Improving Outcomes for Spanish-Speaking Surgical Patients with Limited English Proficiency

改善英语水平有限的西班牙语外科患者的治疗效果

基本信息

批准号：
10624862
负责人：
Gezzer Ortega
金额：
$ 17.27万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-19 至 2027-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10624862
关键词：
Acceleration Address Adverse event Affect Award Bypass Caring Certification Clinical Communication Communication Barriers Communities Complex Complication Continuity of Patient Care Data Discipline Disparity Emergency Situation Equity Evaluation Family Funding Future Gestures Goals Health Healthcare Healthcare Systems Home Hospitals Individual Inequity Institution Institutional Racism Intervention Interview Language Legal Length of Stay Limited English Proficiency Link Medical Medicine Mentors Mission Modeling National Institute on Minority Health and Health Disparities Nurses Operative Surgical Procedures Outcome Participant Patient Care Patient-Centered Care Patient-Focused Outcomes Patients Persons Physicians Play Policies Provider Public Health Qualifying Qualitative Evaluations Qualitative Research Quantitative Evaluations Research Research Methodology Resources Risk Factors Scientist Services Structure Surgeon Surgical Specialties Technology Testing Training Translations United States United States National Institutes of Health Vulnerable Populations adverse event risk career cohort data registry design direct application empowerment experience health data health disparity health inequalities health information technology health outcome disparity high risk hospital readmission implementation science improved improved outcome innovation mobile application mobile computing nonEnglish language patient oriented patient population patient-clinician communication readmission rates skills social social factors social health determinants sociodemographic factors socioeconomics surgery outcome surgical disparities therapy design

项目摘要

Project Summary In 2018, nearly 67 million people in the US spoke a language other than English at home and, among them, 40% met criteria for limited English proficiency (LEP). People with LEP are at higher risk of adverse events during medical care. In fact, 1 in 12 patients is at risk for adverse events because of barriers created by language discordance, which occurs when the patient and provider do not share a common spoken language. Surgical disparities have been studied in various disciplines, but very few studies have focused on the impact of language. Understanding the impact that language and language discordance or concordance have on surgical outcomes represents a vital component of providing effective, high-quality patient care. Our overall objective is to improve outcomes for surgical patients with LEP. The central hypothesis is that socioeconomic and sociodemographic factors impact outcomes of surgical care for patients with LEP and that identifying those factors through quantitative and qualitative research rooted in a social ecological model (SEM) will provide an opportunity to design interventions that address these risk factors and reduce surgical disparities. Building on a deeper understanding of patient experiences and social risk factors, this project will test the use of a mobile technology for live medical interpretation provided directly to patients. We seek to determine if such a solution can improve communication and promote patient-initiated language concordant encounters, thereby leading to better surgical outcomes. While some research suggests the effects of language discordance may be mitigated by the use of trained interpreters, qualified interpreters are not reliably used for all patients with LEP, even at resource-rich health centers. These barriers threaten to compromise the provision of equitable and patient-centered care for this patient population. To that extent, we will test our central hypothesis by pursing three specific aims: (1) Determine whether language concordance is associated with surgical outcomes in a large retrospective surgical patient cohort; (2) Identify the social factors that influence the use of formal interpreter services to treat primary Spanish-speaking surgical patients with LEP; and (3) Evaluate if an immediate interpreter mobile application enables language concordant communication for primary Spanish-speaking patients with LEP. Likewise, studying the complex interaction of structural, interpersonal, and individual factors will enrich our understanding of the impact of language across the continuum of surgical care. The research proposed in this application is innovative because no one has sought to elucidate precisely how LEP may influence surgical outcomes and nor have they applied the SEM in an attempt to have a profound impact for vulnerable populations. Also, by providing the mobile interpretation application directly to patients (in addition to surgeons and nurses), we hope to empower patients with LEP to serve as drivers of their care and improve the patient-centeredness of their care. Ultimately, the findings of this study could be applied to other fields of medicine and patient populations to improve the care of millions of patients by mitigating language and communication barriers to reduce health inequities.

项目概要 2018年，美国有近6700万人在家里使用英语以外的语言，其中40% 符合有限英语水平 (LEP) 的标准。 LEP 患者在治疗期间发生不良事件的风险较高医疗保健。事实上，由于语言障碍，每 12 名患者中就有 1 名面临不良事件的风险不一致，当患者和提供者没有共同的语言时就会发生这种情况。外科不同学科对差异进行了研究，但很少有研究关注语言的影响。了解语言和语言不一致或一致性对手术结果的影响是提供有效、高质量患者护理的重要组成部分。我们的总体目标是改进 LEP 手术患者的结果。核心假设是社会经济和社会人口统计学影响 LEP 患者手术治疗结果的因素以及通过以下方式识别这些因素植根于社会生态模型（SEM）的定量和定性研究将提供一个机会设计干预措施来解决这些风险因素并减少手术差异。建立在更深层次上了解患者体验和社会风险因素，该项目将测试移动技术的使用直接向患者提供现场医疗口译。我们寻求确定这样的解决方案是否可以改进沟通并促进患者发起的语言一致的接触，从而导致更好的手术结果。虽然一些研究表明语言不一致的影响可以通过使用训练有素的口译员，即使在资源丰富的地方，合格的口译员也不能可靠地为所有 LEP 患者提供服务保健中心。这些障碍可能会损害向患者提供公平和以患者为中心的护理服务。这个患者群体。在这个意义上，我们将通过追求三个具体目标来检验我们的中心假设：（1）在大型回顾性手术中确定语言一致性是否与手术结果相关患者队列； (2) 确定影响使用正式口译服务治疗初级儿童的社会因素患有 LEP 的西班牙语手术患者； (3) 评估即时译员移动应用程序是否为主要讲西班牙语的 LEP 患者提供语言一致的沟通。同样地，研究结构、人际和个人因素的复杂相互作用将丰富我们的理解语言对整个手术护理过程的影响。本申请中提出的研究是之所以具有创新性，是因为没有人试图准确阐明 LEP 如何影响手术结果，也没有人试图准确地阐明 LEP 可能如何影响手术结果他们是否应用了 SEM 来尝试对弱势群体产生深远的影响？另外，通过提供我们希望将移动口译应用程序直接面向患者（除了外科医生和护士） LEP 患者成为其护理的推动者并提高护理以患者为中心的程度。最终，这项研究的结果可以应用于其他医学领域和患者群体，以改善护理通过减少语言和沟通障碍来减少健康不平等，惠及数百万患者。