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Blegen MB, Zingmond DS, Jackson NJ, Torres JR, Russell TA, Maggard-Gibbons M, Russell MM. Association of non-English language preference with postoperative hospital visits among California Medicaid enrollees. Surgery 2024:S0039-6060(24)00595-6. [PMID: 39304449 DOI: 10.1016/j.surg.2024.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 08/13/2024] [Accepted: 08/17/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Patients with non-English language preference encounter language barriers across phases of surgical care. Patients with a non-English language preference represent 35% of California households and are disproportionately insured by Medicaid. To determine whether language predicts surgical outcomes, we investigated the association of patient non-English language preference with postoperative emergency department visits and readmissions among California Medicaid enrollees. METHODS Our retrospective analysis of adult Medicaid enrollees undergoing 1 of 10 common inpatient operations using California hospital administrative data (2016-2019) modeled the association between non-English language preference and 30-day postoperative emergency department visits and readmissions using mixed effects logistic regression with hospital random intercept, adjusting for patient, operation, hospital, and community characteristics. Secondary analyses stratified by operation urgency and by insurance type in an all-payor cohort. RESULTS Of 115,527 Medicaid enrollees, 17.2% had non-English language preference (n = 19,881), 66% were female (n = 73,653), and 40% were Hispanic/Latino (n = 45,541). Patients with non-English language preference experienced fewer postoperative emergency department visits (non-English language preference: 13.5%, English preference: 17.9%, P < .001) and readmissions (non-English language preference: 7.5%, English preference: 8.5%, P < .001), which persisted in adjusted models (adjusted odds ratio emergency department, 0.80, 95% confidence interval, 0.77-0.85; readmissions: adjusted odds ratio, 0.86, 95% confidence interval, 0.80-0.92). Non-English language preference was associated with fewer emergency department visits after elective (adjusted odds ratio, 0.80; 95% confidence interval, 0.73-0.88) and urgent/emergent surgery (adjusted odds ratio, 0.80; 95% confidence interval, 0.75-0.85) but not readmissions after elective surgery (adjusted odds ratio, 0.89; 95% confidence interval, 0.78-1.01). This pattern was only observed for Medicaid and not other insurance types. CONCLUSION Patients with non-English language preference who receive Medicaid have fewer postoperative emergency department visits and readmissions, even after urgent surgery. Our findings suggest that patterns of health care seeking after surgery vary by patient language, and investigating explanatory mechanisms is needed.
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Affiliation(s)
- Mariah B Blegen
- Veterans Health Administration, Greater Los Angeles Healthcare System, CA; Department of Surgery, David Geffen School of Medicine at UCLA, CA; National Clinician Scholars Program, University of California, Los Angeles, CA
| | - David S Zingmond
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Nicholas J Jackson
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Jesus R Torres
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, CA
| | - Tara A Russell
- Department of Surgery, David Geffen School of Medicine at UCLA, CA
| | - Melinda Maggard-Gibbons
- Veterans Health Administration, Greater Los Angeles Healthcare System, CA; Department of Surgery, David Geffen School of Medicine at UCLA, CA; Olive View-UCLA Medical Center, Sylmar, CA
| | - Marcia M Russell
- Veterans Health Administration, Greater Los Angeles Healthcare System, CA; Department of Surgery, David Geffen School of Medicine at UCLA, CA.
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Chen YH, Handly N, Chang DC, Chen YW. Racial difference in receiving computed tomography for head injury patients in emergency departments. Am J Emerg Med 2024; 83:54-58. [PMID: 38964277 DOI: 10.1016/j.ajem.2024.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/19/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024] Open
Abstract
STUDY OBJECTIVE Prior studies have suggested potential racial differences in receiving imaging tests in emergency departments (EDs), but the results remain inconclusive. In addition, most prior studies may only have limited racial groups for minority patients. This study aimed to investigate racial differences in head computed tomography (CT) administration rates in EDs among patients with head injuries. METHODS Patients with head injuries who visited EDs were examined. The primary outcome was patients receiving head CT during ED visits, and the primary exposure was patient race/ethnicity, including Asian, Hispanic, Non-Hispanic Black (Black), and Non-Hispanic White (White). Multivariable logistic regression analyses were performed using the National Hospital Ambulatory Medical Care Survey database, adjusting for patients and hospital characteristics. RESULTS Among 6130 patients, 51.9% received a head CT scan. Asian head injury patients were more likely to receive head CT than White patients (59.1% versus 54.0%, difference 5.1%, p < 0.001). This difference persisted in adjusted results (odds ratio, 1.52; 95% CI, 1.06-2.16, p = 0.022). In contrast, Black and Hispanic patients have no significant difference in receiving head CT than White patients after the adjustment. CONCLUSIONS Asian head injury patients were more likely to receive head CT than White patients. This difference may be attributed to the limited English proficiency among Asian individuals and the fact that there is a wide variety of different languages spoken by Asian patients. Future studies should examine rates of receiving other diagnostic imaging modalities among different racial groups and possible interventions to address this difference.
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Affiliation(s)
- Yuan-Hsin Chen
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States of America
| | - Neal Handly
- Department of Emergency Medicine, Contra Costa Regional Medical Center, Martinez, CA, United States of America; Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA, United States of America
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States of America
| | - Ya-Wen Chen
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States of America.
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Bacon E, Thiessen ME, Vogel J, Whitfield J, Cervantes L, Podewils LJ. The Role of Language in Hospital Admissions: The COVID-19 Experience in a Safety-Net Hospital Emergency Department. J Emerg Med 2024:S0736-4679(24)00193-8. [PMID: 39271404 DOI: 10.1016/j.jemermed.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Emergency departments (EDs) are often patients' first point of contact with the health care system. Race, ethnicity, and language all influence factors leading up to ED visits and patient experiences within the ED. There is limited evidence showing how race, ethnicity, and language interact to shape ED experiences, particularly during the COVID-19 pandemic when EDs were extremely strained. OBJECTIVES Using a retrospective review, we evaluated the association of race, ethnicity and preferred language on hospital admissions from the ED for patients with COVID-19 in an urban, safety-net hospital during the first year of the COVID-19 pandemic before vaccines were widely available. METHODS We performed a nested regression analysis using generalized estimating equation (GEE) logit models to estimate the impact of language, race, and ethnicity on hospital admissions while controlling for other health conditions and healthcare utilization. RESULTS Patients who spoke Spanish and were Latino had 72% higher odds [95% confidence interval (CI):1.34-2.2] of hospital admission compared to patients who were White and spoke English. Patients who were Asian, the majority of whom also spoke languages other than English, had 130% higher odds (95% CI: 1.39-3.92) of hospital admission compared to patients who were White and English Speaking. CONCLUSIONS Findings suggest multiple mechanisms influence hospital admissions for patients who are racially and ethnically minoritized and speak Spanish. Providers may have admitted patients as a precaution rather than because of more advanced illness. Evaluating race, ethnicity, and language concurrently can reveal how intersectional factors shape patient experiences in the ED.
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Affiliation(s)
- Emily Bacon
- Denver Health and Hospital Authority, Denver, Colorado.
| | - Molly E Thiessen
- Denver Health and Hospital Authority, Denver, Colorado; Department of Medicine, University of Colorado, Aurora, Colorado
| | - Jody Vogel
- Stanford University, Palo Alto, California
| | - Jennifer Whitfield
- Denver Health and Hospital Authority, Denver, Colorado; Department of Medicine, University of Colorado, Aurora, Colorado
| | - Lilia Cervantes
- Department of Medicine, University of Colorado, Aurora, Colorado
| | - Laura Jean Podewils
- Denver Health and Hospital Authority, Denver, Colorado; Colorado School of Public Health, University of Colorado, Aurora, Colorado
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Twersky SE, Jefferson R, Garcia-Ortiz L, Williams E, Pina C. The Impact of Limited English Proficiency on Healthcare Access and Outcomes in the U.S.: A Scoping Review. Healthcare (Basel) 2024; 12:364. [PMID: 38338249 PMCID: PMC10855368 DOI: 10.3390/healthcare12030364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
A majority of individuals with limited English proficiency (LEP) in the U.S. are foreign-born, creating a complex intersection of language, socio-economic, and policy barriers to healthcare access and achieving good outcomes. Mapping the research literature is key to addressing how LEP intersects with healthcare. This scoping review followed PRISMA-ScR guidelines and included PubMed/MEDLINE, CINAHL, Sociological Abstracts, EconLit, and Academic Search Premier. Study selection included quantitative studies since 2000 with outcomes specified for adults with LEP residing in the U.S. related to healthcare service access or defined health outcomes, including healthcare costs. A total of 137 articles met the inclusion criteria. Major outcomes included ambulatory care, hospitalization, screening, specific conditions, and general health. Overall, the literature identified differential access to and utilization of healthcare across multiple modalities with poorer outcomes among LEP populations compared with English-proficient populations. Current research includes inconsistent definitions for LEP populations, primarily cross-sectional studies, small sample sizes, and homogeneous language and regional samples. Current regulations and practices are insufficient to address the barriers that LEP individuals face to healthcare access and outcomes. Changes to EMRs and other data collection to consistently include LEP status and more methodologically rigorous studies are needed to address healthcare disparities for LEP individuals.
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Affiliation(s)
- Sylvia E. Twersky
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
| | - Rebeca Jefferson
- R. Barbara Gitenstein Library, The College of New Jersey, Ewing Township, NJ 08618, USA;
| | - Lisbet Garcia-Ortiz
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
| | - Erin Williams
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
| | - Carol Pina
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
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Wentzel S, Craft A, Onwuka A, Lind M. Racial, ethnic and language disparities in healthcare utilization in pediatric patients following tonsillectomy. Int J Pediatr Otorhinolaryngol 2024; 176:111805. [PMID: 38043184 DOI: 10.1016/j.ijporl.2023.111805] [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: 08/28/2023] [Revised: 11/12/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
IMPORTANCE Tonsillectomy is one of the most common surgical procedures performed in the United States. However, there is little known about the intersectionality of race, ethnicity, and language and how these factors influence post-tonsillectomy outcomes such as ED utilization and hospital readmission rates. OBJECTIVE To examine disparities in emergency department (ED) utilization and hospital readmissions for post-tonsillectomy complications based on insurance status, patient race, ethnicity and language spoken. DESIGN This was retrospective cohort over four years. SETTING Tertiary Care Children's Hospital. PARTICIPANTS All children (n = 10,215) who underwent tonsillectomy or adenotonsillectomy at a tertiary children's hospital from January 2015 to December 2018 were identified and included. There were no exclusion criteria. EXPOSURE The exposure of interest was tonsillectomy. MAIN OUTCOMES AND MEASURES Outcomes and variables of interest were defined prior to data collection. The primary outcome of this study was emergency department (ED) utilization defined as any ED or urgent care visit within 21 days of the tonsillectomy for surgery-related concerns. The secondary outcome of this study was readmissions following tonsillectomy. RESULTS A total of 10215 pediatric patients (median age, 6 years; 5096 [50 %] male) who underwent tonsillectomy were included in the analysis. 13 % of patients presented to the ED with surgery-related complaints. Among English proficient patients, multi-racial patients were the only group with an elevated odds of ED utilization (OR:1.5, 95 % CI: 1.2, 1.9). Non-English language preference (NELP) patients of Black, Hispanic, Asian, and American Indian/Alaskan Native race/ethnicity also had elevated odds of ED use post-tonsillectomy compared to non-Hispanic White English proficient patients. Six percent of all patients had an unplanned hospital readmission. Asian patients with non-English language preference had 2.1 times the odds of readmission (95 % CI: 1.2, 3.6); and were disproportionately admitted for post-tonsillectomy hemorrhage. CONCLUSIONS and Relevance: Language disparities in ED use and readmission persist after adjusting for risk factors. Non-English language preference populations have a higher rate of ED utilization, especially for minor complications. Disparities may result from differential health literacy or predispositions to complications. Future directions include additional research on mechanisms and targeted interventions to increase education and access to language-appropriate resources.
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Affiliation(s)
- Stephanie Wentzel
- Medical Student Research Program, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Aaron Craft
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Amanda Onwuka
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Meredith Lind
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Otolaryngology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Plys E, Fidai S, Robinson DN, Nogg KA, Phimphasone-Brady P. Open to interpretation: An integrated primary care behavioral health training approach for treating linguistically diverse patients. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2023; 41:537-546. [PMID: 37227825 PMCID: PMC11025311 DOI: 10.1037/fsh0000807] [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] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Integrated primary care settings serve an increasingly high volume of linguistically diverse patients. In English language-dominant countries, limited English proficiency (LEP) is associated with disparities in access and quality of behavioral health (BH) care. Interpretive services (IS) aim to address these disparities by assisting in the delivery of clinical care between patients and providers who speak different languages. Yet, there is a need for greater emphasis on the utilization of IS in clinical training for BH professionals (e.g., psychology, social work, counseling, and family therapy). METHOD In this conceptual article, we describe a BH practicum rotation for predoctoral psychology trainees in a free, student-run integrated primary care clinic that largely serves uninsured adults with LEP. First, we discuss our training model which includes a 90-min didactic lecture on IS for BH and supervised applied clinical experiences (e.g., psychotherapy, warm handoffs, and consultation). Then, we present vignettes prepared by trainees about the challenges and benefits associated with delivering BH care with IS at the predoctoral level of training. RESULTS From the practicum experience, clinical psychology trainees reported improved knowledge and competencies in utilizing IS as well as generalizable skills for delivering BH care with a focus on multicultural practice. DISCUSSION We recommend that other integrated primary care BH training sites consider emphasizing training in IS. This article concludes with recommendations for implementation and dissemination of our training model on other sites. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Evan Plys
- Department of Psychiatry, University of Colorado Denver—Anschutz Medical Campus
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Sophia Fidai
- Graduate School of Professional Psychology, University of Denver
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Chang E, Davis TL, Berkman ND. Differences in Telemedicine, Emergency Department, and Hospital Utilization Among Nonelderly Adults with Limited English Proficiency Post-COVID-19 Pandemic: a Cross-Sectional Analysis. J Gen Intern Med 2023; 38:3490-3498. [PMID: 37592119 PMCID: PMC10713935 DOI: 10.1007/s11606-023-08353-7] [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: 02/09/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND The unprecedented use of telemedicine during the COVID-19 pandemic provided an opportunity to examine its uptake among individuals with limited English proficiency (LEP). OBJECTIVE To assess telemedicine use among nonelderly adults with LEP and the association between use of telehealth and emergency department (ED) and hospital visits. DESIGN Cross-sectional study using the National Health Interview Survey (July 2020-December 2021) PARTICIPANTS: Adults (18-64 years), with LEP (N=1488) or English proficiency (EP) (N=25,873) MAIN MEASURES: Telemedicine, ED visits, and hospital visits in the past 12 months. We used multivariate logistic regression to assess (1) the association of English proficiency on having telemedicine visits; and (2) the association of English proficiency and telemedicine visits on having ED and hospital visits. KEY RESULTS Between July 2020 and December 2021, 22% of adults with LEP had a telemedicine visit compared to 35% of adults with EP. After controlling for predisposing, enabling, and need factors, adults with LEP had 20% lower odds of having a telemedicine visit than adults with EP (p=0.02). While English proficiency was not associated with ED or hospital visits during this time, adults with telemedicine visits had significantly greater odds of having any ED (aOR: 1.80, p<0.001) and hospital visits (aOR: 2.03, p<0.001) in the past 12 months. CONCLUSIONS While telemedicine use increased overall during the COVID-19 pandemic, its use remained much less likely among adults with LEP. Interventions targeting structural barriers are needed to address disparities in access to telemedicine. More research is needed to understand the relationship between English proficiency, telemedicine visits, and downstream ED and hospital visits.
