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Martinez A, Warner A, Powe NR, Fernandez A, Tuot DS. Association between English Proficiency and Kidney Disease Knowledge and Communication Quality among Patients with ESKD. KIDNEY360 2024; 5:560-568. [PMID: 38356152 PMCID: PMC11093550 DOI: 10.34067/kid.0000000000000398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
Key Points In one hospital-based safety-net dialysis unit, only one half of patients with ESKD knew their cause of kidney failure, which did not differ by English proficiency status. Patients with limited English proficiency (versus English-proficient patients) reported poorer communication with the dialysis care team (less listening, fewer clear explanations, less time spent). We highlight the need for tailored, patient-centered communication between limited English-proficient patients and dialysis care team members. Background ESKD is a chronic health condition for which communication between health care teams and patients is important to guide patient self-management activities. Yet, little is known about the quality of communication among patients with ESKD and their care team members. We examined the influence of patient's limited English proficiency (LEP) status on communication experiences at one dialysis center. Methods A survey was administered to adults receiving ESKD care at a dialysis unit within a public health care delivery system between July 2022 and February 2023, to ascertain kidney disease knowledge and perceptions of communication quality with the dialysis care team. Multivariable logistic and ordinal logistic regression models adjusted for age and sex were used to determine associations between LEP status and CKD knowledge. Results Among 93 eligible patients, 88.2% (n =82) completed the survey. Approximately 37.8% (n =31) had LEP, mean age was 58.8 years, 68.3% were men, mean dialysis vintage was 3.9 years, and 25% had a positive depression screen (LEP 30%; English-proficient 22%). A higher proportion of English-proficient patients screened positive for limited health literacy compared to those with LEP (74.5% versus 38.7%, P = 0.002). Overall, knowledge of assigned cause of ESKD (53.4%) and CKD/transplant knowledge (57.3%) was suboptimal. After adjustment, LEP status was not significantly associated with knowing the correct cause of kidney failure (odds ratio, 0.49; 95% confidence interval, 0.19 to 1.27) but was significantly associated with having a higher score on a CKD/transplant knowledge scale (odds ratio, 3.99; 95% confidence interval, 1.66 to 9.58). Patients with LEP reported poorer communication quality with dialysis providers and staff (less listening, fewer clear explanations, less time spent with patients) compared with English-proficient patients, although differences were not statistically significant. Conclusions Overall communication between patients with ESKD and members of the dialysis care team was suboptimal, regardless of English proficiency. Interventions to enhance communication for ESKD patients are needed.
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Affiliation(s)
- Ashley Martinez
- Division of Nephrology, Stanford University School of Medicine, Stanford, California
| | - Austin Warner
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Neil R. Powe
- Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- Center for Vulnerable Populations, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
| | - Alicia Fernandez
- Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- Center for Vulnerable Populations, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
| | - Delphine S. Tuot
- Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- Center for Vulnerable Populations, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
- Division of Nephrology, University of California, San Francisco, San Francisco, California
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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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Lopez Vera A, Thomas K, Trinh C, Nausheen F. A Case Study of the Impact of Language Concordance on Patient Care, Satisfaction, and Comfort with Sharing Sensitive Information During Medical Care. J Immigr Minor Health 2023; 25:1261-1269. [PMID: 36840903 PMCID: PMC9959935 DOI: 10.1007/s10903-023-01463-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 02/26/2023]
Abstract
Linguistic barriers continue to be a source of difficulty and inappropriate treatment in our healthcare system. Several studies have shown the importance of language concordance, which leads to increased trust and higher patient satisfaction. The aim of this is study is to determine patients' satisfaction and comfort levels with sharing sensitive information in Spanish with either the health care provider or an interpreter, respectively, and to compare the results to find out if there is an option that patients prefer. There were two different groups of participants in the study. The experimental group was directly seen by Spanish-speaking student doctors while the control group was seen by English-speaking student doctors that had the aid of an interpreter. Several questions were asked to participants via survey in order to measure their comfort levels during the encounter. The results of this study demonstrate that having Spanish-speaking healthcare providers providing health care to Hispanic patients can raise patients' comfort levels and satisfaction in contrast to having the aid of an interpreter. Providing second language training to student doctors can potentially improve patient care and reduce health inequities facing LEP patients. Given the small sample size of our study, future projects should expand the study to include more participants.
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Affiliation(s)
- Alexandra Lopez Vera
- Department of Medical Education, California University of Science and Medicine, Colton, CA, USA.
| | - Kyle Thomas
- Department of Medical Education, California University of Science and Medicine, Colton, CA, USA
| | - Christina Trinh
- Department of Medical Education, California University of Science and Medicine, Colton, CA, USA
| | - Fauzia Nausheen
- Department of Medical Education, California University of Science and Medicine, Colton, CA, USA
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Wang F, Rothchild E, Lu YH, Ricci JA. Language Disparity Predicts Poor Patient-Reported Outcome and Follow-Up in Microsurgical Breast Reconstruction. J Reconstr Microsurg 2023; 39:681-694. [PMID: 36809784 DOI: 10.1055/a-2040-1750] [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: 02/24/2023]
Abstract
BACKGROUND Patients with limited English proficiency (LEP) have starkly different health care experiences compared with their English-proficient counterparts. The authors aim to examine the link between LEP and postoperative outcomes in patients undergoing microsurgical breast reconstruction. METHODS A retrospective review of all patients who underwent abdominal-based microsurgical breast reconstruction at our institution between 2009 and 2019 was performed. Variables collected included patient demographics, language status, interpreter usage, perioperative complications, follow-up visits, and self-reported outcomes (Breast-Q). Pearson's χ 2 test, Student's t-test, odds ratio analysis, and regression modeling were used for analysis. RESULTS A total of 405 patients were included. LEP patients comprised 22.22% of the overall cohort with 80% of LEP patients utilizing interpreter services. LEP patients reported significantly lower satisfaction with an abdominal appearance at the 6-month follow-up and lower physical and sexual well-being scores at the 1-year follow-up (p = 0.05, 0.02, 0.01, respectively). Non-LEP patients had significantly longer operative times (539.6 vs. 499.3 minutes, p = 0.024), were more likely to have postoperative donor site revisions (p = 0.05), and more likely to receive preoperative neuraxial anesthesia (p = 0.01). After adjusting for confounders, LEP stats was associated with 0.93 fewer follow-up visits (p = 0.02). Interestingly, compared with LEP patients who did not receive interpreter services, LEP patients who did had 1.98 more follow-up visits (p = 0.02). There were no significant differences in emergency room visits or complications between the cohorts. CONCLUSION Our findings suggest that language disparities exist within microsurgical breast reconstruction and underscore the importance of effective, language-conscious communication between surgeon and patient.
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Affiliation(s)
- Fei Wang
- The Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Evan Rothchild
- The Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Yi-Hsueh Lu
- The Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Joseph A Ricci
- The Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Lorenzo E, O’Neal AL, Garcia LC, Mendoza K, Lee RE. Electronic Health Interventions for Type 2 Diabetes and Obesity in Hispanic or Latino Adults: A Systematic Review of English and Spanish Studies. Diabetes Spectr 2023; 37:65-85. [PMID: 38385094 PMCID: PMC10877215 DOI: 10.2337/ds22-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Objective The objective of this study was to synthesize English and Spanish literature to determine whether electronic health interventions (EHIs) such as telehealth, telemedicine, digital health, and mobile health (mHealth) improve A1C, blood glucose, BMI, and/or weight among Hispanic/Latino adults with type 2 diabetes or overweight/obesity in the Americas. Design and methods Searches were conducted in June 2021 using the Scientific Electronic Library Online, Cumulative Index of Nursing and Allied Health Literature, PubMed, and PsycInfo literature databases. Studies were identified that investigated the effect of an EHI on A1C, blood glucose, BMI, or weight in populations that were ≥12% Hispanic/Latino adults with type 2 diabetes or overweight/obesity, were conducted in the Americas, and were published in English or Spanish. Study quality was determined using the Quality Index Score. Data were extracted and synthesized, and themes were identified. Results Twenty-five studies met inclusion criteria, including 23 in English (from the United States) and two in Spanish (from Chile). A total of 22 investigated type 2 diabetes, and three investigated overweight/obesity. The studies encompassed 6,230 participants, including 3,413 Hispanic/Latino adults. Sixty-three percent of studies demonstrated significant improvements in A1C or blood glucose and 67% in weight. Thirteen studies offered an EHI in both English and Spanish, and six offered the intervention in either English or Spanish alone. All EHIs involving mHealth exclusively and most (90%) involving more than one electronic modality demonstrated a higher number of significant findings compared with those having only one EHI modality, especially telehealth (44.4%). EHIs lasting ≤12 months had more significant findings (72.7%) than those lasting >12 months (50%). Six studies had industry-related funding, with 83.3% of those demonstrating significant improvements in outcomes. Conclusion EHIs improved A1C and weight in adults (n = 4,355), including 45.5% Hispanic/Latino adults. mHealth and EHIs using more than one electronic modality and those lasting ≤12 months were especially effective. However, overall study quality was modest. Future research should be conducted in Spanish-speaking countries in Latin America and should compare the effectiveness of different EHI modalities.
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Affiliation(s)
- Elizabeth Lorenzo
- School of Nursing at the University of Texas Medical Branch, Galveston, TX
| | - Alicia Lynn O’Neal
- University of Kansas Medical Center, Kansas City, KS
- Digital Medicine Society, Boston, MA
| | - Lisbeth Cantu Garcia
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Kenny Mendoza
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, México
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA
| | - Rebecca E. Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
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Lee W, Khoong EC, Zeng B, Rios-Fetchko F, Ma Y, Liu K, Fernandez A. Evaluation of Commercially Available Machine Interpretation Applications for Simple Clinical Communication. J Gen Intern Med 2023; 38:2333-2339. [PMID: 36781579 PMCID: PMC10406784 DOI: 10.1007/s11606-023-08079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/30/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Accessing professional medical interpreters for brief, low risk exchanges can be challenging. Machine translation (MT) for verbal communication has the potential to be a useful clinical tool, but few evaluations exist. OBJECTIVE We evaluated the quality of three MT applications for English-Spanish and English-Mandarin two-way interpretation of low complexity brief clinical communication compared with human interpretation. DESIGN Audio-taped phrases were interpreted via human and 3 MT applications. Bilingual assessors evaluated the quality of MT interpretation on four assessment categories (accuracy, fluency, meaning, and clinical risk) using 5-point Likert scales. We used a non-inferiority design with 15% inferiority margin to evaluate the quality of three MT applications with professional medical interpreters serving as gold standards. MAIN MEASURES Proportion of interpretation exchanges deemed acceptable, defined as a composite score of 16 or greater out of 20 based on the four assessment categories. KEY RESULTS For English to Spanish, the proportion of MT-interpreted phrases scored as acceptable ranged from 0.68 to 0.84, while for English to Mandarin, the range was from 0.62 to 0.76. Both Spanish/Mandarin to English MT interpretation had low acceptable scores (range 0.36 to 0.41). No MT interpretation met the non-inferiority threshold. CONCLUSION While MT interpretation was better for English to Spanish or Mandarin than the reverse, the overall quality of MT interpretation was poor for two-way clinical communication. Clinicians should advocate for easier access to professional interpretation in all clinical spaces and defer use of MT until these applications improve.
