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Bakillah E, Moneme A, Brown D, Sharpe J, McGarvey ML, Kelz RR. The influence of primary language on postoperative stroke outcomes. Am J Surg 2024; 234:150-155. [PMID: 38688813 DOI: 10.1016/j.amjsurg.2024.04.023] [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: 01/30/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Language barriers have the potential to influence acute stroke outcomes. Thus, we examined postoperative stroke outcomes among non-English primary language speakers. METHODS Utilizing the Healthcare Cost and Utilization Project State Inpatient Database (2016-2019), we conducted a retrospective cohort study of adults diagnosed with a postoperative stroke in Michigan, Maryland, and New Jersey. Patients were classified by primary language spoken: English (EPL) or non-English (n-EPL). The primary outcome was hospital length-of-stay. Secondary outcomes included stroke intervention, feeding tube, tracheostomy, mortality, cost, disposition, and readmission. Propensity-score matching and post-match regression were used to quantify outcomes. RESULTS Among 3078 postoperative stroke patients, 6.2 % were n-EPL. There were no differences in length-of-stay or secondary outcomes, except for higher odds of feeding tube placement (OR 1.95, 95 % CI 1.10-3.47, p = 0.0227) in n-EPL. CONCLUSIONS Postoperative stroke outcomes were comparable by primary language spoken. However, higher odds of feeding tube placement in n-EPL may suggest differences in patient-provider communication.
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Affiliation(s)
- Emna Bakillah
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Adora Moneme
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Danielle Brown
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - James Sharpe
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael L McGarvey
- Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel R Kelz
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Sprague Martinez L, Araujo Brinkerhoff C, Howard RC, Feldman JA, Kobetz E, White JT, Tumiel Berhalter L, Bilheimer A, Hoffman M, Isasi CR, Killough C, Martinez J, Chesley J, Baig AA, Foy C, Islam N, Petruse A, Rosales C, Kipke MD, Baezconde-Garbanati L, Battaglia TA, Lobb R. Strategies to promote language inclusion at 17 CTSA hubs. J Clin Transl Sci 2024; 8:e67. [PMID: 38690228 PMCID: PMC11058578 DOI: 10.1017/cts.2024.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/30/2023] [Accepted: 01/12/2024] [Indexed: 05/02/2024] Open
Abstract
The prioritization of English language in clinical research is a barrier to translational science. We explored promising practices to advance the inclusion of people who speak languages other than English in research conducted within and supported by NIH Clinical Translational Science Award (CTSA) hubs. Key informant interviews were conducted with representatives (n = 24) from CTSA hubs (n = 17). Purposive sampling was used to identify CTSA hubs focused on language inclusion. Hubs electing to participate were interviewed via Zoom. Thematic analysis was performed to analyze interview transcripts. We report on strategies employed by hubs to advance linguistic inclusion and influence institutional change that were identified. Strategies ranged from translations, development of culturally relevant materials and consultations to policies and procedural changes and workforce initiatives. An existing framework was adapted to conceptualize hub strategies. Language justice is paramount to bringing more effective treatments to all people more quickly. Inclusion will require institutional transformation and CTSA hubs are well positioned to catalyze change.
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Affiliation(s)
- Linda Sprague Martinez
- Boston University School of Social Work, Boston, MA, USA
- Boston University Clinical and Translational Science Institute, Boston, MA, USA
| | - Cristina Araujo Brinkerhoff
- Boston University School of Social Work, Boston, MA, USA
- Boston University Clinical and Translational Science Institute, Boston, MA, USA
| | - Riana C. Howard
- Boston University School of Social Work, Boston, MA, USA
- Boston University Clinical and Translational Science Institute, Boston, MA, USA
| | - James A. Feldman
- Boston University Clinical and Translational Science Institute, Boston, MA, USA
- Boston Medical Center Health System, Boston, MA, USA
| | - Erin Kobetz
- University of Miami Clinical and Translational Science Institute, Miami, FL, USA
| | - J. Tommy White
- North Carolina Translational and Clinical Sciences (NC TraCS) Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Laurene Tumiel Berhalter
- Dept of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- University at Buffalo Clinical and Translational Science Institute, Buffalo, NY, USA
| | - Alicia Bilheimer
- North Carolina Translational and Clinical Sciences (NC TraCS) Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Megan Hoffman
- University of Minnesota Clinical and Translational Science Institute, Minneapolis, MN, USA
| | - Carmen R. Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
- The Harold and Muriel Block Institute for Clinical and Translational Research (ICTR), New York, NY, USA
| | - Cynthia Killough
- Clinical and Translational Science Center, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Julia Martinez
- Clinical and Translational Science Center, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Arshiya A. Baig
- Department of Medicine, University of Chicago Center for Institute for Clinical and Translational Science, University of Chicago, Chicago, IL, USA
| | - Capri Foy
- Wake Forrest University School of Medicine Clinical and Translational Science Institute, Winston-Salem, NC, USA
| | - Nadia Islam
- New York Langone University Clinical and Translational Science Institute, New York, NY, USA
| | - Antonia Petruse
- Clinical and Translational Science Institute Office of Clinical Research, University of California Los Angeles, Los Angeles, CA, USA
| | - Carolina Rosales
- University of Florida Clinical and Translational Science Institute, Gainesville, FL, USA
| | - Michele D. Kipke
- Southern California Clinical and Translational Science Institute (SC CTSI), Los Angeles, CA, USA
| | | | - Tracy A. Battaglia
- Boston University Clinical and Translational Science Institute, Boston, MA, USA
- Boston Medical Center Health System, Boston, MA, USA
| | - Rebecca Lobb
