Harnessing Health Information Technology to Promote Equitable Care for Patients with Limited English Proficiency and complex care needs

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PROJECT SUMMARY/ABSTRACT As the growing population of 25 million people with Limited English Proficiency (having a limited ability to read, speak, write, or understand English) ages, the number with complex care needs is projected to rise. Patients with Limited English Proficiency (LEP) and complex care needs (such as those encountered during critical illness, life-limiting chronic illness, and at end-of-life) suffer worse outcomes and receive poorer quality care than patients who are English-proficient. This disparity is due to suboptimal communication. Regrettably, despite evidence that interpreters improve communication, as well as satisfaction with care and clinical outcomes, interpreters are under-utilized in practice. Mechanisms to increase interpreter use are lacking, but research suggests that systems that facilitate interpreter use are likely to garner clinician support and achieve success more readily than other approaches. The objective of this proposal is to address this critical need through the following specific aims: 1a)To engage stakeholders in testing and validating a health information- based screening tool or “sniffer” to reliably identify patients with LEP and complex care needs; 1b) To engage stakeholders in designing an effective process for proactively reaching patients with unmet interpreter needs early in their hospitalization; 2) To examine the preliminary effectiveness of the developed intervention on interpreter use and time to interpreter use among patients with LEP and complex care needs using a stepped- wedge cluster randomized trial. Aim 1a leverages our investigator group’s previous work developing an artificial intelligence-based algorithm to identify patients who would benefit from a palliative care consult, to build a similar predictive model to identify patients with LEP and complex care needs. Aim 1b engages different stakeholders to co-design and develop an effective process to link interpreter services to the identified patients in a timely manner. Aim 2 will use a pragmatic clinical trial design to evaluate whether the combined predictive model and process (intervention) for identifying and connecting patients with LEP and complex care needs brings interpreters to the bedside more quickly and frequently than current standard practice. The long-term objectives of the primary investigator are to promote equitable care for patients with LEP and complex care needs by developing strategies that address diverse linguistic, social, and cultural factors effectively. The investigator team and research environment is suited to achieve the aims of the proposal, combining content expertise about disparities in communication, decision making, care among patients with LEP and modelling and informatics research methodology experience at a high-volume academic center treating patients with LEP and complex care needs. The research will provide essential foundational data for a future R01 application in which subsequent studies assess the impact of the intervention on healthcare utilization, patient and family satisfaction with decision making, and subsequent care and clinician quality of communication.