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Affiliation(s)
- Won Lee
- University of California San Francisco, 513 Parnassus Ave, Room S-436, San Francisco, CA, 94143, USA.
| | - Elaine C Khoong
- University of California San Francisco, 513 Parnassus Ave, Room S-436, San Francisco, CA, 94143, USA
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Billy Zeng
- University of California San Francisco, 513 Parnassus Ave, Room S-436, San Francisco, CA, 94143, USA
| | - Francine Rios-Fetchko
- University of California San Francisco, 513 Parnassus Ave, Room S-436, San Francisco, CA, 94143, USA
| | - YingYing Ma
- University of California San Francisco, 513 Parnassus Ave, Room S-436, San Francisco, CA, 94143, USA
| | - Kirsten Liu
- University of California San Francisco, 513 Parnassus Ave, Room S-436, San Francisco, CA, 94143, USA
- University of California Berkley, Berkely, CA, USA
| | - Alicia Fernandez
- University of California San Francisco, 513 Parnassus Ave, Room S-436, San Francisco, CA, 94143, USA
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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Rosen CB, Roberts SE, Sharpe J, Gershuni V, Altieri MS, Kelz RR. A study analyzing outcomes after bariatric surgery by primary language. Surg Endosc 2023:10.1007/s00464-023-10127-5. [PMID: 37266743 DOI: 10.1007/s00464-023-10127-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/08/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Communication is key to success in bariatric surgery. This study aims to understand how outcomes after bariatric surgery differ between patients with a non-English primary language and those with English as their primary language. METHODS This retrospective, observational cohort study of bariatric surgery patients age ≥ 18 years utilized the Michigan, Maryland, and New Jersey State Inpatient Databases and State Ambulatory Surgery and Services Databases, 2016 to 2018. Patients were classified by primary spoken language: English and non-English. Primary outcome was complications. Secondary outcomes included length of stay (LOS) and cost, with cost calculated using cost-to-charge ratios provided by Healthcare Cost and Utilization Project and reported in 2019 United States dollars. Multivariable regression models (logistic, Poisson, and quantile) were used to examine associations between primary language and outcomes. Given the uneven distribution of race by primary language, interaction terms were used to examine conditional effects of race. RESULTS Among 69,749 bariatric surgery patients, 2811 (4.2%) spoke a non-English primary language. Covariates, notably race distribution, and unadjusted outcomes differed significantly by primary language. However, after adjustment, non-English primary language was not associated with significantly increased odds of complications (odds ratio 1.24, p = 0.389), significantly different LOS (- 0.02 days, p = 0.677), nor significantly different mean healthcare costs (- $265, p = 0.309). There were no significant conditional effects of race seen among outcomes. CONCLUSIONS Though non-English primary language was associated with a significantly different distribution of observable characteristics (including race, income quartile, and insurance type), after adjustment, non-English primary language was not associated with significant differential risk of adverse outcomes after bariatric surgery, and there were no significant conditional effects of race. As such, this study suggests that disparities in bariatric surgery by primary spoken language more likely related to access to care, or the pre- and post-hospital care continuum, rather than index hospitalization after surgery.
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Affiliation(s)
- Claire B Rosen
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA.
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA.
| | - Sanford E Roberts
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA
| | - James Sharpe
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA
| | - Victoria Gershuni
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
| | - Maria S Altieri
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA
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Zeidan AJ, Smith M, Leff R, Cordone A, Moran TP, Brackett A, Agrawal P. Limited English Proficiency as a Barrier to Inclusion in Emergency Medicine-Based Clinical Stroke Research. J Immigr Minor Health 2023; 25:181-189. [PMID: 35652977 DOI: 10.1007/s10903-022-01368-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 04/08/2022] [Accepted: 05/04/2022] [Indexed: 01/07/2023]
Abstract
AIMS Individuals with Limited English Proficiency (LEP) represent a growing percentage of the U.S. population yet face inequities in health outcomes and barriers to routine care. Despite these disparities, LEP populations are often excluded from clinical research studies. The aim of this study was to assess for the inclusion of LEP populations in published acute care stroke research in the U.S. METHODS A systematic review was conducted of publications from three databases using acute care and stroke specific Medical Subject Heading key terms. The primary outcome was whether language was used as inclusion or exclusion criteria for study participation and the secondary outcome was whether the study explored outcomes by language. RESULTS A total of 167 studies were included. Twenty-two studies (13.2%) indicated the use of language as inclusion/exclusion criteria within the manuscript or dataset/registry and only 17 studies (10.2%) explicitly included LEP patients either in the study or dataset/registry. Only four papers (2%) include language as a primary variable. CONCLUSIONS As LEP populations are not routinely incorporated in acute care stroke research, it is critical that researchers engage in language-inclusive research practices to ensure all patients are equitably represented in research studies and ultimately evidence-based practices.
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Affiliation(s)
- Amy J Zeidan
- Department of Emergency Medicine, Emory University School of Medicine, 80 Jesse Hill Junior Drive S#, 30303, Atlanta, GA, USA.
| | | | - Rebecca Leff
- Department of Emergency Medicine, Mayo Clinic, New York, USA
| | - Alexis Cordone
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Tim P Moran
- Department of Emergency Medicine, Emory University School of Medicine, 80 Jesse Hill Junior Drive S#, 30303, Atlanta, GA, USA
| | | | - Pooja Agrawal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
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Tran AV, Roberts KP. Language Accommodations for Limited English Proficient Patients in Rural Health Care. J Immigr Minor Health 2022; 25:674-679. [PMID: 36251203 DOI: 10.1007/s10903-022-01416-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 10/24/2022]
Abstract
Over 25 million individuals living in America are limited English proficient, many of whom live in rural communities. Adequate language accommodations are critical to providing effective healthcare for these populations. An online questionnaire was delivered to 42 rural facilities in Washington State. It included questions about their demand for language services, modalities of interpretation, translated documentation and barriers to providing accommodations. Fifteen of 42 (35.7%) responded. Spanish, Russian, Vietnamese, Japanese, Ukrainian and Mam were encountered daily. Telephonic and virtual remote interpreter services were the most widely available. Not all facilities had vital documents translated to frequently encountered languages. Challenges to providing language access were reported by nearly all participants. The rural facilities surveyed all encountered LEP patient populations and offered oral interpretation. Overall, these facilities were meeting requirements for providing language accommodation services. Even so, many facilities reported experiencing barriers to providing these services.
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Affiliation(s)
- Ai-Vi Tran
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Kenneth P Roberts
- Department of Translational Medicine & Physiology, Elson S. Floyd College of Medicine, 412 E Spokane Falls Blvd, Spokane, WA, 99202, USA.
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Pande M, Grafals M, Rizzolo K, Pomfret E, Kendrick J. Reducing disparities in kidney transplantation for Spanish-speaking patients through creation of a dedicated center. BMC Nephrol 2022; 23:251. [PMID: 35840913 PMCID: PMC9283817 DOI: 10.1186/s12882-022-02879-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/04/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Hispanic Americans receive disproportionately fewer organ transplants than non-Hispanic whites. In 2018, the Hispanic Kidney Transplant Program (HKTP) was established as at the University of Colorado Hospital (UCH). The purpose of this quality improvement study was to examine the effect of this culturally sensitive program in reducing disparities in kidney transplantation. Methods We performed a mixed-methods analysis of data from 436 Spanish-speaking patients referred for transplant to UCH between 2015 and 2020. We compared outcomes for patients referred between 2015–2017 (n = 156) to those referred between 2018–2020 (n = 280). Semi-structured phone interviews were conducted with 6 patients per time period and with 6 nephrology providers in the Denver Metro Area. Patients and providers were asked to evaluate communication, transplant education, and overall experience. Results When comparing the two time periods, there was a significant increase in the percentage of patients being referred (79.5% increase, p-0.008) and evaluated for transplant (82.4% increase, p = 0.02) during 2018–2020. While the number of committee reviews and number waitlisted increased during 2018–2020, it did not reach statistical significance (82.9% increase, p = 0.37 and 79.5% increase, p = 0.75, respectively. During patient and provider interviews, we identified 4 themes reflecting participation in the HKTP: improved communication, enhanced patient education, improved experience and areas for advancement. Overall, patients and providers reported a positive experience with the HKTP and noted improved patient understanding of the transplantation process. Conclusions The establishment of the HKTP is associated with a significant increase in Spanish-speaking Hispanic patients being referred and evaluated for kidney transplantation.
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Affiliation(s)
- Madhura Pande
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Monica Grafals
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Colorado Center for Transplant Care, Research and Education (CCTCARE), Aurora, CO, USA
| | - Katherine Rizzolo
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth Pomfret
- Colorado Center for Transplant Care, Research and Education (CCTCARE), Aurora, CO, USA.,Division of Transplant Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jessica Kendrick
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Seid K, Gebremedhin T. Nurses Cultural Competence in Southwest Ethiopia: A Cross-Sectional Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:467-473. [PMID: 35572778 PMCID: PMC9091469 DOI: 10.2147/amep.s359578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Diversity is a challenge and an opportunity, resulting in a change toward providing services suited to clients' cultural needs and desires. Nurses working with culturally diverse populations face unique challenges because of the coexistence of diverse cultural and ethnic societies. Hence, the study's purpose has been to evaluate the current state of cultural competence and the factors that influence it among nurses in Southwest Ethiopia. METHODS From December 1 to December 30, 2021, nurses at eight public healthcare facilities in southwest Ethiopia were enrolled in a facility-based cross-sectional study. Participants were selected using a simple random sampling. A self-administered questionnaire was used to collect the data. Epi data 4.1 was used to enter the data, and SPSS version 26 was used for analysis. To identify factors associated with cultural competence, bivariate and multivariable linear regression analyses were performed. The significance level was set at p < 0.05. RESULTS Two hundred thirty-seven nurses took part in the study, yielding an 86.1% response rate. The mean age was 28.83 years (standard deviation = ±5.48). The mean cultural competence score among healthcare professionals was 1.95 ± 0.32. Marital status (p < 0.05) and the use of healthcare interpreters (p < 0.05) were significantly associated with cultural competence. CONCLUSION Nurses had a low level of cultural competence. Cultural competence varies according to a number of factors, including marital status and the use of healthcare interpreters. Nurses are better suited to focus on the ethnic diversity of their patients, which necessitates the provision of cultural competence training for nurses.