- Boston University Clinical and Translational Science Institute, Boston, MA, USA
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Bakdash L, Abid A, Gourisankar A, Henry TL. Chatting Beyond ChatGPT: Advancing Equity Through AI-Driven Language Interpretation. J Gen Intern Med 2024; 39:492-495. [PMID: 37904073 PMCID: PMC10897100 DOI: 10.1007/s11606-023-08497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/16/2023] [Indexed: 11/01/2023]
Abstract
Medical interpretation is an underutilized resource, despite its legal mandate and proven efficacy in improving health outcomes for populations with low English proficiency. This disconnect can often be attributed to the costs and wait-times associated with traditional means of interpretation, making the service inaccessible and burdensome. Technology has improved access to translation through phone and video interpretation; with the acceleration of artificial intelligence (AI) large language models, we have an opportunity to further improve interpreter access through real-time, automated translation. The impetus to utilize this burgeoning tool for improved health equity must be combined with a critical view of the safety, privacy, and clinical decision-making risks involved. Physicians must be active participants and collaborators in both the mobilization of AI tools to improve clinical care and the development of regulations to mitigate harm.
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Affiliation(s)
- Leen Bakdash
- Emory University School of Medicine, Atlanta, GA, 30322, USA.
| | - Areeba Abid
- Emory University School of Medicine, Atlanta, GA, 30322, USA
| | | | - Tracey L Henry
- Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Squires A, Gerchow L, Ma C, Liang E, Trachtenberg M, Miner S. A multi-language qualitative study of limited English proficiency patient experiences in the United States. PEC INNOVATION 2023; 2:100177. [PMID: 37384163 PMCID: PMC10294089 DOI: 10.1016/j.pecinn.2023.100177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/30/2023]
Abstract
Objective The purpose of this study was to understand the limited English proficiency patient experience with health care services in an urban setting in the United States. Methods Through a narrative analysis approach, 71 individuals who spoke either Spanish, Russian, Cantonese, Mandarin, or Korean shared their experiences through semi-structured interviews between 2016 and 2018. Analyses used monolingual and multilingual open coding approaches to generate themes. Results Six themes illustrated patient experiences and identified sources of structural inequities perpetuating language barriers at the point of care. An important thread throughout all interviews was the sense that the language barrier with clinicians posed a threat to their safety when receiving healthcare, citing an acute awareness of additional risk for harm they might experience. Participants also consistently identified factors they felt would improve their sense of security that were specific to clinician interactions. Differences in experiences were specific to culture and heritage. Conclusions The findings highlight the ongoing challenges spoken language barriers pose across multiple points of care in the United States' health care system. Innovation The multi-language nature of this study and its methodological insights are innovative as most studies have focused on clinicians or patient experiences in a single language.
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Affiliation(s)
- Allison Squires
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States of America
| | - Lauren Gerchow
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States of America
| | - Chenjuan Ma
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States of America
| | - Eva Liang
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States of America
| | - Melissa Trachtenberg
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY, United States of America
| | - Sarah Miner
- Wegman's School of Nursing, St. John Fischer College, Rochester, NY, United States of America
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Bower SM, Campbell RL, Mullan AF, Heaton HA, Lim TG, Bellamkonda VR, Lichen IM, Jones DD. Association of limited English proficiency with emergency department irregular departures and return visits: A cross-sectional cohort study in the Upper Midwest between January 2018 and December 2021. Acad Emerg Med 2023; 30:1002-1012. [PMID: 37282847 PMCID: PMC10592595 DOI: 10.1111/acem.14757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/06/2023] [Accepted: 05/23/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Patients with limited English proficiency (LEP) have been shown to experience disparities in emergency department (ED) care. The objectives of this study were to examine the associations between LEP and irregular ED departures and return ED visits. METHODS We conducted a multicenter cross-sectional analysis of 18 EDs within an integrated health system in the upper Midwest from January 1, 2018, to December 31, 2021. ED visits of pediatric and adult patients who were discharged on the index visit were included for analysis. We analyzed the association of LEP with irregular departures, 72-h and 7-day return visits, and ED disposition at the time of that return visit. Multivariable model associations were calculated using generalized estimating equations and reported as odds ratios (OR) with 95% confidence intervals (CIs). RESULTS A total of 745,464 total ED visits were analyzed, including 27,906 (3.7%) visits among patients with LEP. The most common preferred languages among patients with LEP were Spanish (12,759; 45.7%), Somali (4978; 17.8%), and Arabic (3185; 11.4%). After multivariable adjustment there were no differences in proportions of irregular departures (OR 1.09, 95% CI 0.99-1.21), 72-h returns (OR 0.99, 95% CI 0.92-1.06), or 7-day returns (OR 0.99, 95% CI 0.93-1.05) between patients with LEP or English proficiency. Patients with LEP returning within 72 h (OR 1.19, 95% CI 1.01-1.40) and 7 days (OR 1.15, 95% CI 1.01-1.33) were more likely to be admitted to the hospital. CONCLUSIONS After multivariable adjustment, we did not find an increased frequency of irregular ED departures or 72-h or 7-day returns among patients with LEP compared with people proficient in English. However, we did find that higher proportions of patients with LEP were admitted to the hospital at the time of the return ED visit.
