Disparities in Chronic Illness Care for Patients with Language Barriers

有语言障碍的患者在慢性病护理方面的差异

• 批准号: 8281190
• 负责人: Leo Sergio Morales
• 金额: $ 40.72万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8281190
• 关键词: Accident and Emergency department; Adherence; Adverse event; Affect; Applications Grants; Belief; California; Caring; Chinese People; Chronic; Chronic Disease; Chronically Ill; Clinical; Communication; Complex; Comprehension; Crowding; Data; Diabetes Mellitus; Diagnosis; Dose; Electronics; Future; Goals; Health; Health Services Research; Health system; Home environment; Hospitalization; Hyperlipidemia; Hypertension; Individual; Institution; Integrated Health Care Systems; Intervention; Journals; Koreans; Language; Link; Los Angeles; Mainstreaming; Mediating; Mediation; Medical; Modeling; Modification; Morbidity - disease rate; Outcome; Pacific Northwest; Patient Care; Patients; Peer Review; Pharmaceutical Preparations; Population; Provider; Publications; Quality of Care; Recommendation; Recording of previous events; Reporting; Research; Research Institute; Research Personnel; Risk; Screening for cancer; Statistical Methods; Surveys; System; Testing; United States; Universities; Visit; Vulnerable Populations; Washington; Wisconsin; base; common treatment; experience; foreign language; health care quality; improved; innovation; medication compliance; novel; satisfaction; skills; theories; treatment adherence; treatment program

DESCRIPTION (provided by applicant): This project's overall goals are: 1) to investigate the impact of language barriers on medication adherence (following a prescribed medication program) and treatment intensification (increasing treatment) in patients with diabetes mellitus (DM), hypertension (HTN), and hyperlipidemia (HL); and 2) to identify modifiable factors for targeting future interventions to enhance outcomes. Approximately 55 million people in the United States report speaking a foreign language at home and nearly 45% of these individuals (~25 million) report limited English proficiency (LEP). Patients with LEP are at increased risk for poor health care quality and poor health outcomes, but little research has looked at how language barriers affect treatment of common chronic conditions. The proposed project will be conducted at Group Health, a large, non-profit integrated health system in the Pacific Northwest with a long history of innovative health services research. A novel conceptual model of adherence to prescribed medications in LEP patients, based on previously developed adherence models, was created and used to guide selection of key factors to analyze. Data for the study will be collected from Group Health's extensive electronic health systems, augmented by surveys in Chinese, Korean, Spanish, Vietnamese, and English, given to 600 LEP patients. Data will be analyzed using advanced statistical methods. The Specific Aims of the project are: Aim 1) To evaluate how medication adherence, and treatment intensification, differ by LEP status in patients with DM, HTN, and HL; Aim 2) To characterize differences between patients by LEP status in patient, provider, and health system factors associated with medication adherence and treatment intensification, and to investigate the extent to which these factors explain differences identified in Aim 1 between LEP and non-LEP patients; and Aim 3) To identify modifiable patient, provider, and health system factors associated with medication adherence and treatment intensification in LEP populations. Findings from this project will go well beyond previous studies on LEP patients by identifying theory-driven modifiable patient-, provider- and system-levels factors associated with medication adherence and treatment intensification in subjects with limited English skills. The project brings together junior and senor researchers from Group Health, the University of Washington, UCLA, and the University of Wisconsin-Madison. We expect our findings to stimulate research on improving care for LEP patients, through publications in peer-reviewed journals and new grant applications that propose interventions to improve medication adherence and treatment intensification in patients facing language barriers. PUBLIC HEALTH RELEVANCE: Approximately 55 million people in the United States report speaking a foreign language at home and 45% of these individuals (~25 million) report limited English proficiency (LEP). This project's goals are to investigate the impact of language barriers on medication adherence and treatment intensification in patients with diabetes mellitus (DM), hypertension (HTN), and hyperlipidemia (HL), and to identify modifiable factors for targeting future interventions to enhance outcomes. Findings from this study will increase understanding of how language barriers contribute to disparities in health and provide groundwork for future research and interventions to reduce disparities due to language barriers.

描述（由申请人提供）：该项目的总体目标是：1）调查语言障碍对药物依从性的影响（遵循处方药物计划）和治疗强化（增加的治疗）（较高的治疗）对糖尿病（DM），高血压（HTN）和高脂血症（HL）的影响； 2）确定可修改因素以靶向未来的干预措施以增强结果。美国大约有5500万人报告说在家中说外语，其中近45％的人（约2500万）报告了英语能力有限（LEP）。 LEP患者的风险增加 医疗保健质量差和健康状况不佳，但很少的研究研究语言障碍如何影响常见慢性病的治疗。拟议的项目将在太平洋西北部的大型非营利性综合卫生系统集团健康中进行，具有创新卫生服务研究的悠久历史。基于先前开发的依从性模型，一种新型的遵守LEP患者处方药的概念模型被创建并用于指导关键因素进行分析。该研究的数据将从Group Health的广泛电子卫生系统中收集，并通过中文，韩国，西班牙语，越南语和英语进行调查增强，并给了600名LEP患者。将使用高级统计方法分析数据。该项目的具体目的是：目标1）评估DM，HTN和HL患者的LEP状态的药物依从性和治疗加强的不同； 目的2）表征患者在患者，提供者和卫生系统因素因素依从性和治疗强化相关的患者中的差异，并研究这些因素解释在LEP和非LEP患者之间在AIM 1中鉴定出的差异的程度；目标3）确定与药物依从性和LEP种群中治疗加强相关的可修改患者，提供者和卫生系统因素。该项目的发现将远远超出对LEP患者的先前研究，通过识别理论驱动的可修改的患者，提供者和系统级别的因素，这些因素与具有有限英语技能的受试者的药物依从性和治疗加强相关。该项目汇集了集团健康，华盛顿大学，加州大学洛杉矶分校和威斯康星大学麦迪逊分校的初级研究人员。我们希望通过同行评审的期刊和新的赠款应用中的出版物提出干预措施，以改善面临语言障碍的患者的治疗依从性和治疗强化，从而刺激改善LEP患者护理的研究。 公共卫生相关性：美国大约有5500万人报告说在家中说外语，其中45％的人（约2500万）报告有限英语能力（LEP）。该项目的目标是调查语言障碍对糖尿病（DM）患者（HTN）和高脂血症（HL）患者的药物依从性和治疗强化的影响，并识别可修改的因素，以靶向未来的干预措施以增强增强效果。这项研究的发现将增加对语言障碍如何促进健康差异的理解，并为未来的研究和干预措施提供基础，以减少由于语言障碍而导致的差异。