feasible. All 13 process indicators reached consensus, of which 8 were deemed feasible. Sixteen outcome indicators reached consensus, of which 7 were deemed feasible. CONCLUSIONS This Delphi study identified structural, process, and outcome indicators that can inform delivery and assessment of quality rehabilitation services for individuals with LEP. Future research should operationalize and measure these quality indicators in clinical practice.
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Affiliation(s)
- Mansha Mirza
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL.
| | - Elizabeth A Harrison
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL
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Mong J, Cram P, Syed K, Rawal S. Interpretation use for consent to hip fracture surgery in patients with limited English proficiency. J Am Geriatr Soc 2021; 69:2358-2361. [PMID: 33856689 DOI: 10.1111/jgs.17157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/26/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Jonathon Mong
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Cram
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada
| | - Khalid Syed
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopedic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Shail Rawal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada
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Lion KC, Gritton J, Scannell J, Brown JC, Ebel BE, Klein EJ, Mangione-Smith R. Patterns and Predictors of Professional Interpreter Use in the Pediatric Emergency Department. Pediatrics 2021; 147:peds.2019-3312. [PMID: 33468598 PMCID: PMC7906072 DOI: 10.1542/peds.2019-3312] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Professional interpretation for patients with limited English proficiency remains underused. Understanding predictors of use is crucial for intervention. We sought to identify factors associated with professional interpreter use during pediatric emergency department (ED) visits. METHODS We video recorded ED visits for a subset of participants (n = 50; 20% of the total sample) in a randomized trial of telephone versus video interpretation for Spanish-speaking limited English proficiency families. Medical communication events were coded for duration, health professional type, interpreter (none, ad hoc, or professional), and content. With communication event as the unit of analysis, associations between professional interpreter use and assigned interpreter modality, health professional type, and communication content were assessed with multivariate random-effects logistic regression, clustered on the patient. RESULTS We analyzed 312 communication events from 50 ED visits (28 telephone arm, 22 video arm). Professional interpretation was used for 36% of communications overall, most often for detailed histories (89%) and least often for procedures (11%) and medication administrations (8%). Speaker type, communication content, and duration were all significantly associated with professional interpreter use. Assignment to video interpretation was associated with significantly increased use of professional interpretation for communication with providers (adjusted odds ratio 2.7; 95% confidence interval: 1.1-7.0). CONCLUSIONS Professional interpreter use was inconsistent over the course of an ED visit, even for patients enrolled in an interpretation study. Assignment to video rather than telephone interpretation led to greater use of professional interpretation among physicians and nurse practitioners but not nurses and other staff.
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Affiliation(s)
- K. Casey Lion
- Department of Pediatrics and,Center for Child Health, Behavior and Development and
| | - Jesse Gritton
- Center for Child Health, Behavior and Development and
| | - Jack Scannell
- Center for Child Health, Behavior and Development and
| | - Julie C. Brown
- Department of Pediatrics and,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Beth E. Ebel
- Department of Pediatrics and,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; and,Center for Child Health, Behavior and Development and
| | - Eileen J. Klein
- Department of Pediatrics and,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Rita Mangione-Smith
- Department of Pediatrics and,Center for Child Health, Behavior and Development and
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19
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Khan A, Yin HS, Brach C, Graham DA, Ramotar MW, Williams DN, Spector N, Landrigan CP, Dreyer BP. Association Between Parent Comfort With English and Adverse Events Among Hospitalized Children. JAMA Pediatr 2020; 174:e203215. [PMID: 33074313 PMCID: PMC7573792 DOI: 10.1001/jamapediatrics.2020.3215] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Children of parents expressing limited comfort with English (LCE) or limited English proficiency may be at increased risk of adverse events (harms due to medical care). No prior studies have examined, in a multicenter fashion, the association between language comfort or language proficiency and systematically, actively collected adverse events that include family safety reporting. OBJECTIVE To examine the association between parent LCE and adverse events in a cohort of hospitalized children. DESIGN, SETTING, AND PARTICIPANTS This multicenter prospective cohort study was conducted from December 2014 to January 2017, concurrent with data collection from the Patient and Family Centered I-PASS Study, a clinician-family communication and patient safety intervention study. The study included 1666 Arabic-, Chinese-, English-, and Spanish-speaking parents of general pediatric and subspecialty patients 17 years and younger in the pediatric units of 7 North