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Affiliation(s)
- Kalid Seid
- Department of Nursing, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan, South West Ethiopia Peoples' Region, Ethiopia
| | - Tsehaye Gebremedhin
- Department of Nursing, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan, South West Ethiopia Peoples' Region, Ethiopia
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Stolarski AE, Alonso A, Aly S, Feeney T, Pereira F, Carter C, Hess D, Pernar LI, Carmine B, Drake FT. The impact of English proficiency on outcomes after bariatric surgery. Surg Endosc 2022; 36:7385-7391. [DOI: 10.1007/s00464-022-09148-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
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13
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Oliver M, Fernberg T, Lyons P, Elango S, Green GJ, Talib ZM. Addressing health disparities in hispanic communities through an innovative team-based medical spanish program at the medical school level - a single-institution study. BMC MEDICAL EDUCATION 2022; 22:98. [PMID: 35164733 PMCID: PMC8845388 DOI: 10.1186/s12909-022-03151-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND There are insufficient Spanish-speaking physicians to effectively serve a large and rapidly growing Spanish-speaking patient population. METHODS A team-based hybrid medical Spanish program was designed and implemented at a single medical school in Southern California. This pilot program consisted of a weekly in-person portion where students reviewed Spanish vocabulary and grammar and practiced clinical encounters in teams through active role play. Students supplemented in-class learning with online coursework. Program success was measured through physician-evaluated clinical encounters with Spanish-speaking standardized patients, a 100-question multiple-choice exam, and pre- and post-program surveys. RESULTS 97% of students in the program (n = 32) received a passing grade at program completion. Student surveys demonstrated enthusiasm and engagement in weekly sessions (95% overall attendance, 97% reported feeling either excited or ready to learn prior to class). In a post-program survey, 100% of students felt better suited and increased desire to treat Hispanic patients. Additionally, all students indicated an interest in the continued use of Spanish in both their schooling and future practice. In a follow-up survey after three months of clinical experience in their 3rd year of medical school, 100% of students reported that medical Spanish is "very beneficial" in patient care and that students with medical Spanish proficiency have advantages over non-speaking students when it comes to patient care opportunities. 100% felt that time spent learning medical Spanish during pre-clinical years was time well spent and that the medical Spanish program enhanced their care of Spanish-speaking students. CONCLUSIONS The results of the pilot program show a significant increase in the ability of students to engage in clinical interaction in Spanish. The results of our study demonstrate a significant increase in the knowledge, clinical skills, and self-reported confidence of students to treat Hispanic patients. Furthermore, all students not only felt better equipped and more confident to treat Hispanic patients, but they also had an increased desire to do so moving forward in their careers. We conclude that an effective medical Spanish program can be executed simultaneously with a pre-clinical medical school curriculum.
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Affiliation(s)
- Michael Oliver
- California University of Science and Medicine, Colton, CA USA
| | - Taylor Fernberg
- California University of Science and Medicine, Colton, CA USA
| | - Paul Lyons
- California University of Science and Medicine, Colton, CA USA
| | | | - Gordon J. Green
- California University of Science and Medicine, Colton, CA USA
| | - Zohray M. Talib
- California University of Science and Medicine, Colton, CA USA
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14
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Lamberti-Castronuovo A, Pine JA, Brogiato G, Kinkel HF. Agricultural Migrants' Health and Ability to Access Care: A Case Study in Southern Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312615. [PMID: 34886339 PMCID: PMC8656562 DOI: 10.3390/ijerph182312615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
Although a large amount of research exists about migration into the European Union (EU) and the role of migrants in European society, relatively little information is available on the health status of migrants after arriving in the EU. This is particularly true in the case of the most marginalised migrants, migrants from sub-Saharan Africa, who work as itinerant laborers harvesting fruits and vegetables in southern Italy. This study analyzes demographic and health data gathered by a non-governmental organization-run primary healthcare clinic in order to understand the challenges these migrants face when trying to maintain their health. Results show that their health suffers greatly due to substandard living and working conditions, partially due to the fact that these individuals experience many barriers when trying to access care from the national health system. The health status of this population cannot improve without broad reforms to the welfare system and the agricultural sector. Government action is needed to ensure that such individuals are not denied their basic human rights and freedoms, including the right to health.
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Affiliation(s)
- Alessandro Lamberti-Castronuovo
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy;
- iNGO EMERGENCY, 20122 Milan, Italy;
| | | | | | - Hans-Friedemann Kinkel
- Institute of Tropical Medicine and International Health, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany
- Correspondence:
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15
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Blundell AR, Moustafa D, Bartenstein DW, Smith GP, Hawryluk EB. Language-centered approach to care improvement in a pediatric dermatology clinic. Pediatr Dermatol 2021; 38 Suppl 2:161-163. [PMID: 34047402 DOI: 10.1111/pde.14635] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Language-congruent care can improve clinical outcomes. As a quality improvement initiative supported by the Department of Dermatology at Massachusetts General Hospital, the American Academy of Dermatology, and the Society for Pediatric Dermatology, our group established monthly pediatric dermatology "Spanish clinics" that scheduled Spanish-speaking patients on the same day and utilized a dedicated, live interpreter who stayed with the clinical team throughout the clinic. Patients reported high satisfaction scores, averaging 9.8 out of 10, and 90.5% of patients preferred this model to traditional appointments. Our participating physician found "Spanish clinics" allowed for more efficient care not only in the monthly pilot clinics, but in all clinics occurring during the time period.
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Affiliation(s)
- Andrew R Blundell
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,San Juan Bautista School of Medicine, Caguas, Puerto Rico
| | - Danna Moustafa
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Diana W Bartenstein
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Gideon P Smith
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Elena B Hawryluk
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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16
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Malespin M, May EJ, Nephew LD, Paul S, McCary A, Kilaru S, Mukhtar NA, Hassan MA, Brady CW. AASLD Deepens Commitment to Diversity, Equity, and Inclusion. Hepatology 2021; 74:2216-2225. [PMID: 34028073 DOI: 10.1002/hep.31918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/07/2021] [Accepted: 04/23/2021] [Indexed: 01/24/2023]
Affiliation(s)
| | | | - Lauren D Nephew
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
| | - Sonali Paul
- Section of Gastroenterology Center for Liver Diseases, University of Chicago Medicine, Chicago, IL
| | - Alexis McCary
- Department of Gastroenterology, Mid-Atlantic Permanente Medical Group, Upper Marlboro, MD
| | - Saikiran Kilaru
- Division of Gastroenterology and Hepatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Nizar A Mukhtar
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA
| | - Mohamed A Hassan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN
| | - Carla W Brady
- Department of Medicine, Division of Gastroenterology, Duke University, Durham, NC
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17
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Ji X, Chow E, Abdelhamid K, Naumova D, Mate KKV, Bergeron A, Lebouché B. Utility of mobile technology in medical interpretation: A literature review of current practices. PATIENT EDUCATION AND COUNSELING 2021; 104:2137-2145. [PMID: 33653659 DOI: 10.1016/j.pec.2021.02.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/16/2020] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Language barriers limit healthcare access. However, professional interpretation usage is infrequent due to high cost and poor interpreter availability. Healthcare-oriented mobile applications are becoming more accepted and may help alleviate this burden. This literature review aims to better understand the utility of mobile technology in healthcare interpretation. Specifically, the objective of this review is to synthesize the feasibility, outcome, and challenges of implementing technological medical interpretation services. PATIENT INVOLVEMENT No patients were involved for this review. METHODS In December 2019, MEDLINE (Ovid) was systematically searched according to PRISMA guidelines. All articles discussing the utility of technology in healthcare interpretation encounters were included. RESULTS Two major themes emerged: 1) comparing video and phone interpretation with in-person interpretation and 2) assessing direct translation software in healthcare settings. Phone and video interpretation help reduce overall patient wait-times. Both patients and clinicians preferred in-person or video interpretation over interpretation by phone. Chief benefits of using direct translation software include immediate access, low costs, and sustainability. Several studies discussed potential translation inaccuracies and the importance of having professional interpreters in medico-legal discussions. CONCLUSION Mobile applications may be used to facilitate access to medical interpreters with high clinician and patient satisfaction. Direct in-app translations facilitate access but risk inaccuracies with important medico-legal considerations. PRACTICAL VALUE Mobile applications are available at low costs and can improve access to interpreters though video and phone calls. Mobile software can also provide direct translation and facilitate clinical care. Clinicians should prioritize face-to-face encounters with professional medical interpreters, whenever possible. In a time of social distancing amidst the current COVID-19 pandemic, there is crucial value in elucidating the best telehealth interpretation practices.
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Affiliation(s)
- Xinyu Ji
- Faculty of Medicine, McGill University, Montreal, Canada.
| | - Ellen Chow
- Faculty of Medicine, McGill University, Montreal, Canada
| | | | - Darya Naumova
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Kedar K V Mate
- Center of Outcomes Research and Evaluation, McGill University Health Centre-Research, Montreal, Canada; Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Canada; Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, Canada.
| | - Amy Bergeron
- Medical Libraries, McGill University Health Centre, Montreal, Canada.
| | - Bertrand Lebouché
- Faculty of Medicine, McGill University, Montreal, Canada; Center of Outcomes Research and Evaluation, McGill University Health Centre-Research, Montreal, Canada; Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Canada; Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, Canada; Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada.
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18
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Rotoli JM, Hancock S, Park C, Demers-Mcletchie S, Panko TL, Halle T, Wills J, Scarpino J, Merrill J, Cushman J, Jones C. Emergency Medical Services Communication Barriers and the Deaf American Sign Language User. PREHOSP EMERG CARE 2021; 26:437-445. [PMID: 34060987 DOI: 10.1080/10903127.2021.1936314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: We sought to identify current Emergency Medical Services (EMS) practitioner comfort levels and communication strategies when caring for the Deaf American Sign Language (ASL) user. Additionally, we created and evaluated the effect of an educational intervention and visual communication tool on EMS practitioner comfort levels and communication. Methods: This was a descriptive study assessing communication barriers at baseline and after the implementation of a novel educational intervention with cross-sectional surveys conducted at three time points (pre-, immediate-post, and three months post-intervention). Descriptive statistics characterized the study sample and we quantified responses from the baseline survey and both post-intervention surveys. Results: There were 148 EMS practitioners who responded to the baseline survey. The majority of participants (74%; 109/148) previously responded to a 9-1-1 call for a Deaf patient and 24% (35/148) reported previous training regarding the Deaf community. The majority felt that important details were lost during communication (83%; 90/109), reported that the Deaf patient appeared frustrated during an encounter (72%; 78/109), and felt that communication limited patient care (67%; 73/109). When interacting with a Deaf person, the most common communication strategies included written text (90%; 98/109), friend/family member (90%; 98/109), lip reading (55%; 60/109), and spoken English (50%; 55/109). Immediately after the training, most participants reported that the educational training expanded their knowledge of Deaf culture (93%; 126/135), communication strategies to use (93%; 125/135), and common pitfalls to avoid (96%; 129/135) when caring for Deaf patients. At 3 months, all participants (100%, 79/79) reported that the educational module was helpful. Some participants (19%, 15/79) also reported using the communication tool with other non-English speaking patients. Conclusions: The majority of EMS practitioners reported difficulty communicating with Deaf ASL users and acknowledged a sense of patient frustration. Nearly all participants felt the educational training was beneficial and clinically relevant; three months later, all participants found it to still be helpful. Additionally, the communication tool may be applicable to other populations that use English as a second language.
