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Pilarz MS, Bleed E, Rodriguez VA, Daniels LA, Jackson KL, Sanchez-Pinto LN, Foster CC. Medical Complexity, Language Use, and Outcomes in the Pediatric ICU. Pediatrics 2024; 153:e2023063359. [PMID: 38747049 PMCID: PMC11153320 DOI: 10.1542/peds.2023-063359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/27/2024] [Accepted: 03/05/2024] [Indexed: 06/02/2024] Open
Abstract
OBJECTIVES To determine whether use of a language other than English (LOE) would be associated with medical complexity, and whether medical complexity and LOE together would be associated with worse clinical outcomes. METHODS The primary outcome of this single-site retrospective cohort study of PICU encounters from September 1, 2017, through August 31, 2022 was an association between LOE and medical complexity. Univariable and multivariable analyses were performed between demographic factors and medical complexity, both for unique patients and for all encounters. We investigated outcomes of initial illness severity (using Pediatric Logistic Organ Dysfunction-2), length of stay (LOS), days without mechanical ventilation or organ dysfunction using a mixed effects regression model, controlling for age, sex, race and ethnicity, and insurance status. RESULTS There were 6802 patients and 10 011 encounters. In multivariable analysis for all encounters, Spanish use (adjusted odds ratio [aOR], 1.29; 95% confidence interval [CI], 1.11-1.49) and language other than English or Spanish (LOES) (aOR, 1.36; 95% CI, 1.02-1.80) were associated with medical complexity. Among unique patients, there remained an association between use of Spanish and medical complexity in multivariable analysis (aOR, 1.26; 95% CI, 1.05-1.52) but not between LOES and medical complexity (aOR, 1.30; 95% CI, 0.92-1.83). Children with medical complexity (CMC) who used an LOES had fewer organ dysfunction-free days (P = .003), PICU LOS was 1.53 times longer (P = .01), and hospital LOS was 1.45 times longer (P = .01) compared with CMC who used English. CONCLUSIONS Use of an LOE was independently associated with medical complexity. CMC who used an LOES had a longer LOS.
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Affiliation(s)
| | | | - Victoria A. Rodriguez
- Division of Hospital Based Medicine
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - L. Nelson Sanchez-Pinto
- Division of Critical Care
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Carolyn C. Foster
- Division of Advanced General Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Smith C, Boylen S, Mutch R, Cherian S. Hear Our Voice: Pediatric Communication Barriers From the Perspectives of Refugee Mothers With Limited English Proficiency. J Pediatr Health Care 2024; 38:114-126. [PMID: 38429024 DOI: 10.1016/j.pedhc.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/27/2023] [Accepted: 12/03/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND Adverse health outcomes are more common for health consumers with limited English proficiency (LEP). This study examines the consumer experience of refugee mothers with LEP when communicating with paediatric health services. METHOD A community-based participatory qualitative study engaging participants from refugee-like backgrounds. Focus groups and in-depth individual interviews (using professional interpreters) were conducted in community settings and analysed using Grounded Theory principles. RESULTS Fifty ethnolinguistically diverse participants reported universal communication barriers; (i) "Negative health care experiences" (fear, helplessness, lack of safety, trust and dignity), (ii) "Ineffective health service communication and adverse outcomes", (iii) "Logistical access barriers" and (iv) self-sourced solutions". The "importance of professional interpreter utilisation" and subsequent "sense of empowerment" was unanimous. CONCLUSIONS This study highlights gaps in current health interactions which negatively impact care, inclusion, and culturally safe engagement. Recommendations include orgainzational reform enhancing language services, increased cultural competency, long term support, and research with LEP populations.
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Affiliation(s)
- Cassie Smith
- Cassie Smith, Paediatric Advanced Trainee (General Paediatrics and Gastroenterology) Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Western Australia, Australia.