American hospitals. Data were analyzed from January 2018 to May 2020. EXPOSURES Language-comfort data were collected through parent self-reporting. LCE was defined as reporting any language besides English as the language in which parents were most comfortable speaking to physicians or nurses. MAIN OUTCOMES AND MEASURES The primary outcome was adverse events; the secondary outcome was preventable adverse events. Adverse events were collected using a systematic 2-step methodology. First, clinician abstractors reviewed patient medical records, solicited clinician reports, hospital incident reports, and family safety interviews. Then, review and consensus classification were completed by physician pairs. To examine the association of LCE with adverse events, a multivariable logistic regression was conducted with random intercepts to adjust for clustering by site. RESULTS Of 1666 parents providing language-comfort data, 1341 (80.5%) were female, and the mean (SD) age of parents was 35.4 (10.0) years. A total of 147 parents (8.8%) expressed LCE, most of whom (105 [71.4%]) preferred Spanish. Children of parents who expressed LCE had higher odds of having 1 or more adverse events compared with children whose parents expressed comfort with English (26 of 147 [17.7%] vs 146 of 1519 [9.6%]; adjusted odds ratio, 2.1; 95% CI, 1.2-3.7), after adjustment for parent race and education, complex chronic conditions, length of stay, site, and the intervention period. Similarly, children whose parents expressed LCE were more likely to experience 1 or more preventable adverse events (adjusted odds ratio, 2.3; 95% CI, 1.2-4.2). CONCLUSIONS AND RELEVANCE Hospitalized children of parents expressing LCE were twice as likely to experience harms due to medical care. Targeted strategies are needed to improve communication and safety for this vulnerable group of children.
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Affiliation(s)
- Alisa Khan
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - H. Shonna Yin
- Department of Pediatrics and Department of Population Health, New York University Langone Health/Hassenfeld Children’s Hospital, New York,Department of Pediatrics and Department of Population Health, New York University School of Medicine, New York
| | - Cindy Brach
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Dionne A. Graham
- Harvard Medical School, Boston, Massachusetts,Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts
| | - Matthew W. Ramotar
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - David N. Williams
- Harvard Medical School, Boston, Massachusetts,Institutional Centers for Clinical and Translational Studies, Boston Children’s Hospital, Boston, Massachusetts
| | - Nancy Spector
- The Hedwig van Amerigen Executive Leadership in Academic Medicine (ELAM) Program, Philadelphia, Pennsylvania,Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Christopher P. Landrigan
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts,Division of Sleep Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Benard P. Dreyer
- Division of Developmental-Behavioral Pediatrics, New York University Langone Health/Hassenfeld Children's Hospital, New York,Department of Pediatrics, New York University School of Medicine, New York
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20
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Hategeka C, Ruton H, Karamouzian M, Lynd LD, Law MR. Use of interrupted time series methods in the evaluation of health system quality improvement interventions: a methodological systematic review. BMJ Glob Health 2020; 5:e003567. [PMID: 33055094 PMCID: PMC7559052 DOI: 10.1136/bmjgh-2020-003567] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND When randomisation is not possible, interrupted time series (ITS) design has increasingly been advocated as a more robust design to evaluating health system quality improvement (QI) interventions given its ability to control for common biases in healthcare QI. However, there is a potential risk of producing misleading results when this rather robust design is not used appropriately. We performed a methodological systematic review of the literature to investigate the extent to which the use of ITS has followed best practice standards and recommendations in the evaluation of QI interventions. METHODS We searched multiple databases from inception to June 2018 to identify QI intervention studies that were evaluated using ITS. There was no restriction on date, language and participants. Data were synthesised narratively using appropriate descriptive statistics. The risk of bias for ITS studies was assessed using the Cochrane Effective Practice and Organisation of Care standard criteria. The systematic review protocol was registered in PROSPERO (registration number: CRD42018094427). RESULTS Of 4061 potential studies and 2028 unique records screened for inclusion, 120 eligible studies assessed eight QI strategies and were from 25 countries. Most studies were published since 2010 (86.7%), reported data using monthly interval (71.4%), used ITS without a control (81%) and modelled data using segmented regression (62.5%). Autocorrelation was considered in 55% of studies, seasonality in 20.8% and non-stationarity in 8.3%. Only 49.2% of studies specified the ITS impact model. The risk of bias was high or very high in 72.5% of included studies and did not change significantly over time. CONCLUSIONS The use of ITS in the evaluation of health system QI interventions has increased considerably over the past decade. However, variations in methodological considerations and reporting of ITS in QI remain a concern, warranting a need to develop and reinforce formal reporting guidelines to improve its application in the evaluation of health system QI interventions.