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Affiliation(s)
- Eva Chang
- Advocate Aurora Research Institute, Advocate Health, 945 N. 12th St., Milwaukee, WI, 53233, USA.
| | - Teaniese L Davis
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, USA
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Pourat N, Lu C, Chen X, Zhou W, Hair B, Bolton J, Hoang H, Sripipatana A. Factors associated with frequent emergency department visits among health centre patients receiving primary care. J Eval Clin Pract 2023; 29:964-975. [PMID: 36788435 DOI: 10.1111/jep.13818] [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: 08/10/2022] [Revised: 01/23/2023] [Accepted: 01/29/2023] [Indexed: 02/16/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES We sought to examine specific care-seeking behaviours and experiences, access indicators, and patient care management approaches associated with frequency of emergency department (ED) visits among patients of Health Resources and Services Administration-funded health centres that provide comprehensive primary care to low-income and uninsured patients. METHOD We used cross-sectional data of a most recent nationally representative sample of health centre adult patients aged 18-64 (n = 4577) conducted between October 2014 and April 2015. These data were merged with the 2014 Uniform Data System to incorporate health centre characteristics. We measured care-seeking behaviours by whether the patient called the health centre afterhours, for an urgent appointment, or talked to a provider about a concern. Access to care indicators included health centre continuity of care and receipt of transportation or translation services. We included receipt of care coordination and specialist referral as care management indicators. We used a multilevel multinomial logistic regression model to identify the association of independent variables with number of ED visits (4 or more visits, 2-3 visits, 1 visit, vs. 0 visits), controlling for predisposing, enabling, and need characteristics. RESULTS Calling the health centre after-hours (OR = 2.41) or for urgent care (OR = 2.53), and being referred to specialists (OR = 2.36) were associated with higher odds of four or more ED visits versus none. Three or more years of continuity with the health centre (OR = 0.32) was also associated with lower odds of four or more ED visits versus none. CONCLUSIONS Findings underscore opportunities to reduce higher frequency of ED visits in health centres, which are primary care providers to many low-income populations. Our findings highlight the potential importance of improving patient retention, better access to providers afterhours or for urgent visits, and access to specialist as areas of care in need of improvement.
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Affiliation(s)
- Nadereh Pourat
- UCLA Center for Health Policy Research, Los Angeles, California, USA
- UCLA Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, California, USA
| | - Connie Lu
- UCLA Center for Health Policy Research, Los Angeles, California, USA
| | - Xiao Chen
- UCLA Center for Health Policy Research, Los Angeles, California, USA
| | - Weihao Zhou
- UCLA Center for Health Policy Research, Los Angeles, California, USA
| | - Brionna Hair
- U.S. Department of Health and Human Services, Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, Maryland, USA
| | - Joshua Bolton
- U.S. Department of Health and Human Services, Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, Maryland, USA
| | - Hank Hoang
- U.S. Department of Health and Human Services, Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, Maryland, USA
| | - Alek Sripipatana
- U.S. Department of Health and Human Services, Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, Maryland, USA
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Schwei RJ, Hoang L, Wilson P, Greene MZ, Lor M, Shah MN, Pulia MS. Patient-centered care outcomes for patients in the emergency department with a non-English language preference: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 114:107875. [PMID: 37399665 DOI: 10.1016/j.pec.2023.107875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE This review highlights what is known about patient-centered care outcomes (PCCOs) for emergency department (ED) patients with non-English language preferences (NELP). METHODS Four databases were searched and included article were written in English, presented primary evidence, published in a peer-reviewed journal, and reported PCCOs from the perspective of ED patients with NELP. PCCOs were defined using the Institute of Medicine definition, outcomes that evaluate respect and responsiveness to patient preferences, needs and values. Two reviewers assessed all articles, extracted data, and resolved discrepancies. PCCOs were grouped in categories (needs, preferences, and values) based on the definition's domains. RESULTS Of the 6524 potentially eligible studies, 20 met inclusion criteria. Of these, 16 focused on needs; 4 on preferences and 8 on values. Within patient need, five studies found a large unmet need for language services. Within patient value, three found that language discordance negatively influenced perceptions of care. CONCLUSIONS Most studies in this review found that not speaking English negatively influenced perceptions of care and highlighted a large unmet need for language services in the ED. PRACTICE IMPLICATIONS More work needs to be done to characterize PCCOs in ED patients with NELP and develop interventions to improve care.
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Affiliation(s)
- Rebecca J Schwei
- 800 University Bay Drive, Suite 310, Madison, WI 53705, USA; BerbeeWalsh Department of Emergency Medicine, University of Wisconsin Madison School of Medicine and Public Health, Suite 310, Madison, WI 53705, USA.
| | - Ly Hoang
- 800 University Bay Drive, Suite 310, Madison, WI 53705, USA; BerbeeWalsh Department of Emergency Medicine, University of Wisconsin Madison School of Medicine and Public Health, Suite 310, Madison, WI 53705, USA
| | - Paije Wilson
- Ebling Library for the Health Sciences, University of Wisconsin Madison School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53705, USA
| | - Madelyne Z Greene
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave, Madison, WI 53705, USA
| | - Maichou Lor
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave, Madison, WI 53705, USA
| | - Manish N Shah
- 800 University Bay Drive, Suite 310, Madison, WI 53705, USA; BerbeeWalsh Department of Emergency Medicine, University of Wisconsin Madison School of Medicine and Public Health, Suite 310, Madison, WI 53705, USA; Department of Medicine (Geriatrics and Gerontology), University of Wisconsin Madison School of Medicine and Public Health, 1685 Highland Ave, Madison, WI 53792, USA; Department of Population Health Sciences, University of Wisconsin Madison School of Medicine and Public Health, Warf Office Bldg, 610 Walnut St. #707, Madison, WI 53726, USA
| | - Michael S Pulia
- 800 University Bay Drive, Suite 310, Madison, WI 53705, USA; BerbeeWalsh Department of Emergency Medicine, University of Wisconsin Madison School of Medicine and Public Health, Suite 310, Madison, WI 53705, USA; Department of Industrial and Syste ms Engineering, College of Engineering, University of Wisconsin-Madison, 3107 Mechanical Engineering Building, 1513 University Ave, Madison, WI 53706, USA
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Chen Q, Maher CG, Rogan E, Machado G. Management of low back pain in Australian emergency departments for culturally and linguistically diverse populations from 2016 to 2021. Emerg Med J 2023:emermed-2022-212718. [PMID: 37085180 DOI: 10.1136/emermed-2022-212718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Disparate care in the ED for minority populations with low back pain is a long-standing issue reported in the USA. Our objective was to compare care delivery for low back pain in Australian EDs between culturally and linguistically diverse (CALD) and non-CALD patients. METHODS This is a retrospective review of medical records of the ED of three public hospitals in Sydney, New South Wales, Australia from January 2016 to October 2021. We included adult patients diagnosed with non-serious low back pain at ED discharge. CALD status was defined by country of birth, preferred language and use of interpreter service. The main outcome measures were ambulance transport, lumbar imaging, opioid administration and hospital admission. RESULTS Of the 14 642 included presentations, 7656 patients (52.7%) were born overseas, 3695 (25.2%) preferred communicating in a non-English language and 1224 (8.4%) required an interpreter. Patients born overseas were less likely to arrive by ambulance (adjusted OR (aOR) 0.68, 95% CI 0.63 to 0.73) than Australian-born patients. Patients who preferred a non-English language were also less likely to arrive by ambulance (aOR 0.82, 95% CI 0.75 to 0.90), yet more likely to be imaged (aOR 1.12, 95% CI 1.01 to 1.23) or be admitted to hospital (aOR 1.16, 95% CI 1.04 to 1.29) than Native-English-speaking patients. Patients who required an interpreter were more likely to receive imaging (aOR 1.43, 95% CI 1.25 to 1.64) or be admitted (aOR 1.49, 95% CI 1.29 to 1.73) compared with those who communicated independently. CALD patients were generally less likely to receive weak opioids than non-CALD patients (aOR range 0.76-0.87), yet no difference was found in the use of any opioid or strong opioids. CONCLUSION Patients with low back pain from a CALD background, especially those lacking English proficiency, are significantly more likely to be imaged and admitted in Australian EDs. Future interventions improving the quality of ED care for low back pain should give special consideration to CALD patients.
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Affiliation(s)
- Qiuzhe Chen
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Eileen Rogan
- Canterbury Hospital, Campsie, New South Wales, Australia
| | - Gustavo Machado
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Ramirez N, Shi K, Yabroff KR, Han X, Fedewa SA, Nogueira LM. Access to Care Among Adults with Limited English Proficiency. J Gen Intern Med 2023; 38:592-599. [PMID: 35882706 PMCID: PMC9971409 DOI: 10.1007/s11606-022-07690-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are approximately 25.6 million individuals with limited English proficiency (LEP) in the USA, and this number is increasing. OBJECTIVE Investigate associations between LEP and access to care in adults. DESIGN Cross-sectional nationally representative survey. PARTICIPANTS Adults with (n = 18,908) and without (n = 98,060) LEP aged ≥ 18 years identified from the 2014-2018 Medical Expenditure Panel Survey MAIN MEASURES: Associations between LEP and access to healthcare and preventive services were evaluated with multivariable logistic regression models, stratified by age group (18-64 and ≥ 65 years). The official government definition of LEP (answers "not at all/not well/well" to the question "How well do you speak English?") was used. Access to care included having a usual source of care (and if so, distance from usual source of care, difficulty contacting usual source of care, and provision of extended hours), visiting a medical provider in the past 12 months, having to forego or delay care, and having trouble paying for medical bills. Preventive services included blood pressure and cholesterol check, flu vaccination, and cancer screening. KEY RESULTS Adults aged 18-64 years with LEP were significantly more likely to lack a usual source of care (adjusted odds ratios [aOR] = 2.48; 95% confidence interval [CI] = 2.27-2.70), not have visited a medical provider (aOR = 2.02; CI = 1.89-2.16), and to be overdue for receipt of preventive services, including blood pressure check (aOR = 2.00; CI = 1.79-2.23), cholesterol check (aOR = 1.22; CI = 1.03-1.44), and colorectal cancer screening (aOR = 1.58; CI = 1.37-1.83) than adults without LEP. Results were similar among adults aged ≥ 65 years. CONCLUSIONS Adults with LEP had consistently worse access to care than adults without LEP. System-level interventions, such as expanding access to health insurance coverage, providing language services, improving provider training in cultural competence, and increasing diversity in the medical workforce may minimize barriers and improve equity in access to care.
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Affiliation(s)
- Natalia Ramirez
- Surveillance and Health Equity Sciences, American Cancer Society, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kewei Shi
- Surveillance and Health Equity Sciences, American Cancer Society, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Sciences, American Cancer Society, Atlanta, GA, USA
| | - Xuesong Han
- Surveillance and Health Equity Sciences, American Cancer Society, Atlanta, GA, USA
| | - Stacey A Fedewa
- Surveillance and Health Equity Sciences, American Cancer Society, Atlanta, GA, USA
| | - Leticia M Nogueira
- Surveillance and Health Equity Sciences, American Cancer Society, Atlanta, GA, USA.
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12
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Schlange SA, Palmer-Wackerly AL, Chaidez V. A Narrative Review of Medical Interpretation Services and their Effect on the Quality of Health Care. South Med J 2022; 115:317-321. [PMID: 35504613 DOI: 10.14423/smj.0000000000001392] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Half of the foreign-born population in the United States speaks English "less than very well." The extant literature suggests that low-English-proficient (LEP) patients experience poorer healthcare outcomes than do language-concordant patients. It remains unclear which methods of interpreter services are best for communicating effectively and achieving positive health outcomes for LEP patients. This review examines interpretation methods to compare their effectiveness and frequency of use and identifies the remaining gaps in our knowledge. The evidence suggests that any type of professional language service is superior to untrained interpreting and vastly better than not using an interpreter at all. Even with this knowledge, use of interpreter services is unacceptably low and gaps remain. Further research is needed to isolate and examine different methods of interpretation and measure objective health outcomes. In addition, education is needed for interpreters and healthcare providers to ensure the most effective communicative strategies for LEP patients.