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Affiliation(s)
- Sarah M Bower
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ronna L Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aidan F Mullan
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Heather A Heaton
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas G Lim
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Isabella M Lichen
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Derick D Jones
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Choy J, Pourkazemi F, Anderson C, Bogaardt H. Dosages of Swallowing Exercises Prescribed in Stroke Rehabilitation: A Medical Record Audit. Dysphagia 2023; 38:686-699. [PMID: 35951119 PMCID: PMC10006267 DOI: 10.1007/s00455-022-10500-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 07/13/2022] [Indexed: 01/19/2023]
Abstract
This study investigated how swallowing exercise dosage is recorded, and what swallowing exercise dosages are reported in a stroke rehabilitation setting. We additionally explored the relation between mean daily swallowing repetitions and likelihood of improvement in functional swallowing status and considered how swallowing exercise dosages in practice compared to evidence-based principles of neural plasticity and strength training. We audited medical records for 42 patients with post-stroke dysphagia admitted to an inpatient rehabilitation unit over 18 months. Data were collected on participant characteristics, swallowing exercises and dosages, and clinical outcomes. The relation between dosage and outcomes was investigated using logistic regression analysis. On average, patients were seen for a median of 2.4 swallowing intervention sessions per week (IQR: 1.7) over 21 days (IQR: 16) and received a median 44.5 swallowing exercise repetitions per session (IQR: 39.6). Results indicated variable reporting of swallowing exercise dosages. Frequency, intervention duration, exercise type, and number of repetitions were routinely recorded in medical records, while intensity, session length, content, and adherence to home exercise programs were not. Frequency of swallowing intervention was lower in practice compared to research studies, and swallowing exercises did not follow specificity or progressive resistance principles. Likelihood of improvement in swallowing status was partially explained by age (B = -.015, p = .007) but not by mean daily swallowing exercise repetitions. This study illustrates dosages of swallowing exercises used in clinical practice. Results highlight the need for improved consideration and reporting of dosage, and application of evidence-based principles to swallowing exercise dosages.
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Affiliation(s)
- Jacinda Choy
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia.
- HammondCare Braeside Hospital, 340 Prairie Vale Road, Prairiewood, NSW, 2176, Australia.
| | - Fereshteh Pourkazemi
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Caitlin Anderson
- HammondCare Braeside Hospital, 340 Prairie Vale Road, Prairiewood, NSW, 2176, Australia
| | - Hans Bogaardt
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, 5005, Australia
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Smith M, Tibbetts C, Agrawal P, Cordone A, Leff R, Smith RN, Moran TP, Brackett A, Zeidan A. Representation of patients with non-English language preferences in motor vehicle collision trauma and emergency medicine research. Inj Prev 2023; 29:253-258. [PMID: 36854627 DOI: 10.1136/ip-2022-044813] [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: 11/14/2022] [Accepted: 02/16/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Individuals with non-English language preferences (NELP) represent a growing proportion of the USA population. Prior studies demonstrate disparate health outcomes related to NELP status; however, this patient population is often excluded from medical research. There is a paucity of literature describing the impact of NELP status on trauma, specifically injury and outcomes related to vehicle occupants injured during motor vehicle collisions (MVCs). The goal of this study was to evaluate the representation of patients with NELP in both emergency medicine and trauma literature. METHODS We conducted a systematic search of US-based publications from 2010 to 2021. Titles, abstracts and full texts of eligible articles were evaluated. Data were extracted using an a priori determined standardised reporting tool to evaluate language as study inclusion/exclusion criteria, manuscript reporting of language, assessment of language as a primary variable and consideration of language in study methodology. RESULTS A total of 82 studies met inclusion criteria. Twenty-three studies (28%) excluded NELP populations and only one study explicitly included the NELP population. None of the studies evaluated language as a primary outcome of the study or included language as a variable in the analysis. Over half of the studies (53.6%) used a public data set or registry. CONCLUSION NELP populations are routinely excluded from and are difficult to identify in MVC trauma research. Without appropriate inclusion and identification, it will be difficult to understand the prevalence and outcomes of traumatic injury in NELP patients and to develop culturally and linguistically appropriate interventions.
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Affiliation(s)
- Margaret Smith
- Department of Internal Medicine, University of California, La Jolla, California, USA
| | | | - Pooja Agrawal
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alexis Cordone
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rebecca Leff
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rand N Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Timothy P Moran
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alexandria Brackett
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Amy Zeidan
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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