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Affiliation(s)
- Jason M Rotoli
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Sarah Hancock
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Chanjun Park
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Susan Demers-Mcletchie
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Tiffany L Panko
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Trevor Halle
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Jennifer Wills
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Julie Scarpino
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Johannah Merrill
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Jeremy Cushman
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
| | - Courtney Jones
- Department of Emergency Medicine, University of Rochester, Rochester, New York (JMR, TH, JW, JS, JM, JC, CJ); School of Medicine and Dentistry, University of Rochester, Rochester, New York (SH, CP); Rochester Institute of Technology, Rochester, New York (TLP); Partners in Deaf Health Inc, Rochester, New York (JMR, SD-M, TLP)
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Cano-Ibáñez N, Zolfaghari Y, Amezcua-Prieto C, Khan KS. Physician-Patient Language Discordance and Poor Health Outcomes: A Systematic Scoping Review. Front Public Health 2021; 9:629041. [PMID: 33816420 PMCID: PMC8017287 DOI: 10.3389/fpubh.2021.629041] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/08/2021] [Indexed: 01/08/2023] Open
Abstract
Objective: This systematic review assessed whether physician-patient language concordance, compared with discordance, is associated with better health outcomes. Methods: A systematic literature search was conducted, without language restrictions, using PubMed, EMBASE, Web of Science, and PsycINFO, from inception to July 2020. We included studies that evaluated the effects of physician-patient language concordance on health outcomes. Articles were screened, selected, and data-extracted in duplicate. Review protocol was prospectively registered (PROSPERO, CRD42020157229). Results: There were 541 citations identified through databases and eight citations through reverse search and Google Scholar. A total of 15 articles (84,750 participants) were included reporting outcomes within five domains: diabetes care (four studies), inpatient care (five studies), cancer screening (three studies), healthcare counseling (two studies), and mental health care (one study). Ten studies were of good quality, four were fair, and one was poor, according to the modified Newcastle-Ottawa Scale. Eight studies (53%) showed a significant negative association between language discordance and at least one clinical outcome. Five studies (33%) found no association. Conclusion: Over half the evidence collated showed that physician-patient language concordance was associated with better health clinical outcomes.
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Affiliation(s)
- Naomi Cano-Ibáñez
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada, Spain.,Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Yasmin Zolfaghari
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, London, United Kingdom
| | - Carmen Amezcua-Prieto
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada, Spain.,Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada, Spain
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20
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Hispanic Ethnicity as a Predictor of Voice Therapy Adherence. J Voice 2021; 35:329.e1-329.e5. [DOI: 10.1016/j.jvoice.2019.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/05/2019] [Accepted: 09/20/2019] [Indexed: 11/21/2022]
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21
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Knuesel S, Chuang W, Olson E, Betancourt J. Language Barriers, Equity, and COVID-19: The Impact of a Novel Spanish Language Care Group. J Hosp Med 2021; 16:109-111. [PMID: 33357323 DOI: 10.12788/jhm.3542] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/28/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Steven Knuesel
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Warren Chuang
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Elena Olson
- Center for Diversity & Inclusion, Massachusetts General Hospital, Boston, Massachusetts
| | - Joseph Betancourt
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Center for Diversity & Inclusion, Massachusetts General Hospital, Boston, Massachusetts
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22
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Lor M, Martinez GA. Scoping review: Definitions and outcomes of patient-provider language concordance in healthcare. PATIENT EDUCATION AND COUNSELING 2020; 103:1883-1901. [PMID: 32507590 DOI: 10.1016/j.pec.2020.05.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/17/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To conduct a scoping literature review to understand the conceptualization and nature of the research on patient-provider language concordance (LC) in health care. METHODS We searched PubMed, EMBASE, CINAHL, PsycINFO, and Scopus to identify peer-reviewed articles between January 1961 and August 2018. We extracted study characteristics, content, definitions, and findings. RESULTS Fifty studies were included. Forty studies were quantitative, seven were qualitative, and three were mixed methods. Overall, the studies revealed inconsistent definitions and measures of patient-provider LC. Outcomes studied in connection to LC included: (1) interpersonal relationships, (2) access to health information, (3) access to care, (4) satisfaction and health-care experience, and (5) patient-related health outcomes. While four studies found that LC care had a negative or no impact on health outcomes, 46 studies reported positive outcomes associated with LC care. CONCLUSIONS The study findings highlight the need for more research on LC care and a consistent definition of LC using multiple measures of LC to capture the complex and multidimensional nature of language in social interaction. PRACTICAL IMPLICATIONS The study findings highlight the importance of how ideologies of language shape the perceptions of language and LC, thereby influence resource allocation and priorities.
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Affiliation(s)
- Maichou Lor
- School of Nursing, University of Wisconsin-Madison, Madison, WI, United States.
| | - Glenn A Martinez
- Department of Spanish and Portuguese, Ohio State University, OH, United States.
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Bischoff A. The evolution of a healthcare interpreting service mapped against the bilingual health communication model: a historical qualitative case study. Public Health Rev 2020; 41:19. [PMID: 32774991 PMCID: PMC7401237 DOI: 10.1186/s40985-020-00123-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/07/2020] [Indexed: 11/20/2022] Open
Abstract
Background Twenty-five years ago, the need for health care interpreting in Switzerland increased due to the sharp influx of asylum seekers from war zones and countries of political unrest. Due to complex health needs, there was a need to move away from using volunteers as interpreters towards qualified interpreter services. Methods A historical qualitative case study design was used to describe the evolution of the language assistance programmes at Geneva University Hospitals, between 1992 and 2017. The aim was to map the evolution of the interpreter services against the Bilingual Health Communication Model with the constructs—Communicative Goals, Individual Agency, System Norms and Quality and Equality of Care—while identifying key factors to optimise interpreter service and patient care. Results and discussion Five phases were identified during the 25 years of service evolution studied: (1) Service initiation—the interpreter services were first used in a small service that cared for refugees and asylum seekers. (2) Growth and formalisation—due to the arrival of high numbers of Albanian-speaking asylum seekers, Albanian-speaking interpreters were provided to all departments of the Geneva University Hospitals. This helped roll out the use of interpreters among doctors and nurses. (3) Ensuring quality—the care for all patients, whether foreign-language speaking or not, became an issue and led to research into the quality of patient-provider communication. (4) Institutionalisation—this phase dealt with challenges including the lack of interpreter financing regulation and the clarification of interpreter roles. (5) Equity—healthcare interpreter services were put in an overall framework of equity standards. The Bilingual Health Communication Model was applied and showed that some items were not implemented: clear shifts (i) towards a culturally sensitive focus, (ii) towards community interpreting, (iii) towards triadic communication, (iv) towards spelling out the right to have an interpreter and (v) towards the involvement of insurance companies. Finally, the inclusion of healthcare interpreting as an essential ingredient in healthcare provision, including chronic disease management, is incomplete or missing. Conclusions Healthcare interpreting at Geneva University Hospitals has evolved from a ‘muddling-through’ approach towards an institutional approach by addressing quality of care, by focussing on the mental health of asylum seekers, training of both interpreters and users of interpreters and institutional policy based on equity.
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Affiliation(s)
- Alexander Bischoff
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Route des Cliniques 15, CH-1700 Fribourg, Switzerland.,Institute of Global Health, Faculty of Medicine, University of Geneva, 24 rue du Général-Dufour, 1211 Genève 4, Switzerland
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24
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Brophy-Williams S, Boylen S, Gill FJ, Wilson S, Cherian S. Use of professional interpreters for children and families with limited English proficiency: The intersection with quality and safety. J Paediatr Child Health 2020; 56:1201-1209. [PMID: 32259354 DOI: 10.1111/jpc.14880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 02/12/2020] [Accepted: 03/11/2020] [Indexed: 11/30/2022]
Abstract
AIM Linguistic diversity is increasing nationally; patients with limited English proficiency require provision of professional interpreters. We reviewed hospital-wide use of interpreters for low English proficiency in a tertiary hospital across emergency (ED), outpatient and inpatient presentations. METHODS Two cohorts with low English proficiency presenting to Princess Margaret Hospital were audited. Records of new Refugee Health Service patients (presenting between January and July 2015) and non-Refugee Health Service low English proficiency patients (obtained through Language Services bookings) were reviewed to assess demographic profiles and use of interpreters for any occasion of service over the following 12 months (for each patient). RESULTS Data from 188 patients were reviewed (Refugee Health Service: 119 patients; non-Refugee Health Service: 69 patients; total 1027 occasions of service); all were under 18 years of age. High socio-economic disadvantage and limited education was noted. Almost all (98.5%) had low English proficiency; 3 Refugee Health Service parents spoke English; 68% of non-Refugee Health Service patients were in families previously transitioned from that service. Interpreter use was poor across all areas. Thirty-four patients had 46 inpatient admissions with documented interpreter use for 59% (20/34) of these. All patients underwent at least one procedure, with no instances of interpreter documentation for procedure consent. Documented interpreter use was minimal in outpatient occasions of service (32/118, 27% Refugee Health Service; 18/222, 8% non-Refugee Health Service). Only one Refugee Health Service patient had evidence of ED interpreter use, out of 78 ED occasions of service (34 patients). CONCLUSIONS Despite documented low English proficiency, suboptimal and inadequate use of professional interpreters persists. Low English proficiency patients are vulnerable, with socio-economic disadvantage, likely to impact on health outcomes and compliance. Organisational risk also is highlighted, including impact on clinical handover, informed consent and non-compliance with state language services policy. Further staff education and quality improvement work is essential.