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Affiliation(s)
- Stacie A Schlange
- From Nutrition and Health Sciences and Communication Studies, University of Nebraska-Lincoln, Lincoln
| | - Angela L Palmer-Wackerly
- From Nutrition and Health Sciences and Communication Studies, University of Nebraska-Lincoln, Lincoln
| | - Virginia Chaidez
- From Nutrition and Health Sciences and Communication Studies, University of Nebraska-Lincoln, Lincoln
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13
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Ndukwe T, Cole E, Scanzera AC, Chervinko MA, Chiang MF, Campbell JP, Chan RVP. Health Equity and Disparities in ROP Care: A Need for Systematic Evaluation. Front Pediatr 2022; 10:806691. [PMID: 35433564 PMCID: PMC9010777 DOI: 10.3389/fped.2022.806691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/03/2022] [Indexed: 12/04/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that can have devastating visual sequelae if not managed appropriately. From an ophthalmology standpoint, ROP care is complex, since it spans multiple care settings and providers, including those in the neonatal intensive care unit (NICU), step down nurseries, and the outpatient clinic setting. This requires coordination and communication between providers, ancillary staff, and most importantly, effective communication with the patient's family members and caregivers. Often, factors related to the social determinants of health play a significant role in effective communication and care coordination with the family, and it is important for ophthalmologists to recognize these risk factors. The aim of this article is to (1) review the literature related to disparities in preterm birth outcomes and infants at risk for ROP; (2) identify barriers to ROP care and appropriate follow up, and (3) describe patient-oriented solutions and future directions for improving ROP care through a health equity lens.
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Affiliation(s)
- Tochukwu Ndukwe
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Emily Cole
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Angelica C. Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Margaret A. Chervinko
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
| | - Michael F. Chiang
- National Institutes of Health, National Eye Institute, Bethesda, MD, United States
| | - John Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, United States
| | - Robison Vernon Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States
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14
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Clark JR, Shlobin NA, Batra A, Liotta EM. The Relationship Between Limited English Proficiency and Outcomes in Stroke Prevention, Management, and Rehabilitation: A Systematic Review. Front Neurol 2022; 13:790553. [PMID: 35185760 PMCID: PMC8850381 DOI: 10.3389/fneur.2022.790553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/11/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Individuals with limited English proficiency (LEP) face structural challenges to communication in English-speaking healthcare environments. We performed a systematic review to characterize the relationship between LEP and outcomes in stroke prevention, management, and recovery. Methods A systematic review was conducted using the PubMed, Embase, Scopus, and Web of Science databases. Titles and abstracts from articles identified were read and selected for full text review. Studies meeting inclusion criteria were reviewed in full for study design, aim, and outcomes. Results Of 891 unique articles, 20 were included. Eleven articles did not provide information about interpreter availability or usage, limiting the ability to draw conclusions about the effect of LEP on measured outcomes in these studies. Overall, studies demonstrated that English proficiency is associated with better outcomes in preventive aspects of stroke care such as stroke symptom awareness, anticoagulation maintenance, and knowledge of warfarin indication. Some acute stroke care metrics were independent of English proficiency in seven studies while other evidence showed associations between interpreter requirement and quality of inpatient care received. LEP and English-proficient groups show similar mortality despite greater lengths of stay and greater proportions of care in dedicated stroke units for LEP patients. Post-stroke quality of life can be worse for those with LEP, and language barriers can negatively impact patient and provider experiences of rehabilitation. Conclusions Stroke patients with LEP face barriers to equitable care at multiple stages. While some studies demonstrate worse outcomes for LEP patients, equitable care was shown in multiple studies frequently in the setting of a high degree of interpreter availability. Patients with LEP will benefit from tailored education regarding stroke symptom recognition and medication regimens, and from provision of translated written educational material. Inequities in inpatient care and rehabilitation exist despite similar mortality rates in four studies. Future studies should report interpreter availability and usage within LEP groups and whether patient interactions were language-concordant or discordant in order to allow for more generalizable and reliable conclusions.
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15
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Gutman CK, Lion KC, Fisher CL, Aronson PL, Patterson M, Fernandez R. Breaking through barriers: the need for effective research to promote language-concordant communication as a facilitator of equitable emergency care. J Am Coll Emerg Physicians Open 2022; 3:e12639. [PMID: 35072163 PMCID: PMC8759339 DOI: 10.1002/emp2.12639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 02/05/2023] Open
Abstract
Individuals with limited English proficiency (LEP) are at high risk for adverse outcomes in the US health care system. This is particularly true for patients with LEP seeking care in the emergency department (ED). Although professional language interpretation improves the quality of care for these patients, it remains underused. The dynamic, discontinuous nature of an ED visit poses distinct challenges and opportunities for providing equitable, high-quality care for patients with LEP. Evidence-based best practices for identifying patients with LEP and using professional interpretation are well described but inadequately implemented. There are few examples in the literature of rigorous interventions to improve quality of care and outcomes for patients with LEP. There is an urgent need for high-quality research to improve communication with patients with LEP along the continuum of emergency care in order to achieve equity in outcomes.
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Affiliation(s)
- Colleen K Gutman
- Department of Emergency Medicine University of Florida College of Medicine Gainesville Florida USA
| | - K Casey Lion
- Department of Pediatrics University of Washington School of Medicine Seattle, Washington USA
- Center for Child Health, Behavior, and Development Seattle Children's Research Institute Seattle, Washington USA
| | - Carla L Fisher
- STEM Translational Communication Center University of Florida College of Journalism and Communication Gainesville Florida USA
- UF Health Cancer Center, Center for Arts in Medicine University of Florida Gainesville Florida USA
| | - Paul L Aronson
- Department of Pediatrics Yale School of Medicine New Haven Connecticut USA
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
| | - Mary Patterson
- Department of Emergency Medicine University of Florida College of Medicine Gainesville Florida USA
- Center for Experiential Learning and Simulation University of Florida College of Medicine Gainesville Florida USA
| | - Rosemarie Fernandez
- Department of Emergency Medicine University of Florida College of Medicine Gainesville Florida USA
- Center for Experiential Learning and Simulation University of Florida College of Medicine Gainesville Florida USA
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16
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Isbey S, Badolato G, Kline J. Pediatric Emergency Department Discharge Instructions for Spanish-Speaking Families: Are We Getting It Right? Pediatr Emerg Care 2022; 38:e867-e870. [PMID: 34140448 DOI: 10.1097/pec.0000000000002470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Patients who speak Spanish are less likely to comply with discharge instructions, adhere to appointments, and take medications than English-speaking patients. However, adherence is improved when discharge instructions are provided in Spanish. This study was designed to assess the frequency of providing written discharge instructions in Spanish to patients who speak Spanish and request interpretation services, and to determine factors associated with receiving written discharge instructions in the preferred language in a pediatric emergency department (ED). METHODS This was a retrospective cross-sectional study of all discharges of Spanish-speaking patients who requested an interpreter in 1 year from a large urban pediatric ED and an associated community ED. Multivariable logistic regression was used to identify patient and visit level characteristics associated with receiving written discharge instructions in Spanish. RESULTS Sixty-one percent of 11,545 patient encounters where a Spanish interpreter was requested received written discharge instructions in Spanish. Patients aged 1 to 3 years (adjusted odds ratio [aOR], 2.87; 95% CI, 2.18-3.77) and aged 4 to 12 years (aOR, 2.06; 95% CI, 1.6-2.65), those seen without a trainee (aOR, 1.37; 95% CI, 1.25-1.5), and those with low acuity triage levels (aOR, 1.6; 95% CI, 1.29-1.97) were more likely to receive discharge instruction in Spanish. Female patients were less likely to receive Spanish discharge instructions (aOR, 0.9; 95% CI, 0.83-0.97). CONCLUSIONS Discharged pediatric ED patients often do not receive written instructions in the preferred language. Patient and provider factors are associated with receiving written instructions in Spanish. Quality improvement efforts are needed to ensure appropriate language discharge education.
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Affiliation(s)
- Sarah Isbey
- From the Department of Emergency Medicine, Children's National Hospital, School of Medicine and Health Sciences, George Washington University
| | - Gia Badolato
- Department of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Jaclyn Kline
- From the Department of Emergency Medicine, Children's National Hospital, School of Medicine and Health Sciences, George Washington University
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17
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Reaume M, Batista R, Rhodes E, Knight B, Imsirovic H, Seale E, Riad K, Prud'homme D, Tanuseputro P. The Impact of Language on Emergency Department Visits, Hospitalizations, and Length of Stay Among Home Care Recipients. Med Care 2021; 59:1006-1013. [PMID: 34432768 DOI: 10.1097/mlr.0000000000001638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research considering the impact of language on health care utilization is limited. We conducted a population-based study to: (1) investigate the association between residents' preferred language and hospital-based health care utilization; and (2) determine whether this association is modified by dementia, a condition which can exacerbate communication barriers. METHODS We used administrative databases to establish a retrospective cohort study of home care recipients (2015-2017) in Ontario, Canada, where the predominant language is English. Residents' preferred language (obtained from in-person home care assessments) was coded as English (Anglophones), French (Francophones), or other (Allophones). Diagnoses of dementia were ascertained with a previously validated algorithm. We identified all emergency department (ED) visits and hospitalizations within 1 year. RESULTS Compared with Anglophones, Allophones had lower annual rates of ED visits (1.3 vs. 1.8; P<0.01) and hospitalizations (0.6 vs. 0.7; P<0.01), while Francophones had longer hospital stays (9.1 vs. 7.6 d per admission; P<0.01). After adjusting for potential confounders, Francophones and Allophones were less likely to visit the ED or be hospitalized than Anglophones. We found evidence of synergism between language and dementia; the average length of stay for Francophones with dementia was 25% (95% confidence interval: 1.10-1.39) longer when compared with Anglophones without dementia. CONCLUSIONS Residents whose preferred language was not English were less frequent users of hospital-based health care services, a finding that is likely attributable to cultural factors. Francophones with dementia experienced the longest stays in hospital. This may be related to the geographic distribution of Francophones (predominantly in rural areas) or to suboptimal patient-provider communication.
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Affiliation(s)
- Michael Reaume
- Faculty of Medicine, University of Ottawa
- Institut du Savoir Montfort
| | - Ricardo Batista
- Institut du Savoir Montfort
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa
- ICES
| | - Emily Rhodes
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa
| | - Braden Knight
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa
- ICES
| | - Haris Imsirovic
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa
- ICES
| | - Emily Seale
- Faculty of Medicine, University of Ottawa
- Institut du Savoir Montfort
| | - Karine Riad
- Faculty of Medicine, University of Ottawa
- Institut du Savoir Montfort
| | - Denis Prud'homme
- Institut du Savoir Montfort
- Faculty of Health Sciences, University of Ottawa
| | - Peter Tanuseputro
- Faculty of Medicine, University of Ottawa
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa
- ICES
- Bruyère Research Institute, Ottawa, Canada
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18
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Hong AS, Nguyen DQ, Lee SC, Courtney DM, Sweetenham JW, Sadeghi N, Cox JV, Fullington H, Halm EA. Prior Frequent Emergency Department Use as a Predictor of Emergency Department Visits After a New Cancer Diagnosis. JCO Oncol Pract 2021; 17:e1738-e1752. [PMID: 34038164 PMCID: PMC8600510 DOI: 10.1200/op.20.00889] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To determine whether emergency department (ED) visit history prior to cancer diagnosis is associated with ED visit volume after cancer diagnosis. METHODS This was a retrospective cohort study of adults (≥ 18 years) with an incident cancer diagnosis (excluding nonmelanoma skin cancers or leukemia) at an academic medical center between 2008 and 2018 and a safety-net hospital between 2012 and 2016. Our primary outcome was the number of ED visits in the first 6 months after cancer diagnosis, modeled using a multivariable negative binomial regression accounting for ED visit history in the 6-12 months preceding cancer diagnosis, electronic health record proxy social determinants of health, and clinical cancer-related characteristics. RESULTS Among 35,090 patients with cancer (49% female and 50% non-White), 57% had ≥ 1 ED visit in the 6 months immediately following cancer diagnosis and 20% had ≥ 1 ED visit in the 6-12 months prior to cancer diagnosis. The strongest predictor of postdiagnosis ED visits was frequent (≥ 4) prediagnosis ED visits (adjusted incidence rate ratio [aIRR]: 3.68; 95% CI, 3.36 to 4.02). Other covariates associated with greater postdiagnosis ED use included having 1-3 prediagnosis ED visits (aIRR: 1.32; 95% CI, 1.28 to 1.36), Hispanic (aIRR: 1.12; 95% CI, 1.07 to 1.17) and Black (aIRR: 1.21; 95% CI, 1.17 to 1.25) race, homelessness (aIRR: 1.95; 95% CI, 1.73 to 2.20), advanced-stage cancer (aIRR: 1.30; 95% CI, 1.26 to 1.35), and treatment regimens including chemotherapy (aIRR: 1.44; 95% CI, 1.40 to 1.48). CONCLUSION The strongest independent predictor for ED use after a new cancer diagnosis was frequent ED visits before cancer diagnosis. Efforts to reduce potentially avoidable ED visits among patients with cancer should consider educational initiatives that target heavy prior ED users and offer them alternative ways to seek urgent medical care.
