Adapting an Evidence-Based Intervention to Improve the Hospital Discharge Process for Patients with Limited English Proficiency

采用循证干预措施改善英语水平有限患者的出院流程

• 批准号: 10783353
• 负责人: Kirsten Austad
• 金额: $ 16.19万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-23 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10783353
• 关键词: Address; Admission activity; Adverse event; Appointment; Boston; Calendar; Caring; Client satisfaction; Clinical; Clinical Trials Design; Communication; Communication Barriers; Communities; Comprehension; Conduct Clinical Trials; Dangerousness; Data; Disparity; Disparity population; Educational process of instructing; Effectiveness; Engineering; Ensure; Environment; Equity; Ethnic Origin; Evaluation; Evidence based intervention; Exclusion; Face; Failure; Family; Frequencies; Goals; Haitian; Home; Hospital Costs; Hospitalists; Hospitalization; Hospitals; Hybrids; Inequity; Inferior; Instruction; Intervention; Interview; Knowledge; Language; Lead; Limited English Proficiency; Linguistics; Logit Models; Measures; Medical; Medical center; Medication Errors; Mentors; Methodology; Methods; Minority Groups; Modeling; Modification; National Institute on Minority Health and Health Disparities; Nurses; Outcome; Participant; Patient Care; Patient Discharge; Patient Education; Patient Preferences; Patients; Pharmaceutical Preparations; Population; Positioning Attribute; Preparation; Primary Care; Process; Provider; Randomized, Controlled Trials; Reporting; Research; Research Personnel; Review Literature; Safety; Sampling; Science; Series; Site; Structure; Survey Methodology; Symptoms; Testing; Time; Training; Translations; Underserved Population; United States; Work; Writing; acceptability and feasibility; barrier to care; care coordination; care providers; disparity reduction; effectiveness/implementation trial; evidence base; experience; experimental study; feasibility trial; health disparity; health disparity populations; health equity; high risk; hospital readmission; implementation intervention; implementation outcomes; implementation science; improved; improved outcome; insight; medication compliance; multi-component intervention; multidisciplinary; patient safety; person centered; pilot trial; poor health outcome; preference; programs; readmission rates; recruit; response; retention rate; safety net; service coordination; social health determinants; social vulnerability; standardize measure; success; treatment as usual; verbal

Project Summary Hospital discharge is a high-risk time due to the frequency of miscommunication, medication errors, and discontinuity of providers which lead to dangerous and costly hospital readmissions. Patients with limited English proficiency (LEP)—a growing demographic in the United States—are the most likely to be negatively impacted by these gaps in quality and safety given the communication barriers created by language discordant care and their additional social vulnerabilities. Patients with LEP are more likely to have poor comprehension of discharge instructions, face barriers to obtaining medications, report new or worsening symptoms once home, and suffer post-discharge adverse events. Such inequities lead to poor outcomes, which drive health disparities. While multiple care transition interventions have been shown to improve these outcomes, they have excluded patients with LEP. ReEngineered Discharge (RED) is a multi-component discharge intervention that was shown to reduce reutilization by 32% and improve patient experience. To improve health equity in outcomes relating to hospital discharge, care transition programs such as RED must be adapted to meet the needs of those with LEP, addressing language barriers, cultural factors, and social determinants of health salient at the time of discharge. Adaptation is a proven strategy to reduce disparities by ensuring intervention fit, and thus effectiveness, in health disparity populations. The goal of this application is to adapt RED for patients with LEP, informed by new data on patient preferences and a multidisciplinary adaptation process utilizing key stakeholders, and test it in a pilot trial. In Aim 1, I will conduct a discrete choice experiment (DCE), a modified survey methodology to quantify preferences through implicit trade-offs in choices, to understand how those with LEP value different discharge supports. In Aim 2, I will apply the ADAPT methodology, an evidence-based approach that harnesses wisdom from a diverse team of stakeholders, to determine the specific adaptations to RED. In Aim 3, I will test the adapted intervention (RED-LEP) in a diverse safety net LEP population through a pilot randomized controlled trial with the goal to assess key implementation outcomes (fidelity, acceptability, and feasibility) as well as the feasibility collecting data on clinical outcomes. The proposed research will provide me with experience in the following domains, which address specific deficits in my training in implementation science to date: quantitative approaches to understanding stakeholder preference, intervention adaptation, and conduct of clinical trials with participants with LEP. This research builds on my prior work with ethnic and linguistic minority populations in the global setting and my clinical expertise as a hospitalist in a diverse safety net setting. My training aims—along with my multi-disciplinary mentor/advisor team with experience in health equity research, implementation science, and linguistic barriers to care—will facilitate my transition to research independence and position me to test the RED-LEP model in a multi-site hybrid type II effectiveness-implementation trial.

项目摘要 由于沟通不畅，药物错误和 提供者的不连续性导致危险且昂贵的医院再入院。有限的患者 英语水平（LEP） - 美国的人口增长 - 最可能是负面的 鉴于语言不一致的沟通障碍，受这些质量和安全差距的影响 关心及其额外的社会脆弱性。 LEP患者对 出院说明，获得药物的面部障碍，报告回家后的新症状或恶化， 并遭受放假后的广告活动。这种不平等导致结果不佳，这会促进健康 差异。尽管已显示多个护理过渡干预措施可以改善这些结果，但 他们排除了LEP患者。重新设计的排放（红色）是多组分排放 干预措施被证明可以减少32％的重新注入并改善患者的经验。改善健康 与医院出院有关的结果的公平性，护理过渡计划（例如红色）必须适应 满足LEP的人的需求，解决语言障碍，文化因素和社会决定者的需求 出院时的健康显着。适应是一种可靠的策略，可以通过确保来减少分布 干预措施适合健康差异人群。该应用的目的是 适用于LEP患者的红色，并通过有关患者偏好和多学科的新数据告知 使用主要利益相关者的适应过程，并在试点试验中对其进行测试。在AIM 1中，我将进行离散的选择 实验（DCE），一种修改的调查方法，可通过隐含的权衡来量化偏好 选择，以了解LEP价值不同放电的人如何支持。在AIM 2中，我将应用适应 方法论是一种基于证据的方法，它利用利益相关者的潜水团队的智慧， 确定对红色的特定改编。在AIM 3中，我将在A中测试改编的干预措施（Red-Lep） 通过飞行员随机对照试验的不同安全网LEP人群，其目标是评估钥匙 实施结果（忠诚，可接受性和可行性）以及收集数据的可行性 临床结果。拟议的研究将为我提供以下领域的经验， 解决我在实施科学培训中的特定定义：迄今为止的定量方法 了解利益相关者的偏好，干预适应以及与参与者的临床试验进行 与LEP。这项研究是基于我在全球范围内与种族和语言少数民族的工作 设置和我作为潜水员安全网中医院主义者的临床专业知识。我的培训目标 - 我的多学科导师/顾问团队拥有健康公平研究，实施科学方面的经验， 以及护理的语言障碍 - 将有助于我对独立的过渡，并将我定位为测试 在多站点混合II型有效性试验试验中，红色LEP模型。