Improving linguistic health equity in prehospital emergency care

改善院前急救护理中的语言健康公平

• 批准号: 10786657
• 负责人: HENDRIKA W. MEISCHKE
• 金额: $ 57.4万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-25 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10786657
• 关键词: Accident and Emergency department; Adverse event; Affect; Awareness; Belief; Caring; Characteristics; Charge; Chinese; Client satisfaction; Clinics and Hospitals; Communication; Communication Barriers; Communities; Complex; Decision Making; Delphi Technique; Development; Disparity; Emergency Care; Emergency Situation; Emergency medical service; Emergency response; Emotional; Emotions; Environment; Fright; Goals; Health; Health Status; Individual; Inequity; Instruction; Knowledge; Language; Life; Limited English Proficiency; Linguistics; Medical; Medical emergency; Methods; Nature; Outcome; Patients; Pattern; Policies; Pre-hospitalization care; Prehospital Emergency Care; Process; Recording of previous events; Reporting; Research; Route; Sampling; Services; System; Telephone; Time; Training; Translating; Translations; Triage; United States; Visit; Work; care delivery; clinical care; distrust; emergency settings; experience; first responder; health equity; health equity promotion; improved; patient-clinician communication; policy recommendation; response; satisfaction; skills; social; stem; training opportunity

Project Summary Language barriers in prehospital emergency care can deny patients live-saving clinical care and build distrust with the emergency medical system. When non/limited English proficient (LEP) patients call 9-1-1, they are more likely to experience delays, less likely to receive and perform pre-arrival instructions and more likely to experience adverse health outcomes and unscheduled emergency department return visits than their English- speaking counterparts. With 25 million LEP individuals in the United States we need a better understanding of the gaps in prehospital emergency care and modify the system to promote health equity in care delivery. In hospital and clinic settings, the gold standard for overcoming language barriers is the use of professional interpreters, which has shown to improve care delivery, patient satisfaction and health outcomes. While over- the-phone interpreter (OPI) use in the 9-1-1 Dispatch emergency setting can be critical to facilitating assessment and pre-arrival instruction delivery, suboptimal utilization (over, under or delayed utilization of OPI) can result in worsened outcomes. This may explain some of the disparities seen in research showing that 9-1- 1 calls with LEP callers more frequently result in triage errors, increased time to dispatching response, and that pre-arrival instructions are often delayed and/or not performed by LEP callers. We propose a multi-method study, guided by the Feldman-Stewart et al. (2005) provider-patient communication framework, to increase our understanding of the complex interaction between LEP callers, dispatchers and interpreters during the first critical minutes of emergency care. This study has three aims and one sub-aim: 1) Identify call characteristics that are associated with use of OPI and associated communication and care delivery outcomes during real-life 9-1-1 calls with LEP callers. 1a.) analyze three-way communication patterns between dispatcher, caller and OPI in a sample of Spanish and Chinese (i.e., Mandarin/Cantonese) 9-1-1 calls with OPI. 2) Identify key dispatcher attributes associated with use of and time to OPI during simulated scenarios (developed based on information collected in Aim#1), with LEP Spanish and Chinese mock callers. 3) Translate and disseminate the results of the study via training opportunities and policy recommendations identified by emergency medical services (EMS) and community stakeholders, using a participatory Delphi technique. Our research group has contributed significantly to the existing research on linguistic inequities in prehospital care. We bring our vast knowledge of the complexity of communication in an emergency setting and a 30-year history of collaborative work with EMS and community partners to shed light on OPI use in prehospital care and guide translation of findings into policies and training on OPI use in prehospital care delivery.

项目概要 院前急救中的语言障碍可能会导致患者无法获得挽救生命的临床护理并造成不信任 与紧急医疗系统。当英语水平不高/英语水平有限 (LEP) 患者拨打 9-1-1 时，他们 更有可能遇到延误，不太可能接收和执行抵达前指示，更有可能 与英国人相比，他们经历了不良的健康结果和计划外的急诊室回访 发言的同行。美国有 2500 万 LEP 人士，我们需要更好地了解 院前急救护理方面的差距，并修改系统以促进护理服务中的卫生公平。 在医院和诊所环境中，克服语言障碍的黄金标准是使用专业人士 口译员已被证明可以改善护理服务、患者满意度和健康结果。虽然过度 在 9-1-1 调度紧急情况下使用电话口译员 (OPI) 对于促进 评估和抵达前指导交付、次优利用率（OPI 的利用率过高、不足或延迟） 可能会导致更糟糕的结果。这可以解释研究中发现的一些差异，表明 9-1- 1 与 LEP 呼叫者的呼叫更频繁地导致分类错误，增加了调度响应的时间，并且 LEP 呼叫者经常延迟和/或不执行到达前指示。 我们提出了一项由 Feldman-Stewart 等人指导的多方法研究。 (2005) 提供者-患者 通信框架，以增加我们对 LEP 调用者之间复杂交互的理解， 调度员和口译员在紧急护理的最初关键时刻。这项研究有三个目的 一个子目标： 1) 识别与 OPI 和相关通信的使用相关的呼叫特征 在现实生活中与 LEP 呼叫者进行 9-1-1 通话期间的护理交付结果。 1a.) 分析示例中调度程序、调用程序和 OPI 之间的三向通信模式 与 OPI 进行西班牙语和中文（即普通话/粤语）9-1-1 通话。 2) 识别模拟场景中与 OPI 的使用和时间相关的关键调度程序属性 （根据 Aim#1 中收集的信息开发），使用 LEP 西班牙语和中文模拟来电。 3）通过培训机会和政策转化和传播研究结果 紧急医疗服务 (EMS) 和社区利益相关者确定的建议，使用 参与式德尔菲技术。 我们的研究小组对院前语言不平等的现有研究做出了重大贡献 关心。我们凭借对紧急情况下通信复杂性的丰富知识以及 30 年的经验 与 EMS 和社区合作伙伴合作的历史，以阐明 OPI 在院前护理中的使用 并指导将调查结果转化为院前护理中 OPI 使用的政策和培训。