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Affiliation(s)
- Arthur S. Hong
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX,Arthur S. Hong, MD, MPH, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390; e-mail:
| | - Danh Q. Nguyen
- University of Texas Southwestern Medical School, Dallas, TX
| | - Simon Craddock Lee
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | - D. Mark Courtney
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - John W. Sweetenham
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | - Navid Sadeghi
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX,Parkland Health & Hospital System, Dallas, TX
| | - John V. Cox
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX,Parkland Health & Hospital System, Dallas, TX
| | - Hannah Fullington
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ethan A. Halm
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
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19
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Ro A, Yang HW, Du S, Hanlon CL, Young AS. Severity of Inpatient Hospitalizations Among Undocumented Immigrants and Medi-Cal Patients in a Los Angeles, California, Hospital: 2019. Am J Public Health 2021; 111:2019-2026. [PMID: 34648382 PMCID: PMC8630503 DOI: 10.2105/ajph.2021.306485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To compare the severity of inpatient hospitalizations between undocumented immigrants and Medi-Cal patients in a large safety-net hospital in Los Angeles, California. Methods. We conducted a retrospective analysis of all 2019 inpatient stays at a Los Angeles hospital (n = 22 480), including patients of all races/ethnicities. We examined 3 measures by using insurance status to approximate immigration status: illness severity, length of hospital stay, and repeat hospitalizations. We calculated group differences between undocumented and Medi-Cal patients by using inverse probability weighted regression adjustment separately for patients aged 18 to 64 years and those aged 65 years and older. Results. Younger undocumented patients had less severe illness and shorter lengths of stay than their Medi-Cal counterparts. Older undocumented immigrants also had less severe illness, but had similar lengths of stay and were more likely to have repeated hospitalizations. Conclusions. While existing work suggests that undocumented immigrants could have more severe health care needs on account of their poorer access to medical care, we did not see clear health disadvantages among hospitalized undocumented immigrants, especially younger patients. There were fewer differences between undocumented and Medi-Cal patients who were older. (Am J Public Health. 2021;111(11):2019-2026. https://doi.org/10.2105/AJPH.2021.306485).
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Affiliation(s)
- Annie Ro
- Annie Ro is with the Department of Health, Society, and Behavior at the University of California, Irvine. At the time the study was conducted, Helen W. Yang was a chief resident in Internal Medicine at the Keck School of Medicine of University of Southern California (USC), Los Angeles. Senxi Du is a medical student at the Keck School of Medicine of Medicine. Courtney L. Hanlon is with the Los Angeles County and USC Medical Center, Los Angeles. Andrew Shane Young is with the Division of Geriatric, Hospital, Palliative, and General Internal Medicine, Department of Medicine, Keck School of Medicine
| | - Helen W Yang
- Annie Ro is with the Department of Health, Society, and Behavior at the University of California, Irvine. At the time the study was conducted, Helen W. Yang was a chief resident in Internal Medicine at the Keck School of Medicine of University of Southern California (USC), Los Angeles. Senxi Du is a medical student at the Keck School of Medicine of Medicine. Courtney L. Hanlon is with the Los Angeles County and USC Medical Center, Los Angeles. Andrew Shane Young is with the Division of Geriatric, Hospital, Palliative, and General Internal Medicine, Department of Medicine, Keck School of Medicine
| | - Senxi Du
- Annie Ro is with the Department of Health, Society, and Behavior at the University of California, Irvine. At the time the study was conducted, Helen W. Yang was a chief resident in Internal Medicine at the Keck School of Medicine of University of Southern California (USC), Los Angeles. Senxi Du is a medical student at the Keck School of Medicine of Medicine. Courtney L. Hanlon is with the Los Angeles County and USC Medical Center, Los Angeles. Andrew Shane Young is with the Division of Geriatric, Hospital, Palliative, and General Internal Medicine, Department of Medicine, Keck School of Medicine
| | - Courtney L Hanlon
- Annie Ro is with the Department of Health, Society, and Behavior at the University of California, Irvine. At the time the study was conducted, Helen W. Yang was a chief resident in Internal Medicine at the Keck School of Medicine of University of Southern California (USC), Los Angeles. Senxi Du is a medical student at the Keck School of Medicine of Medicine. Courtney L. Hanlon is with the Los Angeles County and USC Medical Center, Los Angeles. Andrew Shane Young is with the Division of Geriatric, Hospital, Palliative, and General Internal Medicine, Department of Medicine, Keck School of Medicine
| | - Andrew Shane Young
- Annie Ro is with the Department of Health, Society, and Behavior at the University of California, Irvine. At the time the study was conducted, Helen W. Yang was a chief resident in Internal Medicine at the Keck School of Medicine of University of Southern California (USC), Los Angeles. Senxi Du is a medical student at the Keck School of Medicine of Medicine. Courtney L. Hanlon is with the Los Angeles County and USC Medical Center, Los Angeles. Andrew Shane Young is with the Division of Geriatric, Hospital, Palliative, and General Internal Medicine, Department of Medicine, Keck School of Medicine
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20
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Chang H, Hutchinson C, Gullick J. Pulled away: the experience of bilingual nurses as ad hoc interpreters in the emergency department. ETHNICITY & HEALTH 2021; 26:1045-1064. [PMID: 31046427 DOI: 10.1080/13557858.2019.1613518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/24/2019] [Indexed: 06/09/2023]
Abstract
This study aimed to understand the experiences of bilingual nurses asked to interpret in the Emergency Department (ED), and the subsequent impact on safety climate. Australian ED clinicians assess and treat high numbers of linguistically diverse patients, many with limited English proficiency. New South Wales Health policy mandates the use of accredited interpreters when collecting personal and health information, and when obtaining consent for medical procedures. Semi-structured interviews with 12 nurses (representing 12 languages) from two metropolitan EDs were audio-recorded and analysed using qualitative content analysis, guided by Glendon & Stanton's model of organisational climate and culture. Analysis revealed widespread underlying assumptions that engaging interpreters is difficult, time-consuming and costly. Bilingual ED nurses with variable language fluency were used across organisations as the first choice due to clinical urgency, task urgency, and hospital workflow pressures. While the use of nurse interpreters facilitated timely assessment for the benefit of patients, it equally led to increased nurse workload, missed or misinterpreted information and subsequent perceived clinical risk. These practices were supported and facilitated by unit level managerial and multidisciplinary team practices, physician pressure and the nurses' own values and beliefs. While some, (but not all) participants were aware of the interpreter policy, they were torn between their acknowledgement of risky translation practices and their desire to support their colleagues to provide timely, culturally-competent assessment and care. Findings suggests a 'top-down' approach to translation policy has failed to influence the local safety culture and practices and does not address a climate created by clinical urgency and workflow. Formal training and accreditation of bilingual nurses, and/or embedded interpreters for common language groups may reduce risks for non-English speaking patients.
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Affiliation(s)
- Heesun Chang
- Emergency Department, Concord Repatriation General Hospital, Concord West, NSW, Australia
| | - Claire Hutchinson
- Emergency Department, The Canterbury Hospital, Campsie, NSW, Australia
| | - Janice Gullick
- Susan Wakil School of Nursing & Midwifery, University of Sydney, Camperdown, NSW, Australia
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21
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Communication in Health Care: Impact of Language and Accent on Health Care Safety, Quality, and Patient Experience. Am J Med Qual 2021; 36:355-364. [PMID: 34285178 DOI: 10.1097/01.jmq.0000735476.37189.90] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Permanent or temporary migration results in communication issues related to language barriers. The migrant's mother tongue is often different from that of the host country. Even when the same language is spoken, communication barriers arise because of differences in accent. These communication barriers have a significant negative impact on migrants accessing health care and their ability to understand instructions and seek follow-up care. A multidisciplinary team often has professionals from various countries. These migrant health care professionals find it difficult to communicate with patients of the host country and with their colleagues. Communication barriers, therefore, result in miscommunication or no communication between health care professionals and between health care professionals and patients. This increases the risk of medical errors and impacts quality of care and patient safety. This review looks at the impact of communication barriers in health care and endeavors to find effective solutions.
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22
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Schulson L, Lin MY, Paasche-Orlow MK, Hanchate AD. Limited English Proficient Patient Visits and Emergency Department Admission Rates for Ambulatory Care Sensitive Conditions in California: a Retrospective Cohort Study. J Gen Intern Med 2021; 36:2683-2691. [PMID: 33528781 PMCID: PMC8390610 DOI: 10.1007/s11606-020-06523-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the risk of admission for emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) by limited English proficient (LEP) patients. OBJECTIVE Estimate admission rates from ED for ACSCs comparing LEP and English proficient (EP) patients and examine how these rates vary at hospitals with a high versus low proportion of LEP patients. DESIGN Retrospective cohort study of California's 2017 inpatient and ED administrative data PARTICIPANTS: Community-dwelling individuals ≥ 18 years without a primary diagnosis of pregnancy or childbirth. LEP patients had a principal language other than English. MAIN MEASURES We used a series of linear probability models with incremental sets of covariates, including patient demographics, primary diagnosis, and Elixhauser comorbidities, to examine admission rate for visits of LEP versus EP patients. We then added an interaction covariate for high versus low LEP-serving hospital. We estimated models with and without hospital-level random effects. KEY RESULTS These analyses included 9,641,689 ED visits; 14.7% were for LEP patients. . Observed rate of admission for all ACSC ED visits was higher for LEP than for EP patients (26.2% vs. 25.2; p value < .001). Adjusted rate of admission was not statistically significant (27.3% [95% CI 25.4-29.3%] vs. 26.2% [95% CI 24.3-28.1%]). For COPD, the difference was significant (36.8% [95% CI 35.0-38.6%] vs. 33.3% [95% CI 31.7-34.9%]). Difference in adjusted admission rate for LEP versus EP visits did not differ in high versus low LEP-serving hospitals. CONCLUSIONS In adjusted analyses, LEP was not a risk factor for admission for most ACSCs. This finding was observed in both high and low LEP-serving hospitals.
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Affiliation(s)
- Lucy Schulson
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. .,RAND Corporation, 20 Park Plaza #920, Boston, MA, 02116, USA.
| | - Meng-Yun Lin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael K Paasche-Orlow
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Amresh D Hanchate
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Carreras Tartak JA, Brisbon N, Wilkie S, Sequist TD, Aisiku IP, Raja A, Macias‐Konstantopoulos WL. Racial and ethnic disparities in emergency department restraint use: A multicenter retrospective analysis. Acad Emerg Med 2021; 28:957-965. [PMID: 34533261 DOI: 10.1111/acem.14327] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Research regarding disparities in physical restraint use in the emergency department (ED) is limited. We evaluated the role of race, ethnicity, and preferred language on the application of physical restraint among ED patients held under a Massachusetts section 12(a) order for mandatory psychiatric evaluation. METHODS We identified all ED patient encounters with a section 12(a) order across a large integrated 11-hospital health system from January 2018 through December 2019. Information on age, race, ethnicity, preferred language, insurance, mental illness, substance use, history of homelessness, and in-network primary care provider was obtained from the electronic health record. We evaluated for differences in physical restraint use between subgroups via a mixed-effect logistic regression with random-intercept model. RESULTS We identified 32,054 encounters involving a section 12(a) order. Physical restraints were used in 2,458 (7.7%) encounters. Factors associated with physical restraint included male sex (adjusted odds ratio [aOR] = 1.44, 95% confidence interval [CI] = 1.28 to 1.63), Black/African American race (aOR = 1.22, 95% CI = 1.01 to 1.48), Hispanic ethnicity (aOR = 1.45, 95% CI = 1.22 to 1.73), Medicaid insurance (aOR = 1.21, 95% CI = 1.05 to 1.39), and a diagnosis of bipolar disorder or psychotic disorder (aOR = 1.51, 95% CI = 1.31 to 1.74). Across all age groups, patients who were 25 to 34 years of age were at highest risk of restraint (aOR = 2.01, 95% CI = 1.69 to 2.39). Patients with a primary care provider within our network (aOR = 0.81, 95% CI = 0.72 to 0.92) were at lower risk of restraint. No associations were found between restraint use and language, history of alcohol or substance use, or homelessness. CONCLUSION Black/African American and Hispanic patients under an involuntary mandatory emergency psychiatric evaluation hold order experience higher rates of physical restraint in the ED. Factors contributing to racial disparities in the use of physical restraint, including the potential role of structural racism and other forms of bias, merits further investigation.
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Affiliation(s)
| | - Nicholas Brisbon
- Data and Analytics Organization Mass General Brigham Boston Massachusetts USA
| | - Sarah Wilkie
- Department of Quality and Patient Experience Mass General Brigham Boston Massachusetts USA
| | - Thomas D. Sequist
- Department of Quality and Patient Experience Mass General Brigham Boston Massachusetts USA
| | - Imoigele P. Aisiku
- Department of Emergency Medicine Brigham and Women’s Hospital Boston Massachusetts USA
| | - Ali Raja
- Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
| | - Wendy L. Macias‐Konstantopoulos
- Department of Emergency Medicine Center for Social Justice and Health Equity Massachusetts General Hospital Boston Massachusetts USA
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24
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Ridgeway JL, Njeru JW, Breitkopf CR, Mohamed AA, Quirindongo-Cedeño O, Sia IG, Wieland ML. Closing the Gap: Participatory Formative Evaluation to Reduce Cancer Screening Disparities among Patients with Limited English Proficiency. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:795-803. [PMID: 32052262 DOI: 10.1007/s13187-020-01706-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Patients with limited English proficiency (LEP) have disproportionately lower rates of cancer screening than English-proficient patients. Given the multifactorial nature of screening disparities, strategies to improve screening rates must address barriers within and outside of the clinic setting. The objectives of this study were to understand local barriers from multiple stakeholder perspectives, to identify potential multilevel intervention approaches, and to mobilize community-engaged intervention decision making and planning. This participatory formative evaluation approach employed needs assessment and user engagement in order to enhance intervention usefulness and relevance. The study took place in several stages and involved clinic and community partners in a small metropolitan area of the Midwest USA. Interviews were conducted with LEP patients (n = 9) who had not completed three recommended screenings (breast, cervical, and colorectal), primary care providers (n = 5), medical interpreter (n = 5), and community members (n = 3). These highlighted multilevel barriers including limited patient understanding of preventive health, time and cost constraints, and variable roles of language interpreters. The literature was also reviewed to identify interventions used with similar populations. Findings from this review suggest that interventions are largely focused on single population groups or address single screening barriers. Finally, a community-academic summit (n = 48 participants) was held to review results and develop recommendations for community and clinic interventions. Findings from this study indicate that it is possible to engage a diverse group of stakeholders in strategies that are responsive to health care providers and patients, including LEP patients from heterogeneous backgrounds.