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Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Hinda Ruton
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Public Health, University of Rwanda, Kigali, Rwanda
| | - Mohammad Karamouzian
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- HIV/STI Surveillance Research Centre, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, British Columbia, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
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21
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Stephen JM, Zoucha R. Spanish Speaking, Limited English Proficient Parents whose Children are Hospitalized: An Integrative Review. J Pediatr Nurs 2020; 52:30-40. [PMID: 32163844 DOI: 10.1016/j.pedn.2020.02.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022]
Abstract
PROBLEM Children of non-English speakers are at risk for health disparities. Little is known about the experiences of Spanish speaking parents with limited English proficiency (LEP) whose children are hospitalized. The purposes of this integrative review were to explore what is known and to identify gaps in the literature about the experiences of Spanish speaking parents with LEP whose children are hospitalized. ELIGIBILITY CRITERIA Whittemore and Knafl's (2005) integrative review method guided the process. Studies addressed Spanish speaking parents of hospitalized children in the United States. SAMPLE A final sample consisted of 36 quantitative and qualitative research studies published from 1994 to 2018; located through a search of CINAHL, Pubmed, and Scopus. RESULTS Language services were inconsistent although mandated by standards and laws. Parents experienced mixed emotions related to care. Emergency departments in large, urban cities were the most common care settings. Differences in care outcomes and safety risks for children of Spanish speaking parents existed; however, findings were inconsistent. Only three of the 36 studies addressed nursing care. CONCLUSIONS Research design and quality varied. Parents valued communication in their language. Nurses are the primary healthcare provider in the hospital setting but few studies explored parents' experiences associated with nursing care. No studies explored parents' experiences with their child's hospitalization in the context of culture. IMPLICATIONS Future research is needed to explore the cultural values, beliefs, and experiences of Spanish speaking parents with LEP and the role of nurses and to inform culturally congruent nursing care, research, and policy.
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Tam I, Huang MZ, Patel A, Rhee KE, Fisher E. Spanish Interpreter Services for the Hospitalized Pediatric Patient: Provider and Interpreter Perceptions. Acad Pediatr 2020; 20:216-224. [PMID: 31445969 DOI: 10.1016/j.acap.2019.08.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Many Americans have limited English proficiency (LEP) and difficulty communicating with health care providers, creating inequitable health care delivery. Despite widespread interpreter availability in hospitals, perceptions of interpreter services in the pediatric inpatient setting are largely unknown. OBJECTIVE To investigate staff perspectives regarding: 1) roles of the interpreter and provider (attending, resident, and nurse) during an encounter, 2) modalities of interpretation, and 3) barriers to services. METHODS Focus groups were conducted with: 1) hospital-employed Spanish interpreters, 2) Pediatric Hospital Medicine attendings, 3) pediatric and internal medicine-pediatric residents, and 4) medical unit nurses. Sessions were audio-recorded and transcribed. Using Atlas.ti, 2 investigators created the coding scheme, independently coded the data, and achieved consensus. Qualitative methods were used for thematic analysis. RESULTS Fourteen groups (n = 59 participants) were held: 3 interpreter groups (n = 10), 3 attending groups (n = 14), 2 resident groups (n = 17), and 6 nurse groups (n = 18). Most believed the interpreter's role was to serve as a conduit (provide word-for-word interpretation), act as a cultural broker, and maintain transparency (not withhold information). All groups felt providers should interact with families as they would with English-speaking families. In-person interpreters were preferred over telephone and video for being more accurate, efficient, and personable. Barriers to accessing services included time needed for interpretation, overconfidence in language skills, variable family dynamics, and identification of LEP families. CONCLUSIONS In-person interpreters are highly valued, fulfilling complex roles. However, operational and human factors limit access to services in the hospital. These findings, along with family perspectives, can be used to optimize interpretation experiences.