| | - Susan Boylen
- Susan Boylen, Senior Lecturer & 1(st) Year Academic Advisor, School of Nursing and Midwifery, University of Notre Dame Australia, Perth, Western Australia, Australia
| | - Raewyn Mutch
- Raewyn Mutch, General Paediatrician (Refugee Health Service and General Paediatrics), Department of General Paediatrics, Perth Children's Hospital, Child and Adolescent Health Service, and Clinical Associate Professor Division of Paedaitrics, University of Western Australia, Perth, Western Australia, Australia
| | - Sarah Cherian
- Sarah Cherian, Clinical Associate Professor, Division of Paediatrics, University of Western Australia, and General Paediatrician and Clinical Lead Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital, Child and Adolescent Health Service, and Honorary Research Associate, Wesfarmers Centre for Vaccines and Immunity, Telethon Kids Institute, Perth, Western Australia, Australia
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Segal KR, Gomez JA, Schulz JF, Alvandi LM, Fornari ED. The Impact of Standardized Recovery Pathways on Language Barriers and Inpatient Pain Management. Hosp Pediatr 2023; 13:1001-1009. [PMID: 37850258 DOI: 10.1542/hpeds.2023-007232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Inpatient postoperative care is reliant upon clear, open communication between providers and patient-families, and thus is particularly vulnerable to disparities when discordant languages exist. It is not yet understood how standardized postoperative protocols may mitigate disparities related to language discordance. METHODS This is a retrospective cohort study among adolescent idiopathic scoliosis patients who underwent posterior spinal fusion at a tertiary care children's hospital in Bronx, New York after implementation of a postoperative pathway in 2017. Outcomes reliant upon communication between patient-families and providers were measured, including measures of pain management (number and type of pain medications requested, daily pain assessments, total opioids consumed), as well as outpatient pain scores. RESULTS A total of 160 patients were included (39 language other than English [LOE]). Between patient cohorts, there were no significant differences in demographic or operative characteristics. On univariate analyses, LOE patients were more likely to be given a basal dosing of patient-controlled analgesia or additional boluses (26% vs 12%, P = .03), consumed 0.53 fewer benzodiazepine medications per day (P = .01), and were more likely to have pain at outpatient follow-up (67% vs 43%, P = .03). On multivariate analyses, LOE patients were more likely to be placed on basally dosed or receive additional boluses of patient-controlled analgesia (odds ratio 3.19, 95% confidence interval 1.15-8.85). CONCLUSIONS As standardized pathways become more common in health care, it is critical to monitor for components of these protocols that may be vulnerable to language-related disparities, such as therapies reliant on symptom description and outpatient follow-up.
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Bourgeois FC, Hart NJ, Dong Z, Ngo LH, DesRoches CM, Thomas EJ, Bell SK. Partnering with Patients and Families to Improve Diagnostic Safety through the OurDX Tool: Effects of Race, Ethnicity, and Language Preference. Appl Clin Inform 2023; 14:903-912. [PMID: 37967936 PMCID: PMC10651368 DOI: 10.1055/s-0043-1776055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/24/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Patients and families at risk for health disparities may also be at higher risk for diagnostic errors but less likely to report them. OBJECTIVES This study aimed to explore differences in race, ethnicity, and language preference associated with patient and family contributions and concerns using an electronic previsit tool designed to engage patients and families in the diagnostic process (DxP). METHODS Cross-sectional study of 5,731 patients and families presenting to three subspecialty clinics at an urban pediatric hospital May to December 2021 who completed a previsit tool, codeveloped and tested with patients and families. Prior to each visit, patients/families were invited to share visit priorities, recent histories, and potential diagnostic concerns. We used logistic regression to determine factors associated with patient-reported diagnostic concerns. We conducted chart review on a random subset of visits to review concerns and determine whether patient/family contributions were included in the visit note. RESULTS Participants provided a similar mean number of contributions regardless of patient race, ethnicity, or language preference. Compared with patients self-identifying as White, those self-identifying as Black (odds ratio [OR]: 1.70; 95% confidence interval [CI]: [1.18, 2.43]) or "other" race (OR: 1.48; 95% CI: [1.08, 2.03]) were more likely to report a diagnostic concern. Participants who preferred a language other than English were more likely to report a diagnostic concern than English-preferring patients (OR: 2.53; 95% CI: [1.78, 3.59]. There were no significant differences in physician-verified diagnostic concerns or in integration of patient contributions into the note based on race, ethnicity, or language preference. CONCLUSION Participants self-identifying as Black or "other" race, or those who prefer a language other than English were 1.5 to 2.5 times more likely than their counterparts to report potential diagnostic concerns when proactively asked to provide this information prior to a visit. Actively engaging patients and families in the DxP may uncover opportunities to reduce the risk of diagnostic errors and potential safety disparities.