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Affiliation(s)
- Jennifer L Ridgeway
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jane W Njeru
- Division of Community Internal Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | | | - Ahmed A Mohamed
- Division of Community Internal Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | | | - Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Mark L Wieland
- Division of Community Internal Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
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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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May E, Brown KO, Gracely E, Podkameni G, Franklin L, Pall H. The Role of Health Disparities and Socioeconomic Status in Emergent Gastrointestinal Procedures. Health Equity 2021; 5:270-276. [PMID: 34095706 PMCID: PMC8175256 DOI: 10.1089/heq.2020.0141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives: There is limited data describing the role of health disparity factors and socioeconomic status (SES) on emergent versus nonemergent gastrointestinal (GI) procedures within pediatrics. We aimed to characterize risk factors and determine the role of SES on emergent versus nonemergent GI care. We hypothesized that patients with lower SES incur higher risk of having emergent procedures performed. Methods: Retrospective chart review was performed between 2012 and 2016, with 2556 patient records reviewed. Demographic data and SES categories were determined. The majority of emergent procedures were performed on an inpatient basis. Health disparity factors analyzed included age, gender, insurance type, race, language, and SES using census tracts. Logistic regression analyses and paired t-tests were utilized. Results: Two hundred eighty-six (11.2%) patients had emergent GI procedures performed. Logistic regression (odds ratio [OR], confidence interval (95% CI)] showed patients from 6–11 to 12–17 years of age were less likely to seek emergent care than the youngest group [0.47, 0.33–0.66 and 0.61, 0.45–0.84]. Patients with Medicaid insurance [1.68, 1.27–2.26], African American or “other” race [2.07, 1.48–2.90 and 2.43, 1.77–3.36, respectively], as well as “other” language [2.1, 1.14–3.99] more often sought emergent care. Using geocoded data, we found that as SES increases by 1, emergent risk for procedures decreased by 2.9% (OR 0.97, p=0.045). Conclusions: Children with lower SES, at extremes of age (<5, >18 years), non-English or Spanish speaking and with Medicaid insurance are at higher risk of undergoing emergent GI procedures. This study gives us an opportunity to plan targeted interventions to improve access and quality of care.
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Affiliation(s)
- Eve May
- Department of Gastroenterology, Hepatology, and Nutrition, Children's National Hospital, Washington, District of Columbia, USA
| | - Kristin O Brown
- Section of Gastroenterology, Hepatology, and Nutrition, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Edward Gracely
- Family, Community, and Preventive Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Gisele Podkameni
- Section of Gastroenterology, Hepatology, and Nutrition, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Linda Franklin
- Section of Gastroenterology, Hepatology, and Nutrition, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Harpreet Pall
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.,Department of Pediatrics, K. Hovnanian Children's Hospital at Jersey Shore University Medical Center, Neptune, New Jersey, USA
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Too Little Information: Accessibility of Information About Language Services on Hospital Websites. J Immigr Minor Health 2021; 22:433-438. [PMID: 31989353 DOI: 10.1007/s10903-020-00978-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hospital websites are an important resource to patients with limited English proficiency (LEP) seeking information about a facility's language assistance services. We sought to identify the types of such services described on hospital websites in a diverse state and compare them by hospital characteristics. Washington State acute care hospital websites were systematically reviewed in February 2018 for translated content and information about language assistance services. Hospital characteristics included annual admissions and revenue, bed size and the proportion of populations with LEP in the hospital's county. Of 93 hospitals, 10.8% provided translated websites. Interpreter services were mentioned on 81.7% of websites; access required navigation through 1-4 English webpages. Larger bed-size, higher revenue, and more admissions were positively associated with providing language services information (p < 0.01), whereas county-level population with LEP was not (p = 0.17). Many hospital websites are not translated or lack easily accessible information about language assistance services and consequently may not be a useful resource to patients with LEP.
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Abdulla L, McGowan EC, Tucker RJ, Vohr BR. Disparities in Preterm Infant Emergency Room Utilization and Rehospitalization by Maternal Immigrant Status. J Pediatr 2020; 220:27-33. [PMID: 32111378 DOI: 10.1016/j.jpeds.2020.01.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effects of immigrant mother status and risk factors on the rates of emergency room (ER) visits and rehospitalizations of preterm infants within 90 days after discharge. STUDY DESIGN This was a retrospective cohort study of 732 mothers of 866 preterm infants (<37 weeks of gestational age) cared for in a neonatal intensive care unit (NICU) for >5 days. Medical and demographic data and number of ER visits and rehospitalizations were collected. The primary outcomes were the numbers of ER visits and rehospitalizations. Analysis included bivariate comparisons of immigrant and native mother-infant dyads. Regression models were run to estimate the effects of immigrant mother status and risk factors. RESULTS Compared with native mothers, immigrant mothers (176 of 732; 24%) were more likely to be older, to be gravida >1, to be nonwhite, to have a non-English primary language, to have less than a high school education, and to have Medicaid insurance but less likely to have child protective services, substance abuse, and a mental health disorder. Infants of immigrant mothers (203 of 866; 23%) had higher rates of ER visits and more days of hospitalization compared with infants of native mothers. Among immigrant mothers only, >5 years living in the US, non-English primary language, and bronchopulmonary dysplasia (BPD) were predictive of ER visits, whereas Medicaid and BPD were predictive of rehospitalization. For the total cohort, after an interaction between Medicaid and immigrant status was added to the model, immigrant status became nonsignificant and immigrant mothers with Medicaid emerged as a strong predictor of hospitalization and a borderline predictor for ER visits. CONCLUSIONS Among immigrant mothers, non-English primary language, >5 years living in the US, and BPD increased the odds of an ER visit. For the total cohort, however, the interaction of immigrant mother with Medicaid as a marker of poverty provided a significant modifying effect on increased rehospitalization and ER use.
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Affiliation(s)
- Layla Abdulla
- Division of Biology and Medicine, Undergraduate Program, Brown University, Providence, RI
| | - Elisabeth C McGowan
- Division of Biology and Medicine, Undergraduate Program, Brown University, Providence, RI; Division of Neonatology, Women & Infants Hospital of Rhode Island, Providence, RI; Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI
| | - Richard J Tucker
- Division of Neonatology, Women & Infants Hospital of Rhode Island, Providence, RI
| | - Betty R Vohr
- Division of Biology and Medicine, Undergraduate Program, Brown University, Providence, RI; Division of Neonatology, Women & Infants Hospital of Rhode Island, Providence, RI; Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI.
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Lu T, Myerson R. Disparities in Health Insurance Coverage and Access to Care by English Language Proficiency in the USA, 2006-2016. J Gen Intern Med 2020; 35:1490-1497. [PMID: 31898137 PMCID: PMC7210354 DOI: 10.1007/s11606-019-05609-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/15/2019] [Accepted: 12/06/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the USA, people with limited English proficiency (LEP) disproportionately experience gaps in health insurance coverage and access to care. The Patient Protection and Affordable Care Act (ACA) of 2010 included reforms that could improve these outcomes. OBJECTIVE To describe changes in insurance coverage and access to health care by English language proficiency over 2006-2016. DESIGN We used regression models to estimate changes in coverage and access after 2010 for adults with high vs. limited English proficiency, adjusting for socio-economic status, demographic characteristics, and health care needs. We used difference-in-differences models to assess adjusted changes in disparities by English proficiency after 2010. Supplemental analyses used nearest-neighbor propensity score matching to balance the characteristics of respondents. PARTICIPANTS Respondents aged 18-64 in the Medical Expenditure Panel Survey over 2006-2016, with high (n = 174,214) or limited (n = 16,484) English language proficiency. MAIN MEASURES Insurance coverage was a binary variable indicating any health insurance coverage during the past 12 months. Access to care was measured using binary variables indicating whether the respondent had a usual source of care and received necessary medical, dental, and preventive care. KEY RESULTS Gains in health insurance coverage after 2010 were significant for adults with high English proficiency (1.7 percentage points, p < 0.001) and adults with limited English proficiency (4.6 percentage points, p = 0.007); gains did not significantly vary by English proficiency. Adults with LEP showed larger improvements than adults with high English proficiency in having a usual source of care (5 percentage points, p = 0.007) and receiving needed medical care and dental care (1.4 percentage points, p = 0.013, and 2.8 percentage points, p = 0.009, respectively). Findings remained similar when matching was used to balance the measured characteristics of respondents with high vs. limited English proficiency. CONCLUSIONS Disparities in health care access by English proficiency narrowed after 2010, the year of passage of the ACA.
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Affiliation(s)
- Tianyi Lu
- University of Southern California (USC) School of Pharmacy and Leonard D. Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
| | - Rebecca Myerson
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Abstract
BACKGROUND Limited English proficiency is associated with decreased access to ambulatory care, however, it is unclear if this disparity leads to increased use of emergency departments (EDs) for low severity ambulatory care sensitive conditions (ACSCs). OBJECTIVE We sought to determine the association between the patient's preferred language and hospital utilization for ACSCs. RESEARCH DESIGN We conducted a retrospective cohort study of all ED visits in New Jersey in 2013 and 2014. The primary outcome was hospital admission for acute ACSCs, chronic ACSCs, and fractures (a nonambulatory care sensitive control condition). Secondary outcomes included intensive care unit (ICU) utilization and length of stay. Mixed-effect regression models estimated the association between preferred language (English vs. non-English) and study outcomes, controlling for demographics, comorbidities, and hospital characteristics. RESULTS We examined 201,351 ED visits for acute ACSCs, 251,193 visits for chronic ACSCs, and 148,428 visits for fractures, of which 13.5%, 11.1%, and 9.9%, respectively, were by non-English speakers. In adjusted analyses, non-English speakers were less likely to be admitted for acute ACSCs [-3.1%; 95% confidence interval (CI), -3.6% to -2.5%] and chronic ACSCs (-2.3%; 95% CI, -2.8% to -1.7%) but not fractures (0.4%; 95% CI, -0.2% to 1.0%). Among hospitalized patients, non-English speakers were less likely to receive ICU services but had no difference in length of stay. CONCLUSIONS These findings suggest non-English-speaking patients may seek ED care for lower acuity ACSCs than English-speaking patients. Efforts to decrease preventable ED and increase access to ambulatory care use should consider the needs of non-English-speaking patients.
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The Use of a Mobile Application to Increase Access to Interpreters for Cancer Patients With Limited English Proficiency: A Pilot Study. Med Care 2020; 57 Suppl 6 Suppl 2:S184-S189. [PMID: 31095059 DOI: 10.1097/mlr.0000000000001035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Language barriers can influence the quality of health care and health outcomes of limited English proficient patients with cancer. The use of medical interpretation services can be a valuable asset for improving communications in emergency care settings. OBJECTIVE To evaluate whether a mobile translation application increased call frequency to interpreter services among providers in an Urgent Care Center at a comprehensive cancer center and to assess provider satisfaction of the mobile application. RESEARCH DESIGN Prospective pre-post nonrandomized intervention of a mobile translation application with access to an over the phone interpreter (OPI) service at the push of a button and poststudy satisfaction survey. SUBJECTS Sixty-five clinicians working at the Urgent Care Center in a cancer center in New York City. MEASURES Mean call frequency to OPI services, tested by the nonparametric Wilcoxon Mann Whitney test, and self-reported provider satisfaction descriptives. RESULTS The mobile application contributed to increasing the frequency of phone calls to OPI services during the intervention period (mean=12.8; P=0.001) as compared with the preintervention period (mean=4.3), and showed continued use during the postintervention period (mean=5.7). Most clinicians were satisfied with the use of the mobile application and access to the OPI services. CONCLUSIONS The results suggest that mobile application tools contribute to increasing the use and ease of access to language services. This has the potential to improve the quality of communication between medical providers and limited English proficient patients in the delivery of cancer care in urgent care settings.
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Sigal I, Dayal P, Hoch JS, Mouzoon JL, Morrow E, Marcin JP. Travel, Time, and Cost Savings Associated with a University Medical Center's Video Medical Interpreting Program. Telemed J E Health 2020; 26:1234-1239. [PMID: 32045323 DOI: 10.1089/tmj.2019.0220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Patients with limited English proficiency experience disparities in health care access, quality, costs, and outcomes. Providing qualified medical interpreting services (MIS) in the health care setting can reduce these disparities. Unfortunately, health organizations face logistical and financial difficulties in meeting the need for qualified medical interpreters. Introduction: This descriptive review evaluated travel, time, and cost savings associated with video interpreting services compared to traditional in-person services. Materials and Methods: We conducted a retrospective review of all inpatient and outpatient medical interpreting encounters at a large academic hospital delivered through video and in person between 2006 and 2017. Outcome measures included interpreter travel distance, time, and cost for in-person encounters and savings associated with avoided travel for services provided through video. Results: We reviewed 281,701 interpreting encounters, including 249,357 in person and 32,344 by video. Video encounters occurred both for on-site and off-site visits. For on-site encounters, the use of video resulted in an average round trip walking distance saved of 0.75 miles (SD = 0.33) and an average round trip walking time saved of 14.75 min (SD = 6.30) per encounter. For off-site encounters, the use of video resulted in an average round trip driving distance saved of 8.63 miles (SD = 9.13), an average round trip driving time saved of 23.78 min (SD = 9.50), and an average round trip driving cost savings of $4.66 per encounter. Conclusions: This single institution review of the travel, time, and cost savings associated with providing MIS through video demonstrates the opportunity for more efficient use of time and resources.
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Affiliation(s)
- Ilana Sigal
- Department of Pediatrics, University of California, Davis, Sacramento, California, USA
| | - Parul Dayal
- Department of Pediatrics, University of California, Davis, Sacramento, California, USA
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Sacramento, California, USA
| | - Jamie L Mouzoon
- Department of Pediatrics, University of California, Davis, Sacramento, California, USA
| | - Elena Morrow
- Medical Interpreting Services, University of California, Davis, Sacramento, California, USA
| | - James P Marcin
- Department of Pediatrics, University of California, Davis, Sacramento, California, USA
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Community Health Workers as an Extension of Care Coordination in Primary Care: A Community-Based Cosupervisory Model. J Ambul Care Manage 2019; 41:333-340. [PMID: 30015685 PMCID: PMC6112848 DOI: 10.1097/jac.0000000000000255] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Community health workers (CHWs) bring their unique capacity as liaisons for patients, communities, and health care systems to health care teams. We describe the collaborative development of a community-based CHW program to address the social determinants of health that affect patients. This cosupervisory, generalist CHW model provides an innovative template for cocreation of patient-centered infrastructure and resourcing within an evolving and replicable holistic care continuum across patient ages, diagnoses, health care payers, and communities to promote health equity. The program has been effective in decreasing health care utilization and cost.