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Affiliation(s)
- Ivy Tam
- Department of Pediatrics (I Tam, MZ Huang, A Patel, KE Rhee, and E Fisher), Rady Children's Hospital San Diego and University of California San Diego, San Diego, Calif; Department of Pediatrics (I Tam), The Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY.
| | - Maria Z Huang
- Department of Pediatrics (I Tam, MZ Huang, A Patel, KE Rhee, and E Fisher), Rady Children's Hospital San Diego and University of California San Diego, San Diego, Calif
| | - Aarti Patel
- Department of Pediatrics (I Tam, MZ Huang, A Patel, KE Rhee, and E Fisher), Rady Children's Hospital San Diego and University of California San Diego, San Diego, Calif
| | - Kyung E Rhee
- Department of Pediatrics (I Tam, MZ Huang, A Patel, KE Rhee, and E Fisher), Rady Children's Hospital San Diego and University of California San Diego, San Diego, Calif
| | - Erin Fisher
- Department of Pediatrics (I Tam, MZ Huang, A Patel, KE Rhee, and E Fisher), Rady Children's Hospital San Diego and University of California San Diego, San Diego, Calif
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23
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Choe AY, Unaka NI, Schondelmeyer AC, Bignall WJR, Vilvens HL, Thomson JE. Inpatient Communication Barriers and Drivers When Caring for Limited English Proficiency Children. J Hosp Med 2019; 14:607-613. [PMID: 31339836 PMCID: PMC6817305 DOI: 10.12788/jhm.3240] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Achieving effective communication between medical providers and families with limited English proficiency (LEP) in the hospital is difficult. OBJECTIVE Our objective was to identify barriers to and drivers of effective interpreter service use when caring for hospitalized LEP children from the perspectives of pediatric medical providers and interpreters. DESIGN/PARTICIPANTS/SETTING We used Group Level Assessment (GLA), a structured qualitative participatory method that allows participants to directly produce and analyze data in an interactive group session. Participants from a single academic children's hospital generated individual responses to prompts and identified themes and relevant action items. Themes were further consolidated by our research team and verified by stakeholder groups. RESULTS Four GLA sessions were conducted including 64 participants: hospital medicine physicians and pediatric residents (56%), inpatient nursing staff (16%), and interpreter services staff (28%). Barriers identified included: (1) difficulties accessing interpreter services; (2) uncertainty in communication with LEP families; (3) unclear and inconsistent expectations and roles of team members; and (4) unmet family engagement expectations. Drivers of effective communication were: (1) utilizing a team-based approach between medical providers and interpreters; (2) understanding the role of cultural context in providing culturally effective care; (3) practicing empathy for patients and families; and (4) using effective family-centered communication strategies. CONCLUSIONS Participants identified unique barriers and drivers that impact communication with LEP patients and their families during hospitalization. Future directions include exploring the perspective of LEP families and utilizing team-based and family-centered communication strategies to standardize and improve communication practices.