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Affiliation(s)
- Sam Brophy-Williams
- Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital (PCH), Child and Adolescent Health Service (CAHS), Perth, Western Australia, Australia
| | - Susan Boylen
- Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital (PCH), Child and Adolescent Health Service (CAHS), Perth, Western Australia, Australia.,School of Nursing, Midwifery and Paramedicine, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia.,School of Nursing and Midwifery, University of Notre Dame Australia, Perth, Western Australia, Australia
| | - Fenella J Gill
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia.,Department of Nursing Research, PCH, CAHS, Perth, Western Australia, Australia
| | - Sally Wilson
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia.,Department of Nursing Research, PCH, CAHS, Perth, Western Australia, Australia
| | - Sarah Cherian
- Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital (PCH), Child and Adolescent Health Service (CAHS), Perth, Western Australia, Australia.,Division of Paediatrics, University of Western Australia, Perth, Western Australia, Australia
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Diamond LC, Mujawar I, Vickstrom E, Garzon MG, Gany F. Supply and Demand: Association Between Non-English Language-Speaking First Year Resident Physicians and Areas of Need in the USA. J Gen Intern Med 2020; 35:2289-2295. [PMID: 32488693 PMCID: PMC7403237 DOI: 10.1007/s11606-020-05935-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Over 25 million US inhabitants are limited English proficient (LEP). It is unknown whether physicians fluent in non-English languages are training in geographic areas with the highest proportion of LEP people. Diversity of language ability in the physician workforce is an important complement to language assistance services for providing quality care to LEP patients. OBJECTIVE To determine whether non-English language-speaking resident physicians matched in the geographic areas where language skills are needed. DESIGN Cross-sectional study. PARTICIPANTS Postgraduate medical training applicants to the Association of American Medical College's Electronic Residency Application Service in 2013-2014 (n = 50,766). We included data from the Graduate Medical Education Track database, mapped against American Community Survey data. INTERVENTIONS N/A. MAIN MEASURES We assessed the geographic alignment of non-English language-speaking resident physicians relative to the distribution of the LEP-speaking population. KEY RESULTS While 37% of resident physicians spoke at least one non-English language, in most cases the languages they spoke were not those in greatest need by the US LEP population. LEP speakers' potential exposure to non-English language-speaking residents varied. For Spanish, the language with the lowest national resident physician to Spanish LEP patient ratio, the ratio was most favorable in New York at 23.7/100,000 LEP population versus 5.1 in Los Angeles. For Tagalog, the group with the highest geographic mismatch, the ratio was 70.4 in New York but 0 in San Diego, San Jose, and Seattle. Among the top five LEP languages in the USA, Chinese-speaking resident physicians were the most geographically matched. CONCLUSIONS We found considerable misalignment of the geographic distribution of non-English language-speaking resident physicians relative to the distribution of the LEP-speaking population. Residency programs in areas of high need could consider better matching the non-English language needs of their community with the language abilities of the resident physicians they are recruiting.
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Affiliation(s)
- Lisa C Diamond
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Weill Cornell Medicine, New York, NY, USA.
| | - Imran Mujawar
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erik Vickstrom
- United States Census Bureau, Suitland, MA, USA
- IZA Institute of Labor Economics, Bonn, Germany
| | | | - Francesca Gany
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
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Barwise A, Balls-Berry J, Soleimani J, Karki B, Barrett B, Castillo K, Kreps S, Kunkel H, Vega B, Erwin P, Espinoza Suarez N, Wilson ME. Interventions for End of Life Decision Making for Patients with Limited English Proficiency. J Immigr Minor Health 2020; 22:860-872. [PMID: 31749066 PMCID: PMC7706216 DOI: 10.1007/s10903-019-00947-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patients with limited English proficiency (LEP) experience disparities in end-of-life decision making and advance care planning. Our objective was to conduct a systematic review to assess the literature about interventions addressing these issues. Our search strategy was built around end-of-life (EOL), LEP, ACP, and goals of care. The databases included Ovid MEDLINE(R), and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily from 1946 to November 9, 2018, Ovid EMBASE. Eight studies from the US and Australia were included (seven studies in Spanish and one study in Greek and Italian). Interventions used trained personnel, video images, web-based programs, and written materials. Interventions were associated with increased advance directive completion and decreased preferences for some life-prolonging treatments. Interventions were deemed to be feasible and acceptable. Few interventions exist to improve end-of-life care for patients with LEP. Data are limited regarding intervention effectiveness.
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Affiliation(s)
- Amelia Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Joyce Balls-Berry
- Office for Community Engagement in Research, Center for Clinical and Translational Science, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Jalal Soleimani
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Bibek Karki
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | - Samantha Kreps
- Health Sciences, University of Minnesota, Rochester, MN, USA
| | - Hilary Kunkel
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Beatriz Vega
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Patricia Erwin
- Department of Education Administration, Rochester, MN, USA
| | | | - Michael E Wilson
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Knowledge Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
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Al-Jumaili AA, Ahmed KK, Koch D. Barriers to healthcare access for Arabic-speaking population in an English-speaking country. Pharm Pract (Granada) 2020; 18:1809. [PMID: 32477432 PMCID: PMC7243745 DOI: 10.18549/pharmpract.2020.2.1809] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/10/2020] [Indexed: 11/14/2022] Open
Abstract
Objective: To identify barriers to healthcare access, to assess the health literacy levels of the foreign-born Arabic speaking population in Iowa, USA and to measure their prevalence of seeking preventive healthcare services. Methods: A cross-sectional study of native Arabic speaking adults involved a focus group and an anonymous paper-based survey. The focus group and the Andersen Model were used to develop the survey questionnaire. The survey participants were customers at Arabic grocery stores, worshippers at the city mosque and patients at free University Clinic. Chi-square test was used to measure the relationship between the characteristics of survey participants and preventive healthcare services. Thematic analysis was used to analyze the focus group transcript. Results: We received 196 completed surveys. Only half of the participants were considered to have good health literacy. More than one-third of the participants had no health insurance and less than half of them visit clinics regularly for preventive measures. Two participant enabling factors (health insurance and residency years) and one need factor (having chronic disease(s)) were found to significantly influence preventive physician visits. Conclusions: This theory-based study provides a tool that can be used in different Western countries where Arabic minority lives. Both the survey and the focus group agreed that lacking health insurance is the main barrier facing their access to healthcare services. The availability of an interpreter in the hospital is essential to help those with inadequate health literacy, particularly new arriving individuals. More free healthcare settings are needed in the county to take care of the increasing number of uninsured Arabic speaking patients.
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Affiliation(s)
- Ali A Al-Jumaili
- MPH, PhD. College of Pharmacy, University of Baghdad. Baghdad (Iraq).
| | - Kawther K Ahmed
- PhD. College of Pharmacy, University of Baghdad. Baghdad (Iraq).
| | - Dave Koch
- BS. Johnson County Public Health. Iowa City, IA (United States).
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Russell EA, Tsai C, Linton JM. Children in Immigrant Families: Advocacy Within and Beyond the Pediatric Emergency Department. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020; 21:100779. [PMID: 32922213 PMCID: PMC7480259 DOI: 10.1016/j.cpem.2020.100779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In the United States, 1 in 4 children lives in an immigrant family. State and national policies have historically precluded equitable access to health care among children in immigrant families. More recently, increasingly restrictive policies, political rhetoric, and xenophobic stances have made immigrant families less able to access health care and less comfortable in attempting to do so, thus increasing the likelihood that patients will present to the emergency department. Once in the emergency department, language, cultural, and health literacy barriers make providing high-quality care potentially challenging for some families. Emergency care professionals can therefore glean critical insight regarding inequities from clinical work to inform advocacy and policy changes at institutional, community, regional, and national levels.
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Affiliation(s)
- Eric A Russell
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Carmelle Tsai
- Department of Pediatrics, Division of Emergency Medicine, University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julie M Linton
- Department of Pediatrics and Assistant Dean for Admissions, University of South Carolina School of Medicine Greenville and Prisma Health Children's Hospital, Greenville, SC
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End-of-Life Decision-Making for ICU Patients With Limited English Proficiency: A Qualitative Study of Healthcare Team Insights. Crit Care Med 2020; 47:1380-1387. [PMID: 31389838 DOI: 10.1097/ccm.0000000000003920] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Research indicates that the increasing population of over 25 million people in the United States who have limited English proficiency experience differences in decision-making and subsequent care at end of life in the ICU when compared with the general population. The objective of this study was to assess the perceptions of healthcare team members about the factors that influence discussions and decision-making about end of life for patients and family members with limited English proficiency in the ICU. DESIGN Qualitative study using semistructured interviews with ICU physicians, nurses, and interpreters. SETTING Three ICUs at Mayo Clinic Rochester. SUBJECTS Sixteen ICU physicians, 12 ICU nurses, and 12 interpreters. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS We conducted 40 semistructured interviews. We identified six key differences in end-of-life decision-making for patients with limited English proficiency compared with patients without limited English proficiency: 1) clinician communication is modified and less frequent; 2) clinician ability to assess patient and family understanding is impaired; 3) relationship building is impaired; 4) patient and family understanding of decision-making concepts (e.g., palliative care) is impaired; 5) treatment limitations are often perceived to be unacceptable due to faith-based and cultural beliefs; and 6) patient and family decision-making styles are different. Facilitators of high-quality decision-making in patients with limited English proficiency included: 1) premeeting between clinician and interpreter; 2) interpretation that communicates empathy and caring; 3) bidirectional communication of cultural perspectives; 4) interpretation that improves messaging including appropriate word choice; and 5) clinician cultural humility. CONCLUSIONS End-of-life decision-making is significantly different for ICU patients with limited English proficiency. Participants identified several barriers and facilitators to high-quality end-of-life decision-making for ICU patients and families with limited English proficiency. Awareness of these factors can facilitate interventions to improve high-quality, compassionate, and culturally sensitive decision-making for patients and families with limited English proficiency.
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Reaume M, Batista R, Talarico R, Rhodes E, Guerin E, Carson S, Prud'homme D, Tanuseputro P. The impact of hospital language on the rate of in-hospital harm. A retrospective cohort study of home care recipients in Ontario, Canada. BMC Health Serv Res 2020; 20:340. [PMID: 32316965 PMCID: PMC7175496 DOI: 10.1186/s12913-020-05213-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/13/2020] [Indexed: 02/03/2023] Open
Abstract
Background Patients who live in minority language situations are generally more likely to experience poor health outcomes, including harmful events. The delivery of healthcare services in a language-concordant environment has been shown to mitigate the risk of poor health outcomes related to chronic disease management in primary care. However, data assessing the impact of language-concordance on the risk of in-hospital harm are lacking. We conducted a population-based study to determine whether admission to a language-discordant hospital is a risk factor for in-hospital harm. Methods We used linked administrative health records to establish a retrospective cohort of home care recipients (from 2007 to 2015) who were admitted to a hospital in Eastern or North-Eastern Ontario, Canada. Patient language (obtained from home care assessments) was coded as English (Anglophone group), French (Francophone group), or other (Allophone group); hospital language (English or bilingual) was obtained using language designation status according to the French Language Services Act. We identified in-hospital harmful events using the Hospital Harm Indicator developed by the Canadian Institute for Health Information. Results The proportion of hospitalizations with at least 1 harmful event was greater for Allophones (7.63%) than for Anglophones (6.29%, p < 0.001) and Francophones (6.15%, p < 0.001). Overall, Allophones admitted to hospitals required by law to provide services in both French and English (bilingual hospitals) had the highest rate of harm (9.16%), while Francophones admitted to these same hospitals had the lowest rate of harm (5.93%). In the unadjusted analysis, Francophones were less likely to experience harm in bilingual hospitals than in hospitals that were not required by law to provide services in French (English-speaking hospitals) (RR = 0.88, p = 0.048); the opposite was true for Anglophones and Allophones, who were more likely to experience harm in bilingual hospitals (RR = 1.17, p < 0.001 and RR = 1.41, p < 0.001, respectively). The risk of harm was not significant in the adjusted analysis. Conclusions Home care recipients residing in Eastern and North-Eastern Ontario were more likely to experience harm in language-discordant hospitals, but the risk of harm did not persist after adjusting for confounding variables.