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Seo JY, Kuerban A, Bae SH, Strauss SM. Disparities in Health Care Utilization Between Asian Immigrant Women and Non-Hispanic White Women in the United States. J Womens Health (Larchmt) 2019; 28:1368-1377. [PMID: 31264933 DOI: 10.1089/jwh.2018.7532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Asians accounted for 30% of all U.S. immigrants in 2014, of which 53% were women. Foreign-born Asian immigrant (FBAI) women experience difficulties in obtaining timely and needed health care due to multifaceted barriers. This study examined factors influencing health service utilization among FBAI women compared with native-born (non-Hispanic) White American (NBWA) women. Materials and Methods: A secondary data analysis was conducted using the 2014-2015 California Health Interview Survey. Guided by a modified version of Andersen's behavioral model of health service utilization, FBAI women aged 18 to 64 (n = 1,021) were compared with NBWA women of the same ages (n = 7,086). Outcome variables included having at least one doctor's visit in the past year and having an emergency room (ER) visit in the past year. Analyses included descriptive statistics, t-tests, chi-square tests, and multivariate logistic regressions. Results: FBAI women were significantly less likely to have at least one doctor's visit in the past year and were less likely to have a usual source of care than NBWA women. Significant predictors of having at least one doctor's visit for FBAI women were having high school education, having a usual source of care, having medical insurance, and having a chronic disease. The only significant predictor of having an ER visit for FBAI women was having a chronic disease. Conclusions: Health care providers must be aware of lower levels of health service utilization among FBAI women than NBWA women regardless of whether or not the FBAI women have chronic conditions. It is important to educate these women on the importance of regular health care visits.
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Affiliation(s)
- Jin Young Seo
- Hunter-Bellevue School of Nursing, Hunter College, CUNY, New York, New York
| | - Aliya Kuerban
- The Barbara H. Hagan School of Nursing, Molloy College, Rockville Centre, New York
| | - Sung-Heui Bae
- College of Nursing, Ewha Womans University, Seoul, Republic of Korea
| | - Shiela M Strauss
- Hunter-Bellevue School of Nursing, Hunter College, CUNY, New York, New York.,Rory Meyers College of Nursing, New York University, New York, New York
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Schulson L, Novack V, Smulowitz PB, Dechen T, Landon BE. Emergency Department Care for Patients with Limited English Proficiency: a Retrospective Cohort Study. J Gen Intern Med 2018; 33:2113-2119. [PMID: 30187374 PMCID: PMC6258635 DOI: 10.1007/s11606-018-4493-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/30/2018] [Accepted: 05/11/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited English proficiency (LEP) patients may be particularly vulnerable in the high acuity and fast-paced setting of the emergency department (ED). OBJECTIVE To compare the care processes of LEP patients in the ED. DESIGN Retrospective cohort study. SETTING ED in a large tertiary care academic medical center. PATIENTS Adult LEP and English Proficient (EP) patients during their index presentation to the ED from September 1, 2013, to August 31, 2015. LEP patients were identified as those who selected a preferred language other than English when registering for care. MAIN MEASURES Rates of diagnostic studies, admission, and return visits for those originally discharged from the ED. KEY RESULTS We studied 57,435 visits of which 5241 (9.1%) were for patients with LEP. In adjusted analyses, LEP patients were more likely to receive an X-ray/ultrasound (OR 1.11, CI 1.03-1.19) and be admitted to the hospital (OR 1.09, CI 1.01-1.19). There was no difference in 72-h return visits (OR 0.98, CI 0.73-1.33). LEP patients presenting with complaints related to the cardiovascular system were more likely to receive a stress test (OR 1.51, CI 1.22-1.86), and those with gastrointestinal diagnoses were more likely to have an X-ray/ultrasound (OR 1.31, CI 1.02-1.68). In stratified analyses, Spanish speakers were less likely to be admitted (OR 0.8, CI 0.70-0.91), but those preferring "other" languages, which were all languages with < 500 patients, had a statistically significant higher adjusted rate of admission (OR 1.35, CI 1.17-1.57). CONCLUSIONS ED patients with LEP experienced both increased rates of diagnostic testing and of hospital admission. Research is needed to examine why these differences occurred and if they represent inefficiencies in care.
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Affiliation(s)
- Lucy Schulson
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Victor Novack
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Clinical Research Center, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Peter B Smulowitz
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tenzin Dechen
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Bruce E Landon
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
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Brenner JM, Baker EF, Iserson KV, Kluesner NH, Marshall KD, Vearrier L. Use of Interpreter Services in the Emergency Department. Ann Emerg Med 2018; 72:432-437. [DOI: 10.1016/j.annemergmed.2018.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 10/28/2022]
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Lundin C, Hadziabdic E, Hjelm K. Language interpretation conditions and boundaries in multilingual and multicultural emergency healthcare. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:23. [PMID: 29866163 PMCID: PMC5987383 DOI: 10.1186/s12914-018-0157-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 04/30/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND With an increasing migrant population globally the need to organize interpreting service arises in emergency healthcare to deliver equitable high-quality care. The aims of this study were to describe interpretation practices in multilingual emergency health service institutions and to explore the impact of the organizational and institutional context and possible consequences of different approaches to interpretation. No previous studies on these issues in multilingual emergency care have been found. METHODS A qualitative descriptive study was used. Forty-six healthcare professionals were purposively recruited from different organizational levels in ambulance service and psychiatric and somatic emergency care units. Data were collected between December 2014 and April 2015 through focus-group and individual interviews, and analyzed by qualitative content analysis. RESULTS Organization of interpreters was based on patients' health status, context of emergency care, and access to interpreter service. Differences existed between workplaces regarding the use of interpreters: in somatic emergency care bilingual healthcare staff and family members were used to a limited extent; in psychiatric emergency care the norm was to use professional interpreters on the spot; and in ambulance service persons available at the time, e.g. family and friends were used. Similarities were found in: procuring a professional interpreter, mainly based on informal workplace routines, sometimes on formal guidelines and national laws, but knowledge of existing laws was limited; the ideal was a linguistically competent interpreter with a professional attitude, and organizational aspects such as appropriate time, technical and social environment; and wishes for development of better procedures for prompt access to professional interpreters at the workplace, regardless of organizational context, and education of interpreters and users. CONCLUSION Use of interpreters was determined by health professionals, based on the patients' health status, striving to deliver as fast and individualized care as possible based on humanistic values. Defects in organizational routines need to be rectified and transcultural awareness is needed to achieve the aim of person-centered and equal healthcare. Clear formal guidelines for the use of interpreters in emergency healthcare need to be developed and it is important to fulfill health professionals' wishes for future development of prompt access to interpreters and education of interpreters and users.
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Affiliation(s)
- Christina Lundin
- Department of Social and Welfare Studies, University of Linköping, Campus Norrköping, S- 601 74 Norrköping, Sweden
| | - Emina Hadziabdic
- Department of Social and Welfare Studies, University of Linköping, Campus Norrköping, S- 601 74 Norrköping, Sweden
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Katarina Hjelm
- Department of Social and Welfare Studies, University of Linköping, Campus Norrköping, S- 601 74 Norrköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala university, Uppsala, Sweden
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Healthcare interpreter utilisation: analysis of health administrative data. BMC Health Serv Res 2018; 18:348. [PMID: 29747659 PMCID: PMC5946440 DOI: 10.1186/s12913-018-3135-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/17/2018] [Indexed: 11/10/2022] Open
Abstract
Background Few people with limited English proficiency are provided with the services of a healthcare interpreter when admitted to hospital. This retrospective study utilised health administrative data to explore which patients with limited English proficiency were provided with a healthcare interpreter during their hospital admission. Method A retrospective analysis of health administrative data for adult overnight-stay patients admitted to a public hospital in a region of significant cultural and linguistic diversity in Sydney, Australia in 2014–2015. Descriptive analyses were used to explore demographic and diagnostic data. Chi-square and analysis of variance were used to test for association between variables. Results The site hospital provided for 19,627 overnight-stay episodes of care over the one year period. Emergency admissions made up 70.5% (n = 13,845) of all hospital admissions and obstetric patients 11.7% (n = 2291). For 15.7% (n = 3074) of episodes of care a healthcare interpreter was identified at hospital admission as being required. In 3.7% (n = 727) of episodes of care a healthcare interpreter was provided. Patients who received an interpreter were more likely to be female, of a younger age and admitted to hospital for childbirth. Conclusions A minority of patients with limited English proficiency received a healthcare interpreter during their episode of care. The majority of interpreter services were provided to obstetric patients.
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Collaborative Care for Depression among Patients with Limited English Proficiency: a Systematic Review. J Gen Intern Med 2018; 33:347-357. [PMID: 29256085 PMCID: PMC5834967 DOI: 10.1007/s11606-017-4242-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/13/2017] [Accepted: 11/17/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Patients with limited English proficiency (LEP) have high rates of depression, yet face challenges accessing effective care in outpatient settings. We undertook a systematic review to investigate the effectiveness of the collaborative care model for depression for LEP patients in primary care. METHODS We queried online PubMed, PsycINFO, CINAHL and EMBASE databases (January 1, 2000, to June 10, 2017) for quantitative studies comparing collaborative care to usual care to treat depression in adults with LEP in primary care. We evaluated the impact of collaborative care on depressive symptoms or on depression treatment. Two reviewers independently extracted key data from the studies and assessed risk of bias using the Cochrane bias and quality assessment tool (RCTs) and the Newcastle-Ottawa Quality Assessment Scale (non-RCTs). RESULTS Of 86 titles identified, 15 were included (representing 9 studies: 5 RCTs, 3 cohort studies, and 1 case-control study). Studies included 4859 participants; 2679 (55%) reported LEP. The majority spoke Spanish (93%). The wide variability in study design and outcome definitions precluded performing a meta-analysis. Follow-up ranged from 3 months to 2 years. Three of four high-quality RCTs reported that 13-25% more patients had improved depressive symptoms when treated with culturally tailored collaborative care compared to usual care; the last had high treatment in the control arm and found equal improvement. Two non-RCT studies suggest that Spanish-speaking patients may benefit as much as, if not more than, English-speaking patients treated with collaborative care. The remaining studies reported increased receipt of preferred depression treatment (therapy vs. antidepressants) in the intervention groups. Eight of nine studies used bilingual providers to deliver the intervention. DISCUSSION While limited by the number and variability of studies, the available research suggests that collaborative care for depression delivered by bilingual providers may be more effective than usual care among patients with LEP. Implementation studies of collaborative care, particularly among Asian and non-Spanish-speakers, are needed.
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Mirza M, Harrison EA. Working With Clients With Limited English Proficiency: Mapping Language Access in Occupational Therapy. Occup Ther Health Care 2018; 32:105-123. [PMID: 29461136 DOI: 10.1080/07380577.2018.1434722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Nearly one in ten US residents have difficulty speaking and understanding English and are deemed to have limited English proficiency (LEP). Despite federal mandates for provision of interpreters and other language access services, individuals with LEP experience notable health disparities. Occupational therapists must be prepared to equitably serve this population, however there is a dearth of research evidence and practical recommendations about our profession's readiness to serve this growing population. This paper maps the current healthcare policy environment and existing language access research relevant to occupational therapy. Implications for the future of occupational therapy research, education and practice are discussed.
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Affiliation(s)
- Mansha Mirza
- a Department of Occupational Therapy , University of Illinois at Chicago , Chicago , Illinois , USA
| | - Elizabeth Adare Harrison
- b Department of Occupational Therapy , University of Illinois at Chicago , Chicago , Illinois , USA, United States
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Kilkenny MF, Lannin NA, Anderson CS, Dewey HM, Kim J, Barclay-Moss K, Levi C, Faux S, Hill K, Grabsch B, Middleton S, Thrift AG, Grimley R, Donnan G, Cadilhac DA. Quality of Life Is Poorer for Patients With Stroke Who Require an Interpreter: An Observational Australian Registry Study. Stroke 2018; 49:761-764. [PMID: 29439194 DOI: 10.1161/strokeaha.117.019771] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 12/13/2017] [Accepted: 12/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In multicultural Australia, some patients with stroke cannot fully understand, or speak, English. Language barriers may reduce quality of care and consequent outcomes after stroke, yet little has been reported empirically. METHODS An observational study of patients with stroke or transient ischemic attack (2010-2015) captured from 45 hospitals participating in the Australian Stroke Clinical Registry. The use of interpreters in hospitals, which is routinely documented, was used as a proxy for severe language barriers. Health-Related Quality of Life was assessed using the EuroQoL-5 dimension-3 level measured 90 to 180 days after stroke. Logistic regression was undertaken to assess the association between domains of EuroQoL-5 dimension and interpreter status. RESULTS Among 34 562 registrants, 1461 (4.2%) required an interpreter. Compared with patients without interpreters, patients requiring an interpreter were more often women (53% versus 46%; P<0.001), aged ≥75 years (68% versus 51%; P<0.001), and had greater access to stroke unit care (85% versus 78%; P<0.001). After accounting for patient characteristics and stroke severity, patients requiring interpreters had comparable discharge outcomes (eg, mortality, discharged to rehabilitation) to patients not needing interpreters. However, these patients reported poorer Health-Related Quality of Life (visual analogue scale coefficient, -9; 95% CI, -12.38, -5.62), including more problems with self-care (odds ratio: 2.22; 95% CI, 1.82, 2.72), pain (odds ratio: 1.84; 95% CI, 1.52, 2.34), anxiety or depression (odds ratio: 1.60; 95% CI, 1.33, 1.93), and usual activities (odds ratio: 1.62; 95% CI, 1.32, 2.00). CONCLUSIONS Patients requiring interpreters reported poorer Health Related Quality of Life after stroke/transient ischemic attack despite greater access to stroke units. These findings should be interpreted with caution because we are unable to account for prestroke Health Related Quality of Life. Further research is needed.