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Affiliation(s)
- Angela Y Choe
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Corresponding Author: Angela Y. Choe, MD; E-mail: ; Telephone: 513-636-3893; Twitter: @AChoeMD
| | - Ndidi I Unaka
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amanda C Schondelmeyer
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Whitney J Raglin Bignall
- Division of Psychology in the Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Heather L Vilvens
- Allied Health Department, University of Cincinnati Blue Ash College, Cincinnati, Ohio
| | - Joanna E Thomson
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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24
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Tran JH, Luan Erfe BM, Kirwan CJ, Mejia NI. Challenges and opportunities caring for neurology outpatients across language differences. Neurol Clin Pract 2019; 9:208-217. [PMID: 31341708 PMCID: PMC6615656 DOI: 10.1212/cpj.0000000000000634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/27/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND With over 66 million Americans who speak over 350 languages other than English at home, we sought to examine attitudes and behaviors of neurology clinicians and staff when communicating across language differences. METHODS We conducted an electronic-enabled cross-sectional survey of clinicians and patient services coordinators working at an academic neurology outpatient clinic. Questions focused on professional medical interpreter (PMI) services usage, satisfaction, and perceived barriers to utilization. RESULTS A total of 82/235 (35%) neurology clinicians and 24/52 (46%) coordinators met the study eligibility criteria. Most clinicians (96%) reported seeing at least 1 non-English-speaking patient and using PMI services (85%) in the last month. Most commonly self-reported interpretation modalities were face-to-face PMI services (39%) and patients' family members or friends (28%). Perceived barriers to using PMI included time constraints (60%) and lack of available face-to-face PMI (51%). Among patient services coordinators, 33% reported consistently asking patients their preferred language and 50% if they needed a PMI for appointments. Most respondents (77% clinicians and 71% coordinators) were satisfied with PMI services. Recommendations included having more available face-to-face PMI, greater coordinated efforts to preschedule PMI, and more education on the effective use of PMI. CONCLUSIONS More than 70% of outpatient neurology clinicians and patient services coordinators were satisfied with PMI. However, their perceived barriers and reported practices suggest a need for updated policies and education to improve the use of PMI services.
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Affiliation(s)
- Jessica H Tran
- Massachusetts General Hospital (JHT, CJK, NIM); and Harvard Medical School (BMLE, NIM), Boston, MA
| | - Betty M Luan Erfe
- Massachusetts General Hospital (JHT, CJK, NIM); and Harvard Medical School (BMLE, NIM), Boston, MA
| | - Christopher J Kirwan
- Massachusetts General Hospital (JHT, CJK, NIM); and Harvard Medical School (BMLE, NIM), Boston, MA
| | - Nicte I Mejia
- Massachusetts General Hospital (JHT, CJK, NIM); and Harvard Medical School (BMLE, NIM), Boston, MA
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25
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Abstract
Health care disparities exist along the continuum of care for children admitted to the hospital; they start before admission, impact hospital course, and continue after discharge. During an acute illness, risk of admission, length of stay, hospital costs, communication during family-centered rounds, and risk of readmission have all been shown to vary by socioeconomic status, race, and ethnicity. Understanding factors beyond the acute illness that increase a child's risk of admission, increase hospital course complications, and lower discharge quality is imperative for the new generation of pediatric hospitalists focused on improving health for a population of children. In this article, we describe a framework to conceptualize socioeconomic, racial, and ethnic health disparities for the hospitalized child. Additionally, we offer actions pediatric hospitalists can take to address disparities within their practices.
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Affiliation(s)
- Shaunte McKay
- Department of Pediatrics, Duke University Hospital, Durhan, North Carolina
| | - Victoria Parente
- Department of Pediatrics, Duke University Hospital, Durhan, North Carolina
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26
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Taira BR, Kim K, Mody N. Hospital and Health System-Level Interventions to Improve Care for Limited English Proficiency Patients: A Systematic Review. Jt Comm J Qual Patient Saf 2019; 45:446-458. [PMID: 30910471 DOI: 10.1016/j.jcjq.2019.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Although federal legislation mandates the provision of qualified interpreters for limited English proficiency (LEP) patients, language services are consistently underutilized by health care providers even when readily available. The objective of this study was to systematically review the literature and summarize evidence for interventions at the hospital or health system level that improve communication with, quality of care for, or health outcomes of LEP patients. METHODS The literature was systematically reviewed according to PRISMA guidelines to answer the following question: "For patients with limited English proficiency, which interventions at the hospital or health system level will result in improved communication, quality of care, or health outcomes?" RESULTS The search yielded an initial 16,686 references, 19 of which met the inclusion criteria. Baseline rates of language service utilization were extremely low and remained at low levels postintervention in multiple studies. Most studies focused on language service utilization, patient communication, metric tracking, and access to care, whereas few studies evaluated quality of care or health outcomes of LEP patients. Multifaceted interventions that include elements of administrative emphasis, process evaluation, and education appear to improve language service use and communication. CONCLUSION This review revealed large gaps in the evidence to guide hospital and health system improvement strategies for LEP patient care. Given the large and persistent performance gaps in the provision of language assistance for LEP patients, hospitals, health systems, and granting agencies should invest in implementation and dissemination research focused on language service use.