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Affiliation(s)
- Michael Reaume
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada. .,Institut du Savoir Montfort, Ottawa, Canada.
| | - Ricardo Batista
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Canada.,ICES, Ottawa, Canada
| | | | - Emily Rhodes
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Eva Guerin
- Institut du Savoir Montfort, Ottawa, Canada
| | - Sarah Carson
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.,Institut du Savoir Montfort, Ottawa, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Peter Tanuseputro
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.,Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Canada.,ICES, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada
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Cremer NM, Baptist AP. Race and Asthma Outcomes in Older Adults: Results from the National Asthma Survey. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1294-1301.e7. [PMID: 32035849 DOI: 10.1016/j.jaip.2019.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/26/2019] [Accepted: 12/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The number of older adults with asthma continues to rise, yet the effects of race and ethnicity on asthma outcomes in this population are unknown. OBJECTIVE To characterize the effect of race and ethnicity on asthma outcomes in a large national sample of older adults and to identify factors that are associated with disparities found. METHODS Data from the 2015 Behavioral Risk Factor Surveillance Survey and Asthma Call-Back Survey were analyzed. Respondents were included if they had a current asthma diagnosis, were aged ≥55, and self-identified as non-Hispanic white, African American, or Hispanic. Demographic variables, health care access, comorbidities, and asthma history were correlated with asthma outcomes (health care utilization and asthma control). Asthma outcome variables were further analyzed using multivariable logistic regression. RESULTS A total of 4700 individuals were included. Compared with non-Hispanic white respondents, African American and Hispanic respondents had lower incomes, greater impaired access to health care due to cost, and increased reliance on rescue medications. After controlling for factors including income, education, comorbidities, and health insurance, African American and Hispanic respondents were twice as likely to visit the emergency room (ER) for asthma (P < .001 for both) and 40% less likely to report uncontrolled daytime symptoms (P = .002 and .008). CONCLUSIONS Racial differences in asthma outcomes persist despite controlling for multiple social determinants of health and access to health insurance through Medicare. Minority patients were more likely to visit the ER but less likely to report frequent daytime symptoms. These findings indicate that comprehensive strategies to address assessment, monitoring, and treatment are needed to decrease health disparities.
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Affiliation(s)
- Nicole M Cremer
- Division of Internal Medicine, University of Michigan, Ann Arbor, Mich.
| | - Alan P Baptist
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich
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Mohamed Z, Roche S, Claassen J, Jama Z. Students’ perceptions of the effectiveness of additional language tuition in the University of Cape Town MBChB programme: A descriptive cross-sectional study. Afr J Prim Health Care Fam Med 2019; 11:e1-e10. [PMID: 31714121 PMCID: PMC6852487 DOI: 10.4102/phcfm.v11i1.2121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/03/2019] [Accepted: 09/01/2019] [Indexed: 11/08/2022] Open
Abstract
Background Language barriers between doctors and patients have been shown globally to negatively affect the quality of health care and infringe on basic patient rights. In response to these challenges, the Division of Family Medicine at the University of Cape Town (UCT) integrated career-oriented Afrikaans and Xhosa communication skills classes into the MBChB degree programme in 2003. Aim To measure students’ perceptions of the effectiveness of the language communication skills classes in creating multilingual medical practitioners in the South African context and compare these perceptions between the Afrikaans and Xhosa courses. Setting The study was conducted on the Health Sciences campus of the University of Cape Town, South Africa. Methods The study was a cross-sectional survey. During March 2017, access to an online structured questionnaire was provided to 600 randomly selected medical students from second to sixth year at the UCT. Results The response rate was 43.7%, and students reported a much higher baseline level of Afrikaans compared to Xhosa (99.0% vs. 42.7%). Respondents reported a lack of confidence in the clinical sphere for both languages (Afrikaans 51.5%; Xhosa 60.0%) and a lack of communicative ability (Afrikaans 35.3%; Xhosa 67.2%) as major barriers to patient communication. Conclusions Respondents overwhelmingly agreed that second language learning is valuable for their future as medical practitioners, but did not feel that they are developing sufficient communicative competence. The courses need to be re-evaluated to account for the lower level of pre-MBChB Xhosa exposure, as compared to Afrikaans. Increased time allocated to languages, increased attention to cultural issues and informal variants, and redesigning assessments to better reflect students’ abilities are all potential recommendations.
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Affiliation(s)
- Zahraa Mohamed
- Faculty of Health Sciences, University of Cape Town, Cape Town.
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Greene NE, Fuentes-Juárez BN, Sabatini CS. Access to Orthopaedic Care for Spanish-Speaking Patients in California. J Bone Joint Surg Am 2019; 101:e95. [PMID: 31567810 DOI: 10.2106/jbjs.18.01080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Communication is the foundation of any patient-doctor relationship. Patients who are unable to communicate effectively with physicians because of language barriers may face disparities in accessing orthopaedic care and in the evaluation and treatment of musculoskeletal symptoms. We evaluated whether Spanish-speaking patients face disparities scheduling appointments with orthopaedists via the telephone. METHODS From the American Academy of Orthopaedic Surgeons (AAOS) web site, we randomly selected 50 orthopaedic surgeons' offices in California specializing in knee surgery. The investigator called eligible offices using a script to request an appointment for a hypothetical Spanish-speaking or English-speaking 65-year-old man with knee pain. The caller randomly selected the patient's primary language for this first call. A second call was placed a week later requesting an appointment for an identical patient who spoke the alternate language. RESULTS There was no significant difference between Spanish-speaking and English-speaking patients' access to appointments with an orthopaedic surgeon (p = 0.8256). Thirty-six English-speaking patients and 35 Spanish-speaking patients were offered an appointment. Twenty-eight Spanish-speaking patients were instructed to bring a friend or family member who could translate for them, 3 were told that the provider spoke sufficient Spanish to communicate without the need for an interpreter, and 4 were told that an interpreter would be made available. CONCLUSIONS We did not detect a disparity between Spanish-speaking and English-speaking patients' access to appointments with an orthopaedic surgeon. However, 80% of Spanish-speaking patients were asked to rely on nonqualified interpreters for their orthopaedic appointment. This study suggests that orthopaedic offices in California depend heavily on ad hoc interpreters rather than professional interpretation services. It also highlights potential barriers to the provision of qualified interpreters. Additional study is warranted to assess how this lack of adequate utilization of medical interpreters affects the patient-doctor relationship, the quality of care received, and the financial burden on the health system. CLINICAL RELEVANCE Optimizing the care that we provide to our patients is a goal of every orthopaedic surgeon. We highlight the importance of utilizing professional interpreters as a means to reduce health-care disparities and overall health-care costs, as well as the importance of improving reimbursement and infrastructure for physicians to utilize qualified interpreters in caring for their limited-English-proficient patients.
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Affiliation(s)
- Nattaly E Greene
- School of Medicine, Oregon Health & Science University, Portland, Oregon
| | | | - Coleen S Sabatini
- Department of Orthopaedic Surgery, UCSF Benioff Children's Hospital Oakland, University of California, San Francisco, San Francisco, California
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A Systematic Review of the Impact of Patient-Physician Non-English Language Concordance on Quality of Care and Outcomes. J Gen Intern Med 2019; 34:1591-1606. [PMID: 31147980 PMCID: PMC6667611 DOI: 10.1007/s11606-019-04847-5] [Citation(s) in RCA: 216] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 11/08/2018] [Accepted: 01/11/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Approximately 25 million people in the USA are limited English proficient (LEP). When LEP patients receive care from physicians who are truly language concordant, some evidence show that language disparities are reduced, but others demonstrate worse outcomes. We conducted a systematic review of the literature to compare the impact of language-concordant care for LEP patients with that of other interventions, including professional and ad hoc interpreters. METHODS Data was collected through a systematic review of the literature using PubMed, PsycINFO, Web of Science, Cochrane Library, and EMBASE in October 2017. The literature search strategy had three main components, which were immigrant/minority status, language barrier/proficiency, and healthcare provider/patient relationship. The quality of the articles was appraised using the Downs and Black checklist. RESULTS The 33 studies were grouped by the outcome measure studied, including quality of care (subdivided into primary care, diabetes, pain management, cancer, and inpatient), satisfaction with care/communication, medical understanding, and mental health. Of the 33, 4 (6.9%) were randomized controlled trials and the remaining 29 (87.9%) were cross-sectional studies. Seventy-six percent (25/33) of the studies demonstrated that at least one of the outcomes assessed was better for patients receiving language-concordant care, while 15% (5/33) of studies demonstrated no difference in outcomes, and 9% (3/33) studies demonstrated worse outcomes in patients receiving language-concordant care. DISCUSSION The findings of this review indicate that, in the majority of situations, language-concordant care improves outcomes. Although most studies included were of good quality, none provided a standardized assessment of provider language skills. To systematically evaluate the impact of truly language-concordant care on outcomes and draw meaningful conclusions, future studies must include an assessment of clinician language proficiency. Language-concordant care offers an important way for physicians to meet the unique needs of their LEP patients.
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Vaidya V, Gabriel MH, Patel P, Gupte R, James C. The impact of racial and ethnic disparities in inhaled corticosteroid adherence on healthcare expenditures in adults with asthma. Curr Med Res Opin 2019; 35:1379-1385. [PMID: 30793988 DOI: 10.1080/03007995.2019.1586221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose: The purpose of this study is to determine racial and ethnic disparities with the adherence to inhaled corticosteroids (ICSs) in adults with persistent asthma, and their association with healthcare expenditures. Methods: A retrospective, cross-sectional study using the Medical Expenditure Panel Survey (MEPS) 2013-2014 data included patients ≥18 years with persistent asthma. Median medication possession ratio (MPR) was used to dichotomize adherence levels. Multivariate regression analysis was conducted to ascertain the association between adherence and race/ethnicity. Total expenditures and association with adherence were analyzed using a generalized linear model with a log link function and gamma distribution. Unadjusted expenditures were compared after bootstrapping. Results: The average MPR of ICSs for the sample of 277 patients was 0.34. The average MPR level was 0.33 among whites, 0.37 among African-Americans and 0.35 among other minorities. The average MPR was 0.30 among Hispanics, and 0.35 among non-Hispanics. African-Americans were less likely to be adherent than whites (OR 0.95). Hispanics were less likely to be adherent (OR 0.4; CI 0.206-0.777). Higher adherence was associated with significantly higher total health expenditure than lower adherence ($19,223 vs. $12,840 respectively, p < .0001). African-Americans had slightly higher total expenditure compared to whites; however, other minorities had significantly lower health expenditures compared to whites (p = .01). Non-Hispanics spent significantly less on healthcare compared to Hispanics (p = .04). Conclusions: Valuable insight into the economic cost of the disparities as they relate to persistent asthma provides further evidence of possible ethnic inequities that warrant addressing.