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Affiliation(s)
- Monique F Kilkenny
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., A.G.T., D.A.C.); Eastern Health Clinical School, Monash University, Box Hill, Australia (H.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (M.F.K., J.K., K.B-M., B.G., G.D., D.A.C.); Faculty of Health Sciences, La Trobe University, Bundoora, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Melbourne, Australia (N.A.L.); The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (C.S.A.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (C.S.A.); Acute Stroke Services, John Hunter Hospital, Newcastle, Australia (C.L.); St Vincent's Health Australia, Sydney (S.F.); Stroke Foundation, Melbourne, Australia (K.H.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (S.M.); and Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (R.G.).
| | - Natasha A Lannin
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., A.G.T., D.A.C.); Eastern Health Clinical School, Monash University, Box Hill, Australia (H.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (M.F.K., J.K., K.B-M., B.G., G.D., D.A.C.); Faculty of Health Sciences, La Trobe University, Bundoora, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Melbourne, Australia (N.A.L.); The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (C.S.A.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (C.S.A.); Acute Stroke Services, John Hunter Hospital, Newcastle, Australia (C.L.); St Vincent's Health Australia, Sydney (S.F.); Stroke Foundation, Melbourne, Australia (K.H.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (S.M.); and Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (R.G.)
| | - Craig S Anderson
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., A.G.T., D.A.C.); Eastern Health Clinical School, Monash University, Box Hill, Australia (H.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (M.F.K., J.K., K.B-M., B.G., G.D., D.A.C.); Faculty of Health Sciences, La Trobe University, Bundoora, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Melbourne, Australia (N.A.L.); The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (C.S.A.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (C.S.A.); Acute Stroke Services, John Hunter Hospital, Newcastle, Australia (C.L.); St Vincent's Health Australia, Sydney (S.F.); Stroke Foundation, Melbourne, Australia (K.H.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (S.M.); and Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (R.G.)
| | - Helen M Dewey
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., A.G.T., D.A.C.); Eastern Health Clinical School, Monash University, Box Hill, Australia (H.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (M.F.K., J.K., K.B-M., B.G., G.D., D.A.C.); Faculty of Health Sciences, La Trobe University, Bundoora, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Melbourne, Australia (N.A.L.); The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (C.S.A.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (C.S.A.); Acute Stroke Services, John Hunter Hospital, Newcastle, Australia (C.L.); St Vincent's Health Australia, Sydney (S.F.); Stroke Foundation, Melbourne, Australia (K.H.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (S.M.); and Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (R.G.)
| | - Joosup Kim
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., A.G.T., D.A.C.); Eastern Health Clinical School, Monash University, Box Hill, Australia (H.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (M.F.K., J.K., K.B-M., B.G., G.D., D.A.C.); Faculty of Health Sciences, La Trobe University, Bundoora, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Melbourne, Australia (N.A.L.); The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (C.S.A.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (C.S.A.); Acute Stroke Services, John Hunter Hospital, Newcastle, Australia (C.L.); St Vincent's Health Australia, Sydney (S.F.); Stroke Foundation, Melbourne, Australia (K.H.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (S.M.); and Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (R.G.)
| | - Karen Barclay-Moss
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., A.G.T., D.A.C.); Eastern Health Clinical School, Monash University, Box Hill, Australia (H.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (M.F.K., J.K., K.B-M., B.G., G.D., D.A.C.); Faculty of Health Sciences, La Trobe University, Bundoora, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Melbourne, Australia (N.A.L.); The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (C.S.A.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (C.S.A.); Acute Stroke Services, John Hunter Hospital, Newcastle, Australia (C.L.); St Vincent's Health Australia, Sydney (S.F.); Stroke Foundation, Melbourne, Australia (K.H.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (S.M.); and Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (R.G.)
| | - Chris Levi
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., A.G.T., D.A.C.); Eastern Health Clinical School, Monash University, Box Hill, Australia (H.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (M.F.K., J.K., K.B-M., B.G., G.D., D.A.C.); Faculty of Health Sciences, La Trobe University, Bundoora, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Melbourne, Australia (N.A.L.); The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (C.S.A.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (C.S.A.); Acute Stroke Services, John Hunter Hospital, Newcastle, Australia (C.L.); St Vincent's Health Australia, Sydney (S.F.); Stroke Foundation, Melbourne, Australia (K.H.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (S.M.); and Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (R.G.)
| | - Steven Faux
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., A.G.T., D.A.C.); Eastern Health Clinical School, Monash University, Box Hill, Australia (H.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (M.F.K., J.K., K.B-M., B.G., G.D., D.A.C.); Faculty of Health Sciences, La Trobe University, Bundoora, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Melbourne, Australia (N.A.L.); The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (C.S.A.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (C.S.A.); Acute Stroke Services, John Hunter Hospital, Newcastle, Australia (C.L.); St Vincent's Health Australia, Sydney (S.F.); Stroke Foundation, Melbourne, Australia (K.H.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (S.M.); and Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (R.G.)
| | - Kelvin Hill
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., A.G.T., D.A.C.); Eastern Health Clinical School, Monash University, Box Hill, Australia (H.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (M.F.K., J.K., K.B-M., B.G., G.D., D.A.C.); Faculty of Health Sciences, La Trobe University, Bundoora, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Melbourne, Australia (N.A.L.); The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (C.S.A.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (C.S.A.); Acute Stroke Services, John Hunter Hospital, Newcastle, Australia (C.L.); St Vincent's Health Australia, Sydney (S.F.); Stroke Foundation, Melbourne, Australia (K.H.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (S.M.); and Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (R.G.)
| | - Brenda Grabsch
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., A.G.T., D.A.C.); Eastern Health Clinical School, Monash University, Box Hill, Australia (H.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (M.F.K., J.K., K.B-M., B.G., G.D., D.A.C.); Faculty of Health Sciences, La Trobe University, Bundoora, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Melbourne, Australia (N.A.L.); The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (C.S.A.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (C.S.A.); Acute Stroke Services, John Hunter Hospital, Newcastle, Australia (C.L.); St Vincent's Health Australia, Sydney (S.F.); Stroke Foundation, Melbourne, Australia (K.H.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (S.M.); and Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (R.G.)
| | - Sandy Middleton
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., A.G.T., D.A.C.); Eastern Health Clinical School, Monash University, Box Hill, Australia (H.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (M.F.K., J.K., K.B-M., B.G., G.D., D.A.C.); Faculty of Health Sciences, La Trobe University, Bundoora, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Melbourne, Australia (N.A.L.); The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (C.S.A.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (C.S.A.); Acute Stroke Services, John Hunter Hospital, Newcastle, Australia (C.L.); St Vincent's Health Australia, Sydney (S.F.); Stroke Foundation, Melbourne, Australia (K.H.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (S.M.); and Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (R.G.)
| | - Amanda G Thrift
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., A.G.T., D.A.C.); Eastern Health Clinical School, Monash University, Box Hill, Australia (H.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (M.F.K., J.K., K.B-M., B.G., G.D., D.A.C.); Faculty of Health Sciences, La Trobe University, Bundoora, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Melbourne, Australia (N.A.L.); The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (C.S.A.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (C.S.A.); Acute Stroke Services, John Hunter Hospital, Newcastle, Australia (C.L.); St Vincent's Health Australia, Sydney (S.F.); Stroke Foundation, Melbourne, Australia (K.H.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (S.M.); and Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (R.G.)
| | - Rohan Grimley
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., A.G.T., D.A.C.); Eastern Health Clinical School, Monash University, Box Hill, Australia (H.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (M.F.K., J.K., K.B-M., B.G., G.D., D.A.C.); Faculty of Health Sciences, La Trobe University, Bundoora, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Melbourne, Australia (N.A.L.); The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (C.S.A.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (C.S.A.); Acute Stroke Services, John Hunter Hospital, Newcastle, Australia (C.L.); St Vincent's Health Australia, Sydney (S.F.); Stroke Foundation, Melbourne, Australia (K.H.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (S.M.); and Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (R.G.)
| | - Geoffrey Donnan
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., A.G.T., D.A.C.); Eastern Health Clinical School, Monash University, Box Hill, Australia (H.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (M.F.K., J.K., K.B-M., B.G., G.D., D.A.C.); Faculty of Health Sciences, La Trobe University, Bundoora, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Melbourne, Australia (N.A.L.); The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (C.S.A.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (C.S.A.); Acute Stroke Services, John Hunter Hospital, Newcastle, Australia (C.L.); St Vincent's Health Australia, Sydney (S.F.); Stroke Foundation, Melbourne, Australia (K.H.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (S.M.); and Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (R.G.)
| | - Dominique A Cadilhac
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (M.F.K., J.K., A.G.T., D.A.C.); Eastern Health Clinical School, Monash University, Box Hill, Australia (H.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia (M.F.K., J.K., K.B-M., B.G., G.D., D.A.C.); Faculty of Health Sciences, La Trobe University, Bundoora, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Melbourne, Australia (N.A.L.); The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (C.S.A.); The George Institute for Global Health at Peking University Health Science Center, Beijing, China (C.S.A.); Acute Stroke Services, John Hunter Hospital, Newcastle, Australia (C.L.); St Vincent's Health Australia, Sydney (S.F.); Stroke Foundation, Melbourne, Australia (K.H.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (S.M.); and Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (R.G.)
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Gutman CK, Cousins L, Gritton J, Klein EJ, Brown JC, Scannell J, Lion KC. Professional Interpreter Use and Discharge Communication in the Pediatric Emergency Department. Acad Pediatr 2018; 18:935-943. [PMID: 30048713 PMCID: PMC6855246 DOI: 10.1016/j.acap.2018.07.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Families with limited English proficiency (LEP) experience communication barriers and are at risk for adverse events after discharge from the pediatric emergency department (ED). We sought to describe the characteristics of ED discharge communication for LEP families and to assess whether the use of a professional interpreter was associated with provider communication quality during ED discharge. METHODS Transcripts of video-recorded ED visits for Spanish-speaking LEP families were obtained from a larger study comparing professional interpretation modalities in a freestanding children's hospital. Caregiver-provider communication interactions that included discharge education were analyzed for content and for the techniques that providers used to assess caregiver comprehension. Regression analysis was used to assess for an association between professional interpreter use and discharge education content or assessment of caregiver comprehension. RESULTS We analyzed 101 discharge communication interactions from 47 LEP patient visits; 31% of communications did not use professional interpretation. Although most patients (70%) received complete discharge education content, only 65% received instructions on medication dosing, and only 55% were given return precautions. Thirteen percent of the patient visits included an open-ended question to assess caregiver comprehension, and none included teach-back. Professional interpreter use was associated with greater odds of complete discharge education content (odds ratio [OR], 7.1; 95% confidence interval [CI], 1.4-37.0) and high-quality provider assessment of caregiver comprehension (OR, 6.1; 95% CI, 2.3-15.9). CONCLUSIONS Professional interpreter use is associated with superior provider discharge communication behaviors. This study identifies clear areas for improving discharge communication, which may improve safety and outcomes for LEP children discharged from the ED.
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Affiliation(s)
- Colleen K Gutman
- Present Address: Department of Pediatrics, Emory University, Atlanta, Ga (CK Gutman); Department of Pediatrics, University of Washington (CK Gutman, L Cousins, EJ Klein, JC Brown, and KC Lion).
| | - Liliana Cousins
- Department of Pediatrics, University of Washington (CK Gutman, L Cousins, EJ Klein, JC Brown, and KC Lion)
| | - Jesse Gritton
- Present Address: American Cancer Society, Seattle, Wash (J Gritton); Center for Child Health, Behavior and Development (J Gritton, J Scannell, and KC Lion)
| | - Eileen J Klein
- Department of Pediatrics, University of Washington (CK Gutman, L Cousins, EJ Klein, JC Brown, and KC Lion); Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Wash (EJ Klein, JC Brown)
| | - Julie C Brown
- Department of Pediatrics, University of Washington (CK Gutman, L Cousins, EJ Klein, JC Brown, and KC Lion); Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Wash (EJ Klein, JC Brown)
| | - Jack Scannell
- Present Address: School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom (J Scannell); Center for Child Health, Behavior and Development (J Gritton, J Scannell, and KC Lion)
| | - K Casey Lion
- Department of Pediatrics, University of Washington (CK Gutman, L Cousins, EJ Klein, JC Brown, and KC Lion); Center for Child Health, Behavior and Development (J Gritton, J Scannell, and KC Lion)
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Stowell JR, Filler L, Sabir MS, Roh AT, Akhter M. Implications of language barrier on the diagnostic yield of computed tomography in pulmonary embolism. Am J Emerg Med 2017; 36:677-679. [PMID: 29395769 DOI: 10.1016/j.ajem.2017.12.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/16/2017] [Accepted: 12/26/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To determine if a physician-patient language barrier impacts the diagnostic accuracy of pulmonary embolism (PE) evaluation. METHODS A retrospective chart review, conducted between June 2015 and December 2016, of a consecutive sample of diagnostic computed tomography pulmonary angiogram (CTPA) studies performed on adult patients. Positive and negative CTPA scans were further categorized by patient language and the positive diagnostic yield was determined for each language group. A post collection sub-analysis was performed to determine the yield when interpreter services were identified as necessary. RESULTS The yield for English speaking patients was 10.24% (92/898, 95% CI 8.39% to 12.36%), similar to the yield in Spanish speaking patients of 9.40% (25/266, 95% CI 6.31% to 13.37%, P=0.69). This contrasted with the yield in patients who identified as bilingual, which was significantly lower at 1.41% (1/71, 95% CI 0.07% to 6.75%) compared to both English-(P<0.02) and Spanish-only speakers (P<0.03). The yield for non-English speaking patients who requested an interpreter was 7.37% (14/190, 95% CI 4.26% to 11.77%) versus 3.23% (2/62, 95% CI 0.54% to 10.25%, P=0.25) in those who did not. CONCLUSIONS The diagnostic yield in English- and Spanish-only speaking patients was similar, however, the yield in those that self-identified as bilingual was significantly lower. In patient groups in which a language barrier existed and an interpreter was not utilized, there was a trend toward a lower diagnostic yield. This suggests an increased propensity to order diagnostic imaging when potential communication barriers exist.