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27
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Telephone Interpreting in Home Postpartum Care of Allophone Migrant Women by Midwives / Telefondolmetschen in der geburtshilflichen Nachbetreuung von fremdsprachigen Migrantinnen durch Hebammen zu Hause. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2019. [DOI: 10.2478/ijhp-2019-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Perinatal health disadvantage of migrants is exacerbated in presence of language barriers. Interpreting has the potential to optimize both, communication and outcome of mother and child. In Switzerland, a regional midwifery network provides access to telephone interpreting services although it is not remunerated by health insurances, and thus, is often impeded. This study examined usefulness, areas of use and difficulties of telephone interpreting in home postpartum care by midwives.
Data was collected between September 2013 and March 2016 by midwives of the network. The questionnaire contained multiplechoice questions, a visual analogue scale and free-text fields.
46 questionnaires were evaluated. 10 out of 29 specially trained midwives exerted the service. Telephone interpreting was primarily used to record women’s concerns and provide information. The main topics were the somatic health of mother and child, breastfeeding, and more rarely psychosocial issues and information on care provision. Achieved understanding, increased women’s satisfaction and improved health competence were the perceived advantages in using the service. Difficulties, especially with the extra time needed for the consultation, insufficient telephone connection and professionality of the telephone interpreter, were stated less often. Overall, the midwives estimated the benefits of telephone interpreting for the quality of care with 7.4 out of 10 possible points.
Although telephone interpreting improved the quality of care, midwives did infrequently use it. Specific training and video interpreting have the potential to increase the quality of the interpreted conversations and to minimize possible hurdles. Psychosocial issues should be addressed more intensively.
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Cheston CC, Alarcon LN, Martinez JF, Hadland SE, Moses JM. Evaluating the Feasibility of Incorporating In-Person Interpreters on Family-Centered Rounds: A QI Initiative. Hosp Pediatr 2018; 8:471-478. [PMID: 30018123 DOI: 10.1542/hpeds.2017-0208] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES No best practice has been defined for incorporating in-person interpreters into family-centered rounds (FCRs) for patients with limited English proficiency (LEP). We hypothesized that addressing barriers to scheduling in-person interpreters would make FCR encounters more likely, and thus ensure more equitable care for LEP patients. METHODS A quality improvement initiative was conducted from October 2014 to March 2016 to arrange in-person interpreters for LEP patients during FCRs on the inpatient pediatric service of a large, urban, tertiary care center in Boston. Main interventions included establishing a protocol for scheduling interpreters for rounds and the implementation of a form to track process adherence. Our primary outcome was the percentage of FCR encounters with LEP patients with an interpreter present. Our balancing measures were patient satisfaction, which was assessed using validated surveys administered weekly by nonphysician team members through convenience sampling of families present on the wards, and rounds duration. RESULTS There were 614 encounters with LEP patients during the intervention, 367 of which included in-person interpreters. The percentage of encounters with LEP patients involving interpreters increased from 0% to 63%. Form completion, our primary process measure, reached 87% in the most recent phase. English-proficient and LEP patients reported similar satisfaction with their rounding experience amid a modest increase in rounds duration (preintervention, 105 minutes; postintervention, 130 minutes; P = .056). CONCLUSIONS Using quality improvement as a framework to address key barriers, we successfully implemented a process that increased the participation of in-person interpreters on FCRs on a busy pediatric service.