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Affiliation(s)
| | - Meghan Hufstader Gabriel
- b Department of Health Management and Informatics , University of Central Florida , Orlando , FL , USA
| | | | | | - Cameron James
- c Health Economics and Value Assessment , Sanofi , Bridgewater , NJ , USA
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Hsueh L, Hirsh AT, Maupomé G, Stewart JC. Patient-Provider Language Concordance and Health Outcomes: A Systematic Review, Evidence Map, and Research Agenda. Med Care Res Rev 2019; 78:3-23. [PMID: 31291823 DOI: 10.1177/1077558719860708] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Although patient-provider language concordance has the potential to reduce health disparities for people with limited English proficiency, no previous work has synthesized this literature. Our systematic review sought to describe the characteristics of studies examining relationships between language concordance and health outcomes, summarize the nature of observed associations, and propose an evidence map and research agenda. A comprehensive search of published articles identified 38 quantitative studies for inclusion. Most studies were cross-sectional, conducted in primary care, concentrated in Western states, and focused on Spanish speakers and physician providers. Results were split between supporting a positive association versus no association of language concordance with patient behaviors, provider behaviors, interpersonal processes of care, and clinical outcomes. Several methodological limitations were identified. Based on these results, we developed an evidence map, identified knowledge gaps, and proposed a research agenda. There is a particular need for quasi-experimental longitudinal studies with well-characterized samples.
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Affiliation(s)
- Loretta Hsueh
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Adam T Hirsh
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | | | - Jesse C Stewart
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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Platter E, Hamline MY, Tancredi DJ, Fernandez Y Garcia E, Rosenthal JL. Completeness of Written Discharge Guidance for English- and Spanish-Speaking Patient Families. Hosp Pediatr 2019; 9:516-522. [PMID: 31182648 DOI: 10.1542/hpeds.2018-0250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Written discharge guidance for hospitalized pediatric patients should include language-appropriate key elements to ensure positive discharge outcomes. Our objective in this study was to determine the completeness of written pediatric discharge guidance and to test the hypothesis that Spanish-speaking families with limited English proficiency (LEP) receive less complete written discharge guidance than English-speaking families. METHODS We conducted a retrospective review of written discharge guidance provided to 100 English- and 100 Spanish-speaking families at an urban nonfreestanding children's hospital to assess the inclusion of key elements: follow-up plan, contingency plan, telephone contact, discharge medications, discharge diagnosis, and hospital course. We compared the completeness of discharge guidance (number of elements provided among number of applicable elements) between English- versus Spanish-speaking families. RESULTS When evaluating discharge guidance for the presence of key elements in any language, there was no significant difference between English- and Spanish-speaking families. However, the mean completeness of language-appropriate discharge guidance for English- and Spanish-speaking families was 87.8% (95% confidence interval [CI] 84.4%-91.1%) and 16.0% (95% CI 11.5%-20.4%), respectively. The ordinal logistic regression examining the association between the number of key element deficits and English- (reference group) versus Spanish-speaking families demonstrated an adjusted odds ratio of 339.8 (95% CI 112.4-1027.5). CONCLUSIONS Few Spanish-speaking families with LEP receive written discharge guidance in their preferred language. Complete, language-appropriate discharge guidance was identified as an area for improvement efforts to work toward improving care provided to families with LEP.
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Affiliation(s)
- Erin Platter
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia; and
| | - Michelle Y Hamline
- Department of Pediatrics, University of California, Davis, Sacramento, California
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis, Sacramento, California
| | | | - Jennifer L Rosenthal
- Department of Pediatrics, University of California, Davis, Sacramento, California
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Dinh JV. Prioritization of Diversity During the Residency Match: Trends for a New Workforce. J Grad Med Educ 2019; 11:319-323. [PMID: 31210864 PMCID: PMC6570447 DOI: 10.4300/jgme-d-18-00721.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/27/2018] [Accepted: 03/05/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The medical community has been paying increasing attention to diversity. Nascent research suggests that the physician workforce may be experiencing value shifts in this area. OBJECTIVE This study aims to understand how residency applicant perspectives toward diversity may be evolving. METHODS The National Resident Matching Program surveys all applicants regarding factors they consider important when ranking residency programs. Survey data from 2008-2017 were analyzed for changes in respondent perceptions of cultural, racial, and ethnic diversity of geographic location (geographic diversity) and cultural, racial, ethnic, and gender diversity at the destination institution (institutional diversity). We calculated weighted averages and visualized: percentage of respondents citing diversity as a factor when applying for interviews; and mean applicant ratings of diversity when ranking programs, using a 5-point scale (1, not important, to 5, extremely important). RESULTS Respondents at 5 time points ranged from 13 156 to 16 575, with response rates from 42.4% to 58.5%. Between 2008 and 2017, the percentage of applicants citing diversity as a consideration when applying to interview increased from 27.8% to 33.2% for geographic diversity and from 22.3% to 33.8% for institutional diversity. Applicants' mean ratings of importance of diversity when ranking programs increased from 2.7 to 4.2 for geographic diversity and from 2.4 to 4.2 for institutional diversity. CONCLUSIONS Over the past 9 years and across specialties, a growing percentage of applicants are considering geographic and institutional diversity when applying to interview at residency programs. Applicants report that both forms of diversity are increasingly important when ranking programs.
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Barwise A, Cheville A, Wieland ML, Gajic O, Greenberg-Worisek AJ. Perceived knowledge of palliative care among immigrants to the United States: a secondary data analysis from the Health Information National Trends Survey. ANNALS OF PALLIATIVE MEDICINE 2019; 8:451-461. [PMID: 30943736 DOI: 10.21037/apm.2019.02.06] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/27/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Immigrants to North America receive more interventions at end of life potentially due to knowledge gaps. The primary objective of this study was to measure and describe levels of perceived knowledge about palliative care among immigrants to the United States (US) compared to those born in the US. Our secondary objective was to identify trusted sources for seeking information about palliative care among immigrants and compare these trusted sources with those born in the US. We hypothesized that immigrants would have less knowledge of palliative care than those born in US and would trust different sources for information about palliative care. METHODS We analyzed data from the nationally representative 2018 Health Information National Trends Survey (HINTS 5, cycle 2). Questionnaires were administered via mail between January and May 2018 to a population-based sample of adults. The primary outcome of interest was assessed using the item "How would you describe your level of knowledge about palliative care?" The secondary outcome of interest was determined using the item "Imagine you had a strong need to get information about palliative care, which of the following would you most trust as a source of information about palliative care?" Descriptive statistics were calculated, and bivariate analyses run between the outcomes of interest and sociodemographic characteristics (age, sex, education, race/ethnicity, nativity, fluency with English). Multivariable logistic regressions were conducted to assess the role of nativity, controlling for relevant sociodemographic variables. Jackknife weighting was used to generate population-level estimates. RESULTS About 70% of those born in the US and 77% of immigrants (weighted) responded that they had "never heard of palliative care." Trusted sources of palliative care were very similar between the groups (all P>0.05). Both groups' preferred trusted source of palliative care knowledge was "health care provider," with over 80% of respondents in each group selecting this option. Printed materials and social media were the least popular trusted sources among both groups. After adjusting for relevant sociodemographic characteristics, we found no association between poor knowledge of palliative care and nativity (P=0.22). Female respondents had 2.5-fold increased odds of reporting low levels of perceived knowledge of palliative care (OR =2.58, 95% CI, 1.76-3.78; P<0.001). Education was an important predictor of perceived knowledge of palliative care; as education level increased, so did perceived knowledge of palliative care (P<0.001). CONCLUSIONS Perceived knowledge of palliative care is poor generally, regardless of birthplace. Trusted sources for palliative care are similar between immigrants and those born in the US. Education is important and is a strong predictor of perceived knowledge of palliative care. Women perceive they have lower levels of knowledge of palliative care (PC) than men. Differences in end of life care between immigrants and non-immigrants cannot be explained by knowledge differences.
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Affiliation(s)
- Amelia Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Andrea Cheville
- Division of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark L Wieland
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Tassavor M, Chen AYY. Lost in translation: Caring for limited English proficiency patients. J Am Acad Dermatol 2019; 80:829-831. [DOI: 10.1016/j.jaad.2017.12.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
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Grossman LV, Mitchell EG, Hripcsak G, Weng C, Vawdrey DK. A method for harmonization of clinical abbreviation and acronym sense inventories. J Biomed Inform 2018; 88:62-69. [PMID: 30414475 DOI: 10.1016/j.jbi.2018.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/24/2018] [Accepted: 11/05/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous research has developed methods to construct acronym sense inventories from a single institutional corpus. Although beneficial, a sense inventory constructed from a single institutional corpus is not generalizable, because acronyms from different geographic regions and medical specialties vary greatly. OBJECTIVE Develop an automated method to harmonize sense inventories from different regions and specialties towards the development of a comprehensive inventory. METHODS The method involves integrating multiple source sense inventories into one centralized inventory and cross-mapping redundant entries to establish synonymy. To evaluate our method, we integrated 8 well-known source inventories into one comprehensive inventory (or metathesaurus). For both the metathesaurus and its sources, we evaluated the coverage of acronyms and their senses on a corpus of 1 million clinical notes. The corpus came from a different institution, region, and specialty than the source inventories. RESULTS In the evaluation using clinical notes, the metathesaurus demonstrated an acronym (short form) micro-coverage of 94.3%, representing a substantial increase over the two next largest source inventories, the UMLS LRABR (74.8%) and ADAM (68.0%). The metathesaurus demonstrated a sense (long form) micro-coverage of 99.6%, again a substantial increase compared to the UMLS LRABR (82.5%) and ADAM (55.4%). CONCLUSIONS Given the high coverage, harmonizing acronym sense inventories is a promising methodology to improve their comprehensiveness. Our method is automated, leverages the extensive resources already devoted to developing institution-specific inventories in the United States, and may help generalize sense inventories to institutions who lack the resources to develop them. Future work should address quality issues in source inventories and explore additional approaches to establishing synonymy.