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Affiliation(s)
- Jeffrey R Stowell
- Department of Emergency Medicine, University of Arizona College of Medicine-Phoenix, 550 E Van Buren St., Phoenix, AZ 85004, USA; Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E. Roosevelt St., Phoenix, AZ 85008, USA.
| | - Levi Filler
- Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E. Roosevelt St., Phoenix, AZ 85008, USA
| | - Marya S Sabir
- School of Mathematical and Natural Sciences, Arizona State University, 900 S Palm Walk, Tempe, AZ 85281, USA
| | - Albert T Roh
- Department of Radiology, Maricopa Integrated Health System, 2601 E. Roosevelt St., Phoenix, AZ 85008, USA
| | - Murtaza Akhter
- Department of Emergency Medicine, University of Arizona College of Medicine-Phoenix, 550 E Van Buren St., Phoenix, AZ 85004, USA; Department of Emergency Medicine, Maricopa Integrated Health System, 2601 E. Roosevelt St., Phoenix, AZ 85008, USA
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Njeru JW, Damodaran S, North F, Jacobson DJ, Wilson PM, St Sauver JL, Radecki Breitkopf C, Wieland ML. Telephone triage utilization among patients with limited English proficiency. BMC Health Serv Res 2017; 17:706. [PMID: 29121920 PMCID: PMC5679138 DOI: 10.1186/s12913-017-2651-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 11/02/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Communication between patients with limited English proficiency (LEP) and telephone triage services has not been previously explored. The purpose of this study was to determine the utilization characteristics of a primary care triage call center by patients with LEP. METHODS This was a retrospective cohort study of the utilization of a computer-aided, nurse-led telephone triage system by English proficiency status of patients empaneled to a large primary care practice network in the Midwest United States. Interpreter Services (IS) need was used as a proxy for LEP. RESULTS Call volumes between the 587 adult patients with LEP and an age-frequency matched cohort of English-Proficient (EP) patients were similar. Calls from patients with LEP were longer and more often made by a surrogate. Patients with LEP received recommendations for higher acuity care more frequently (49.4% versus 39.0%; P < 0.0004), and disagreed with recommendations more frequently (30.1% versus 20.9%; P = 0.0004). These associations remained after adjustment for comorbidities. Patients with LEP were also less likely to follow recommendations (60.9% versus 69.4%; P = 0.0029), even after adjusting for confounders (adjusted odds ratio [AOR] = 0.65; 95% confidence interval [CI], 0.49, 0.85; P < 0.001). CONCLUSION Patients with LEP who utilized a computer-aided, nurse-led telephone triage system were more likely to receive recommendations for higher acuity care compared to EP patients. They were also less likely to agree with, or follow, recommendations given. Additional research is needed to better understand how telephone triage can better serve patients with LEP.
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Affiliation(s)
- Jane W Njeru
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Swathi Damodaran
- Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Frederick North
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Rochester, MN, USA
| | - Patrick M Wilson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Rochester, MN, USA
| | - Jennifer L St Sauver
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | | | - Mark L Wieland
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Tung M, Sharma R, Hinson JS, Nothelle S, Pannikottu J, Segal JB. Factors associated with imaging overuse in the emergency department: A systematic review. Am J Emerg Med 2017; 36:301-309. [PMID: 29100783 DOI: 10.1016/j.ajem.2017.10.049] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Emergency departments (ED) are sites of prevalent imaging overuse; however, determinants that drive imaging in this setting are not well-characterized. We systematically reviewed the literature to summarize the determinants of imaging overuse in the ED. METHODS We searched MEDLINE® and Embase® from January 1998 to March 2017. Studies were included if they were written in English, contained original data, pertained to a U.S. population, and identified a determinant associated with overuse of imaging in the ED. RESULTS Twenty relevant studies were included. Fourteen evaluated computerized tomography (CT) scanning in patents presenting to a regional ED who were then transferred to a level 1 trauma center; incomplete transfer of data and poor image quality were the most frequently described reasons for repeat scanning. Unnecessary pre-transfer scanning or repeated scanning after transfer, in multiple studies, was highest among older patients, those with higher Injury Severity Scores (ISS) and those being transferred further. Six studies explored determinants of overused imaging in the ED in varied conditions, with overuse greater in older patients and those having more comorbid diseases. Defensive imaging reportedly influenced physician behavior. Less integration of services across the health system also predisposed to overuse of imaging. CONCLUSIONS The literature is heterogeneous with surprisingly few studies of determinants of imaging in minor head injury or of spine imaging. Older patient age and higher ISS were the most consistently associated with ED imaging overuse. This review highlights the need for precise definitions of overuse of imaging in the ED.
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Affiliation(s)
- Monica Tung
- Johns Hopkins University School of Medicine, Department of Medicine, United States
| | - Ritu Sharma
- Johns Hopkins University Bloomberg School of Public Health, United States
| | - Jeremiah S Hinson
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, United States
| | - Stephanie Nothelle
- Johns Hopkins University School of Medicine, Department of Medicine, United States
| | - Jean Pannikottu
- Johns Hopkins University School of Medicine, Department of Medicine, United States; Northeastern Ohio Medical University, United States(1)
| | - Jodi B Segal
- Johns Hopkins University School of Medicine, Department of Medicine, United States; Johns Hopkins University Bloomberg School of Public Health, United States; Johns Hopkins University Center for Health Services and Outcomes Research, United States.
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Andrews A, Franklin L, Rush N, Witts R, Blanco D, Pall H. Age, Sex, Health Insurance, and Race Associated With Increased Rate of Emergent Pediatric Gastrointestinal Procedures. J Pediatr Gastroenterol Nutr 2017; 64:907-910. [PMID: 27513695 PMCID: PMC5303193 DOI: 10.1097/mpg.0000000000001377] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Few studies have examined the role health disparities play in pediatric gastrointestinal (GI) procedures. We hypothesized that health disparity factors affect whether patients undergo an emergent versus nonemergent GI procedure. The aims were to characterize the existing pediatric population undergoing GI procedures at our institution and assess specific risk factors associated with emergent versus nonemergent care. METHODS We retrospectively reviewed the medical records of 2110 patients undergoing GI procedures from January 2012 to December 2014. Emergent procedures were performed on an urgent inpatient basis. All other procedures were considered nonemergent. Health disparity factors analyzed included age, sex, insurance type, race, and language. Logistic regression analysis identified the odds of undergoing emergent procedures for each factor. RESULTS Most study patients were boys (58.2%), primarily insured by Medicaid (63.8%), white (44.0%), and spoke English (91.7%). Ten percent of all patients had an emergent procedure. Logistic regression analysis showed significant odds ratios (P value) for ages 18 years older (2.16, 0.003), females (0.62, 0.001), commercial insurance users (0.49, <0.0001), African Americans (1.94, <0.0001), and other race (1.72, 0.039). CONCLUSIONS Health disparities in age, sex, insurance, and race appear to exist in this pediatric population undergoing GI procedures. Patients older than 18 years, African Americans, and other races were significantly more likely to have an emergent procedure. Girls and commercial insurance users were significantly less likely to have an emergent procedure. More research is necessary to understand why these relations exist and how to establish appropriate interventions.
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Affiliation(s)
- Ashley Andrews
- Section of Gastroenterology, Hepatology, and Nutrition, St. Christopher’s Hospital for Children, Philadelphia, PA, United States
| | - Linda Franklin
- Section of Gastroenterology, Hepatology, and Nutrition, St. Christopher’s Hospital for Children, Philadelphia, PA, United States
| | - Natasha Rush
- Section of Gastroenterology, Hepatology, and Nutrition, St. Christopher’s Hospital for Children, Philadelphia, PA, United States
| | - Robin Witts
- Section of Gastroenterology, Hepatology, and Nutrition, St. Christopher’s Hospital for Children, Philadelphia, PA, United States
| | - David Blanco
- Section of Gastroenterology, Hepatology, and Nutrition, St. Christopher’s Hospital for Children, Philadelphia, PA, United States
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Harpreet Pall
- Section of Gastroenterology, Hepatology, and Nutrition, St. Christopher’s Hospital for Children, Philadelphia, PA, United States
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA, United States
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Castaneda-Guarderas A, Glassberg J, Grudzen CR, Ngai KM, Samuels-Kalow ME, Shelton E, Wall SP, Richardson LD. Shared Decision Making With Vulnerable Populations in the Emergency Department. Acad Emerg Med 2016; 23:1410-1416. [PMID: 27860022 DOI: 10.1111/acem.13134] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/02/2016] [Indexed: 01/19/2023]
Abstract
The emergency department (ED) occupies a unique position within the healthcare system, serving as a safety net for vulnerable patients, regardless of their race, ethnicity, religion, country of origin, sexual orientation, socioeconomic status, or medical diagnosis. Shared decision making (SDM) presents special challenges when used with vulnerable population groups. The differing circumstances, needs, and perspectives of vulnerable groups invoke issues of provider bias, disrespect, judgmental attitudes, and lack of cultural competence, as well as patient mistrust and the consequences of their social and economic disenfranchisement. A research agenda that includes community-engaged approaches, mixed-methods studies, and cost-effectiveness analyses is proposed to address the following questions: 1) What are the best processes/formats for SDM among racial, ethnic, cultural, religious, linguistic, social, or otherwise vulnerable groups who experience disadvantage in the healthcare system? 2) What organizational or systemic changes are needed to support SDM in the ED whenever appropriate? 3) What competencies are needed to enable emergency providers to consider patients' situation/context in an unbiased way? 4) How do we teach these competencies to students and residents? 5) How do we cultivate these competencies in practicing emergency physicians, nurses, and other clinical providers who lack them? The authors also identify the importance of using accurate, group-specific data to inform risk estimates for SDM decision aids for vulnerable populations and the need for increased ED-based care coordination and transitional care management capabilities to create additional care options that align with the needs and preferences of vulnerable populations.
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Affiliation(s)
- Ana Castaneda-Guarderas
- Department of Emergency Medicine Aventura Hospital and Medical Center; Miami FL
- Department of Emergency Medicine and Knowledge & Evaluation Research Unit; Mayo Clinic; Rochester MN
| | - Jeffrey Glassberg
- Department of Emergency Medicine; The Icahn School of Medicine at Mount Sinai; New York NY
- Center for Health Equity and Community Engaged Research; Department of Population Health Science & Policy; The Icahn School of Medicine at Mount Sinai; New York NY
- Department of Medicine; Division Hematology & Medical Oncology; The Icahn School of Medicine at Mount Sinai; New York NY
| | - Corita R. Grudzen
- Department of Emergency Medicine and the Department of Population Health; New York University; New York NY
| | - Ka Ming Ngai
- Department of Emergency Medicine; The Icahn School of Medicine at Mount Sinai; New York NY
| | | | - Erica Shelton
- Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
| | - Stephen P. Wall
- Department of Emergency Medicine and the Department of Population Health; New York University; New York NY
- Bellevue Hospital Center; New York NY
| | - Lynne D. Richardson
- Department of Emergency Medicine; The Icahn School of Medicine at Mount Sinai; New York NY
- Center for Health Equity and Community Engaged Research; Department of Population Health Science & Policy; The Icahn School of Medicine at Mount Sinai; New York NY
- Department of Population Health Science & Policy; The Icahn School of Medicine at Mount Sinai; New York NY
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Mueller EL, Hall M, Carroll AE, Shah SS, Macy ML. Frequent Emergency Department Utilizers Among Children with Cancer. Pediatr Blood Cancer 2016; 63:859-64. [PMID: 26841193 DOI: 10.1002/pbc.25929] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/05/2016] [Accepted: 01/09/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pediatric frequent emergency department (ED) utilizers contribute a significant proportion of ED visits, but no studies specifically address children with cancer. METHODS A retrospective study of Pediatric Health Information System analyzing ED visits for children with cancer, including ED visits within 365 days from the first inpatient encounter with a discharge diagnosis code for malignancy. We defined frequent ED utilizers as those with four or more visits in the year (top 10th percentile). Patient characteristics and ED services (medications, laboratory, or imaging) for discharged children were assessed. Factors associated with being a frequent ED utilizer were examined with multivariable regression. RESULTS Frequent utilizers accounted for 58% of ED visits. Frequent utilizers differed from infrequent utilizers in terms of type of cancer; 39.3% of frequent utilizers had acute lymphoblastic leukemia (ALL) and 16.0% had central nervous system (CNS) tumors compared with infrequent utilizers (21.9% had ALL and 24.8% CNS tumors, P-value < 0.001). Frequent utilization was associated with age 5-9 years (odds ratio [OR] = 1.4, 95% confidence interval [CI] 1.2-1.6) or 1-4 years (OR = 2.1, 95% CI 1.8-2.4) or <1 year (OR = 2.2, 95% CI 1.9-2.6) compared to 15-19 years and Hispanic ethnicity (OR 1.3, 95% CI 1.1-1.5) compared to white, non-Hispanics, and urban residence (OR = 1.5, 95% CI 1.3-1.7). Few children with cancer received no medication, laboratory, or imaging during their ED visit (frequent 11.0% vs. infrequent 12.5%, P = 0.01). CONCLUSIONS The ED is integral to the care provided to children with cancer. The subset of frequent utilizers should be the focus of future research and quality improvement efforts.
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Affiliation(s)
- Emily L Mueller
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, Indiana.,Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, Indiana
| | - Matt Hall
- Children's Hospital Association, Overland Park, Kansas
| | - Aaron E Carroll
- Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, Indiana.,Center for Health Policy and Professionalism Research, Indiana University, Indianapolis, Indiana
| | - Samir S Shah
- Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Michelle L Macy
- Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan.,Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
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