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Affiliation(s)
- Christine C Cheston
- Departments of Pediatrics and
- Family Medicine, Boston Medical Center, Boston, Massachusetts
| | | | - Julio F Martinez
- School of Medicine, Boston University, Boston, Massachusetts; and
| | - Scott E Hadland
- Departments of Pediatrics and
- Family Medicine, Boston Medical Center, Boston, Massachusetts
| | - James M Moses
- Departments of Pediatrics and
- Family Medicine, Boston Medical Center, Boston, Massachusetts
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29
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Kc A, Bergström A, Chaulagain D, Brunell O, Ewald U, Gurung A, Eriksson L, Litorp H, Wrammert J, Grönqvist E, Edin PA, Le Grange C, Lamichhane B, Shrestha P, Pokharel A, Pun A, Singh C, Målqvist M. Scaling up quality improvement intervention for perinatal care in Nepal (NePeriQIP); study protocol of a cluster randomised trial. BMJ Glob Health 2017; 2:e000497. [PMID: 29071130 PMCID: PMC5640082 DOI: 10.1136/bmjgh-2017-000497] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction Nepal Perinatal Quality Improvement Project (NePeriQIP) intends to scale up a quality improvement (QI) intervention for perinatal care according to WHO/National guidelines in hospitals of Nepal using the existing health system structures. The intervention builds on previous research on the implementation of Helping Babies Breathe-quality improvement cycle in a tertiary healthcare setting in Nepal. The objective of this study is to evaluate the effect of this scaled-up intervention on perinatal health outcomes. Methods/design Cluster-randomised controlled trial using a stepped wedged design with 3 months delay between wedges will be conducted in 12 public hospitals with a total annual delivery rate of 60 000. Each wedge will consist of 3 hospitals. Impact will be evaluated on intrapartum-related mortality (primary outcome), overall neonatal mortality and morbidity and health worker’s performance on neonatal care (secondary outcomes). A process evaluation and a cost-effectiveness analysis will be performed to understand the functionality of the intervention and to further guide health system investments will also be performed. Discussion In contexts where resources are limited, there is a need to find scalable and sustainable implementation strategies for improved care delivery. The proposed study will add to the scarce evidence base on how to scale up interventions within existing health systems. If successful, the NePeriQIP model can provide a replicable solution in similar settings where support and investment from the health system is poor, and national governments have made a global pledge to reduce perinatal mortality. Trial registration number ISRCTN30829654.
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Affiliation(s)
- Ashish Kc
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Health Section, UNICEF, UN House, Lalitpur, Nepal
| | - Anna Bergström
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Institute for Global Health, University College London, London, UK
| | - Dipak Chaulagain
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Lifeline Nepal, Kathmandu, Nepal
| | - Olivia Brunell
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Uwe Ewald
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Leif Eriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Helena Litorp
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Johan Wrammert
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Erik Grönqvist
- Health Economic Forum, Uppsala University, Uppsala, Sweden
| | - Per-Anders Edin
- Department of Economics, Uppsala University, Uppsala, Sweden
| | - Claire Le Grange
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | - Amrit Pokharel
- Department of Health Services, Ministry of Health, Nepal
| | - Asha Pun
- Health Section, UNICEF, UN House, Lalitpur, Nepal
| | | | - Mats Målqvist
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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30
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Kc A, Wrammert J, Nelin V, Clark RB, Ewald U, Peterson S, Målqvist M. Evaluation of Helping Babies Breathe Quality Improvement Cycle (HBB-QIC) on retention of neonatal resuscitation skills six months after training in Nepal. BMC Pediatr 2017; 17:103. [PMID: 28399847 PMCID: PMC5387236 DOI: 10.1186/s12887-017-0853-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 03/31/2017] [Indexed: 12/03/2022] Open
Abstract
Background Each year 700,000 infants die due to intrapartum-related complications. Implementation of Helping Babies Breathe (HBB)-a simplified neonatal resuscitation protocol in low-resource clinical settings has shown to reduce intrapartum stillbirths and first-day neonatal mortality. However, there is a lack of evidence on the effect of different HBB implementation strategies to improve and sustain the clinical competency of health workers on bag-and-mask ventilation. This study was conducted to evaluate the impact of multi-faceted implementation strategy for HBB, as a quality improvement cycle (HBB-QIC), on the retention of neonatal resuscitation skills in a tertiary hospital of Nepal. Methods A time-series design was applied. The multi-faceted intervention for HBB-QIC included training, daily bag-and-mask skill checks, preparation for resuscitation before