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Affiliation(s)
- Lisa V Grossman
- Department of Biomedical Informatics, Columbia University, New York, NY, USA; College of Physicians and Surgeons, Columbia University, New York, NY, USA.
| | - Elliot G Mitchell
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, NY, USA; Value Institute, NewYork-Presbyterian Hospital, New York, NY, USA
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Barwise A, Jaramillo C, Novotny P, Wieland ML, Thongprayoon C, Gajic O, Wilson ME. Differences in Code Status and End-of-Life Decision Making in Patients With Limited English Proficiency in the Intensive Care Unit. Mayo Clin Proc 2018; 93:1271-1281. [PMID: 30100192 PMCID: PMC7643629 DOI: 10.1016/j.mayocp.2018.04.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/28/2018] [Accepted: 04/17/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine whether code status, advance directives, and decisions to limit life support were different for patients with limited English proficiency (LEP) in the intensive care unit (ICU) as compared with patients whose primary language was English. PATIENTS AND METHODS We conducted a retrospective cohort study in adult patients admitted to 7 ICUs in a single tertiary academic medical center from May 31, 2011, through June 1, 2014. RESULTS Of the 27,523 patients admitted to the ICU, 779 (2.8%) had LEP. When adjusted for severity of illness, sex, education level, and insurance status, patients with LEP were less likely to change their code status from full code to do not resuscitate during ICU admission (odds ratio [OR], 0.62; 95% CI, 0.46-0.82; P<.001) and took 3.8 days (95% CI, 1.9-5.6 days; P<.001) longer to change to do not resuscitate. Patients with LEP who died in the ICU were less likely to receive a comfort measures order set (OR, 0.38; 95% CI, 0.16-0.91; P=.03) and took 19.1 days (95% CI, 13.2-25.1 days; P<.001) longer to transition to comfort measures only. Patients with LEP were less likely to have an advance directive (OR, 0.23; 95% CI, 0.18-0.29; P<.001), more likely to receive mechanical ventilation (OR, 1.26; 95% CI, 1.07-1.48; P=.005), and more likely to have restraints used (OR, 1.36; 95% CI, 1.11-1.65; P=.003). The hospital length of stay was 2.7 days longer for patients with LEP. Additional adjustment for religion, race, and age yielded similar results. CONCLUSION There are important differences in end-of-life care and decision making for patients with LEP.
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Affiliation(s)
- Amelia Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Biomedical Ethics Program, Mayo Clinic, Rochester, MN.
| | | | - Paul Novotny
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Mark L Wieland
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Michael E Wilson
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Biomedical Ethics Program, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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Howell EA, Brown H, Brumley J, Bryant AS, Caughey AB, Cornell AM, Grant JH, Gregory KD, Gullo SM, Kozhimannil KB, Mhyre JM, Toledo P, D’Oria R, Ngoh M, Grobman WA. Reduction of Peripartum Racial and Ethnic Disparities: A Conceptual Framework and Maternal Safety Consensus Bundle. J Obstet Gynecol Neonatal Nurs 2018; 47:275-289. [DOI: 10.1016/j.jogn.2018.03.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Howell EA, Brown H, Brumley J, Bryant AS, Caughey AB, Cornell AM, Grant JH, Gregory KD, Gullo SM, Kozhimannil KB, Mhyre JM, Toledo P, D'Oria R, Ngoh M, Grobman WA. Reduction of Peripartum Racial and Ethnic Disparities: A Conceptual Framework and Maternal Safety Consensus Bundle. J Midwifery Womens Health 2018; 63:366-376. [DOI: 10.1111/jmwh.12756] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 11/29/2022]
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Kandasamy S, Anand SS. Cardiovascular Disease Among Women From Vulnerable Populations: A Review. Can J Cardiol 2018; 34:450-457. [PMID: 29571426 DOI: 10.1016/j.cjca.2018.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 12/14/2022] Open
Abstract
On a global scale, cardiovascular disease (CVD) is the leading cause of mortality. It is also the number 1 cause of death among women, resulting in 8.6 million deaths annually and constituting one third of all deaths in women worldwide. The burden of CVD and related risk factors has taken priority in the policy development for noncommunicable diseases. However, vulnerable populations, defined here as women who are socially or economically disadvantaged (eg, low income), nonwhite (specifically South Asian and indigenous women), and those who are elderly have often been overlooked in these discussions. These additional vulnerabilities, which may exist independently or in combination, place such women at higher risk for CVD. Specifically, these vulnerabilities include low socioeconomic status, a low sense of control, high stress, South Asian or indigenous ancestry, and increased age. Thus it is vital that we initiate a multipronged approach to CVD prevention that includes rigorous monitoring of CVD risk factors in high-risk populations and the implementation of timely, accurate, and contextually tailored prevention programs, services, and treatments. Well-trained nonphysician health care workers can support the accurate monitoring and management of CVD and CVD risk factors so that groups of women who may otherwise be overlooked can receive adequate attention.
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Affiliation(s)
- Sujane Kandasamy
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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Okrainec K, Booth GL, Hollands S, Bell CM. Language Barriers Among the Foreign-Born in Canada: Agreement of Self-Reported Measures and Persistence Over Time. J Immigr Minor Health 2017; 19:50-56. [PMID: 26395900 DOI: 10.1007/s10903-015-0279-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Persistent language barriers are associated with poor health outcomes. The agreement between reporting a language barrier at time of immigration and in the 2007-2008 Canadian Community Health Survey (CCHS) was calculated using kappa scores among foreign-born individuals who arrived to Ontario, Canada between 1985 and 2005. A total of 2323 immigrants were included, with a mean (± SD) time of 10.2 ± 6.4 years between immigration and completing the CCHS. Only 6 % of immigrants reported a persistent language barrier, resulting in a low agreement between the two sources (kappa = 0.06, 95 % CI 0.042-0.086). Though immigrants were less likely to report a persistent language barrier the longer they had been in Canada, only 13 % of immigrants who had arrived <2 years ago reported one. Self-reported language barriers at time of immigration are poor indicators of persistent language barriers. There is a need for a better measure of language barriers among Canadian immigrants.
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Affiliation(s)
- Karen Okrainec
- Toronto Western Hospital, University Health Network, 399 Bathurst Street, 8EW-432E, Toronto, ON, M5T 2S8, Canada. .,Samuel Lunenfeld Research Institute of Mount Sinai Hospital, Toronto, ON, Canada.
| | - Gillian L Booth
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Simon Hollands
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Chaim M Bell
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Samuel Lunenfeld Research Institute of Mount Sinai Hospital, Toronto, ON, Canada
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Mirella MV, Pottie K, Welch V, Eslava-Schmalbach JH, Tugwell P. A province-wide survey on self-reported language proficiency and its influence in global health education. Rev Salud Publica (Bogota) 2017; 19:533-541. [DOI: 10.15446/rsap.v19n4.44319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 05/23/2017] [Indexed: 11/09/2022] Open
Abstract
Objetivo De acuerdo con la literatura, el idioma es el obstáculo más común en el contexto de la atención médica y un factor de riesgo asociado con resultados negativos. El objetivo de este estudio es presentar las diferencias percibidas entre los estudiantes de enfermería que hablan un idioma y aquellos que hablan dos o más (competencia lingüística reportada por ellos mismos) y sus habilidades y necesidades de aprendizaje en salud global.Método Estudio observacional de corte transversal entre estudiantes de enfermería de cinco universidades de Ontario. Se diseñó una encuesta para medir el conocimiento, las habilidades y las necesidades de aprendizaje en salud global.Resultados Se observó que los estudiantes que hablan más de dos idiomas tienen mayor probabilidad de interesarse más en aprender sobre problemas de salud global, los riesgos para la salud y su asociación con los viajes y la migración (p=0,44), así como sobre los determinantes sociales de la salud (p=0,042).Conclusión Es necesario que se brinde capacitación en aprendizaje de otros idiomas a los estudiantes de enfermería para que puedan afrontar las barreras impuestas por el lenguaje en los contextos de atención médica y mejorar la salud global, de manera local e internacional.
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Karliner LS, Pérez-Stable EJ, Gregorich SE. Convenient Access to Professional Interpreters in the Hospital Decreases Readmission Rates and Estimated Hospital Expenditures for Patients With Limited English Proficiency. Med Care 2017; 55:199-206. [PMID: 27579909 PMCID: PMC5309198 DOI: 10.1097/mlr.0000000000000643] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Twenty-five million people in the United States have limited English proficiency (LEP); this growing and aging population experiences worse outcomes when hospitalized. Federal requirements that hospitals provide language access services are very challenging to implement in the fast-paced, 24-hour hospital environment. OBJECTIVE To determine if increasing access to professional interpreters improves hospital outcomes for older patients with LEP. DESIGN Natural experiment on a medicine floor of an academic hospital. PARTICIPANTS Patients age 50 years or above discharged between January 15, 2007 and January 15, 2010. EXPOSURE Dual-handset interpreter telephone at every bedside July 15, 2008 to Mar 14, 2009. OUTCOME MEASURES Thirty-day readmission, length of stay, estimated hospital expenditures. RESULTS Of 8077 discharges, 1963 were for LEP, and 6114 for English proficient patients. There was a significant decrease in observed 30-day readmission rates for the LEP group during the 8-month intervention period compared with 18 months preintervention (17.8% vs. 13.4%); at the same time English proficient readmission rates increased (16.7% vs. 19.7%); results remained significant in adjusted analyses. This improved readmission outcome for the LEP group was not maintained during the subsequent postintervention period when the telephones became less accessible. There was no significant intervention impact on length of stay in either unadjusted or adjusted analyses. After accounting for interpreter services costs, the estimated 119 readmissions averted during the intervention period were associated with estimated monthly hospital expenditure savings of $161,404. CONCLUSIONS Comprehensive language access represents an important, high value service that all medical centers should provide to achieve equitable, quality healthcare for vulnerable LEP populations.
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Affiliation(s)
- Leah S Karliner
- Department of Medicine, Multiethnic Health Equity Research Center, Division of General Internal Medicine, University of California, San Francisco, CA
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Quoraishi S, George J, Farboud A, Marnane C. Atypical presentation of Bezold's and Citelli's abscesses, with recollection following an incomplete postoperative course of antibiotics. BMJ Case Rep 2017; 2017:bcr-2016-218072. [PMID: 28096227 DOI: 10.1136/bcr-2016-218072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bezold's and Citelli's abscesses are rare complications of otitis media. We present a case of a 44-year-old Eastern European man, with a history of recurrent otitis media, who was admitted to hospital with mastoiditis and initially treated with antibiotics. Despite clinical improvement, a CT scan showed mastoiditis with Bezold's and Citelli's abscesses. The patient underwent a myringotomy and grommet insertion, in addition to a cortical mastoidectomy and curettage of the neck abscesses. After a good recovery, he was discharged home. However, likely due to the language barrier, he did not complete a course of antibiotics as prescribed, and the abscess re-collected, necessitating a re-admission and re-operation. This report illustrates the importance of considering rare features of a common disease in the differential, and of communication in ensuring compliance.
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Affiliation(s)
- Sadik Quoraishi
- Department of Head and Neck Directorate, University Hospital of Wales, Cardiff, UK
| | | | | | - Conor Marnane
- Abertawe Bro Morgannwg University Health Board, Swansea, UK
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