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Curatola N, Prasad P, Bell BK, Fang MC, Rambachan A. Assessing for differences in opioid administration during inpatient end-of-life care for patients with limited English proficiency. J Hosp Med 2024. [PMID: 38544317 DOI: 10.1002/jhm.13325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/09/2024] [Accepted: 02/23/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Patients with limited English proficiency (LEP) may have worse health outcomes and differences in processes of care. Language status may particularly affect situations that depend on communication, such as symptom management or end-of-life (EOL) care. OBJECTIVE The objective of this study was to assess whether opioid prescribing and administration differs by English proficiency (EP) status among hospitalized patients receiving EOL care. METHODS This single-center retrospective study identified all adult patients receiving "comfort care" on the general medicine service from January 2013 to September 2021. We assessed for differences in the quantity of opioids administered (measured by oral morphine equivalents [OME]) by patient LEP status using multivariable linear regression, controlling for other patient and medical factors. RESULTS We identified 2652 patients receiving comfort care at our institution during the time period, of whom 1813 (68%) died during the hospitalization. There were no significant differences by LEP status in terms of mean OME per day (LEP received 30.8 fewer OME compared to EP, p = .91) or in the final 24 h before discharge (LEP received 61.7 more OME compared to EP, p = .80). CONCLUSION LEP was not associated with differences in the amount of opioids received for patients whose EOL management involved standardized order sets for symptom management at our hospital.
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Affiliation(s)
- Nicole Curatola
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Priya Prasad
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Brieze K Bell
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Palliative Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Margaret C Fang
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Aksharananda Rambachan
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
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Atkinson MK, Wazir M, Barkoudah E, Khalil H, Mani S, Harrison JD, Yao-Cohen E, Weiss R, To C, Bambury EA, Cimino J, Mora R, Maru J, Curatola N, Juergens N, Schnipper JL. Inpatient Understanding of Their Care Team and Receipt of Mixed Messages: a Two-Site Cross-Sectional Study. J Gen Intern Med 2023; 38:2703-2709. [PMID: 36973573 PMCID: PMC10042424 DOI: 10.1007/s11606-023-08178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Patient understanding of their care, supported by physician involvement and consistent communication, is key to positive health outcomes. However, patient and care team characteristics can hinder this understanding. OBJECTIVE We aimed to assess inpatients' understanding of their care and their perceived receipt of mixed messages, as well as the associated patient, care team, and hospitalization characteristics. DESIGN We administered a 30-item survey to inpatients between February 2020 and November 2021 and incorporated other hospitalization data from patients' health records. PARTICIPANTS Randomly selected inpatients at two urban academic hospitals in the USA who were (1) admitted to general medicine services and (2) on or past the third day of their hospitalization. MAIN MEASURES Outcome measures include (1) knowledge of main doctor and (2) frequency of mixed messages. Potential predictors included mean notes per day, number of consultants involved in the patient's care, number of unit transfers, number of attending physicians, length of stay, age, sex, insurance type, and primary race. KEY RESULTS A total of 172 patients participated in our survey. Most patients were unaware of their main doctor, an issue related to more daily interactions with care team members. Twenty-three percent of patients reported receiving mixed messages at least sometimes, most often between doctors on the primary team and consulting doctors. However, the likelihood of receiving mixed messages decreased with more daily interactions with care team members. CONCLUSIONS Patients were often unaware of their main doctor, and almost a quarter perceived receiving mixed messages about their care. Future research should examine patients' understanding of different aspects of their care, and the nature of interactions that might improve clarity around who's in charge while simultaneously reducing the receipt of mixed messages.
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Affiliation(s)
- Mariam Krikorian Atkinson
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Mohammed Wazir
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ebrahim Barkoudah
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Hassan Khalil
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sampathkumar Mani
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - James D Harrison
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Erin Yao-Cohen
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Rachel Weiss
- Department of General Internal Medicine, UVA Health, Charlottesville, VA, USA
| | - C To
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elizabeth A Bambury
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jenica Cimino
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Rosa Mora
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Johsias Maru
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Nicole Curatola
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Nathan Juergens
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey L Schnipper
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
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