every birth, self-evaluation and peer review on neonatal resuscitation skills, and weekly review meetings. Knowledge and skills were assessed through questionnaires, skill checklists, and Objective Structured Clinical Examinations (OSCE) before implementation of the HBB-QIC, immediately after HBB training, and again at 6 months. Means were compared using paired t-tests, and associations between skill retention and HBB-QIC components were analyzed using logistic regression analysis. Results One hundred thirty seven health workers were enrolled in the study. Knowledge scores were higher immediately following the HBB training, 16.4 ± 1.4 compared to 12.8 ± 1.6 before (out of 17), and the knowledge was retained 6 months after the training (16.5 ± 1.1). Bag-and-mask skills improved immediately after the training and were retained 6 months after the training. The retention of bag-and-mask skills was associated with daily bag-and-mask skill checks, preparation for resuscitation before every birth, use of a self-evaluation checklist, and attendance at weekly review meetings. The implementation strategies with the highest association to skill retention were daily bag-and-mask skill checks (RR-5.1, 95% CI 1.9–13.5) and use of self-evaluation checklists after every delivery (RR-3.8, 95% CI 1.4–9.7). Conclusions Health workers who practiced bag-and-mask skills, prepared for resuscitation before every birth, used self-evaluation checklists, and attended weekly review meetings were more likely to retain their neonatal resuscitation skills. Further studies are required to evaluate HBB-QIC in primary care settings, where the number of deliveries is gradually increasing. Trial registration ISRCTN97846009. Date of Registration- 15 August 2012.
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Affiliation(s)
- Ashish Kc
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,United Nation's Children's Fund (UNICEF), Nepal Country Officer, UN House, Lalitpur, Nepal.
| | - Johan Wrammert
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Viktoria Nelin
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Uwe Ewald
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Stefan Peterson
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Global Health, Public Health Services, Karolinska Institute, Stockholm, Sweden.,School of Public Health, Makerere University, Kamala, Uganda.,Health Section, Programme Division, United Nations Children Fund (UNICEF), United Nations Plaza, New York, NY, 10017, USA
| | - Mats Målqvist
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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31
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Abstract
PURPOSE OF REVIEW As the cultural and linguistic diversity of the United States grows, a greater number of patients with limited English proficiency will enter the healthcare system. Best practices for the care of these individuals include identification of their language assistance needs and prompt provision of interpreter services. This review will summarize the legal basis for providing language access in the healthcare setting, discuss the impact of interpretation services on clinical care, and explore the effects of language barriers on health outcomes. RECENT FINDINGS There has been greater awareness of language as an important and independent determinant in the racial and ethnic disparities that exist in healthcare. Studies have shown that there is suboptimal identification of patients who require linguistic assistance and, as such, there are missed opportunities to bridge language gaps with many of our patients. The lack of interpretation, or use of informal, untrained interpreters, has significant effects on patient safety, quality of care, and patient satisfaction. SUMMARY Though federal and regulatory guidelines mandate meaningful access to language services, such processes are still a work in progress in many healthcare settings. Further research and quality improvement initiatives are needed to provide clinicians the knowledge and skills needed to effectively communicate with their limited English proficient patients.
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Mayo R, Parker VG, Sherrill WW, Coltman K, Hudson MF, Nichols CM, Yates AM, Pribonic AP. Cutting Corners. HISPANIC HEALTH CARE INTERNATIONAL 2016; 14:73-80. [DOI: 10.1177/1540415316646097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: This study assessed health providers’ perceptions of factors related to professional interpretation services and the association between these factors and the potential use of ad hoc interpreters. Method: Data were collected from a convenience sample of 150 health services providers at a large, regional health system in South Carolina. Results: Providers rated “ability to communicate effectively during a clinical encounter” as paramount regarding the use of interpretation services. The most important factors related to the likely use of ad hoc interpreters (cutting corners) included locating a qualified interpreter, having to wait for a qualified interpreter, and technical difficulties regarding phone and video technology. Conclusion: Health care organizations may benefit from increasing staff awareness about patient safety and legal and regulatory risks involved with the use of ad hoc interpreters.
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