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Affiliation(s)
- Fabienne C. Bourgeois
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Nicholas J. Hart
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Zhiyong Dong
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Long H. Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Catherine M. DesRoches
- Harvard Medical School, Boston, Massachusetts, United States
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Eric J. Thomas
- Department of Medicine, University of Texas at Houston Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas, United States
- McGovern Medical School at the University of Texas Health Science Center Houston, Houston, Texas, United States
| | - Sigall K. Bell
- Harvard Medical School, Boston, Massachusetts, United States
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
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Brumbaugh JE, Tschida‐Reuter DJ, Barwise AK. Meeting the needs of the patient with non-English language preference in the hospital setting. Health Serv Res 2023; 58:965-969. [PMID: 37580055 PMCID: PMC10480083 DOI: 10.1111/1475-6773.14217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Affiliation(s)
- Jane E. Brumbaugh
- Department of Pediatric and Adolescent MedicineMayo ClinicRochesterMinnesotaUSA
| | | | - Amelia K. Barwise
- Program in Biomedical Ethics Research and Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterMinnesotaUSA
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Batton E, Hurst S, Ramos C, Catalan L, Freeman M, Marc-Aurele K. Communication in the neonatal ICU for Spanish speaking parents: a qualitative interview study. BMC Pediatr 2023; 23:481. [PMID: 37736718 PMCID: PMC10514963 DOI: 10.1186/s12887-023-04301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND In the neonatal intensive care unit (NICU), health outcome disparities exist between patients with limited English proficiency (LEP) and those proficient in English. Our objective was to investigate the communication experience of parents with LEP in the NICU to learn how to mitigate such health disparities. METHODS A certified bilingual provider conducted seventeen interviews of parents who identified Spanish as their preferred language and whose newborn was admitted to the NICU for ≥ 1 week. Interviews were conducted August 2020 - December 2021. Conventional content analysis utilizing an inductive open coding process was performed. RESULTS The experiences of Spanish speaking parents with LEP in the NICU can be characterized by 3 main themes: 1) Information accessibility 2) Perspectives about interpreters and 3) Emotional consequences. CONCLUSIONS Our findings can inform neonatal quality initiatives to facilitate timely and good communication for NICU families with LEP.
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Affiliation(s)
- Emily Batton
- Division of Neonatology, Department of Pediatrics, Loma Linda University, 11175 Campus St Coleman Pavilion Rm 11121, Loma Linda, CA, 92354, USA.
| | - Samantha Hurst
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, USA
| | - Carlos Ramos
- Division of Neonatology, Department of Pediatrics, University of California, San Diego, USA
| | - Leslie Catalan
- Division of Neonatology, Department of Pediatrics, University of California, San Diego, USA
| | - Michele Freeman
- Division of Neonatology, Department of Pediatrics, University of California, San Diego, USA
| | - Krishelle Marc-Aurele
- Division of Neonatology, Department of Pediatrics, University of California, San Diego, USA
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Parente V, White MJ. Equity Is Multilingual: A Call for Language Justice in Pediatric Hospital Medicine. Hosp Pediatr 2023; 13:e51-e53. [PMID: 36740979 PMCID: PMC9986851 DOI: 10.1542/hpeds.2022-007077] [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: 02/07/2023]
Affiliation(s)
- Victoria Parente
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Michelle J. White
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
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Gutierrez-Wu JC, Fuchs J, Flower KB. Recentering Family-Centered Rounds to Address Racial and Ethnic Disparities. Pediatrics 2022; 150:189917. [PMID: 36345696 DOI: 10.1542/peds.2022-058962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jennifer C Gutierrez-Wu
- Divisions of General Pediatrics and Adolescent Medicine.,Department of Pediatrics, School of Medicine.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer Fuchs
- Hospital Pediatrics.,Department of Pediatrics, School of Medicine
| | - Kori B Flower
- Divisions of General Pediatrics and Adolescent Medicine.,Department of Pediatrics, School of Medicine
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Kane J, Thomson J, Khan A. Communicating in Real-Time: Simultaneous In-Person Interpretation on Family-Centered Rounds. Hosp Pediatr 2022; 12:e437-e439. [PMID: 36373279 DOI: 10.1542/hpeds.2022-006973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joelle Kane
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joanna Thomson
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alisa Khan
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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