Mobile Video interpretation to Optimize Communication Across Language barriers: mVOCAL

移动视频口译可优化跨语言障碍的沟通：mVOCAL

• 批准号: 10491101
• 负责人: Katherine Casey Lion
• 金额: $ 80.89万
• 依托单位: SEATTLE CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-20 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10491101
• 关键词: Address; Adherence; Adopted; Adult; Affect; Caring; Childhood; Clinic; Clinic Visits; Communication; Comprehension; Diagnosis; Education; Effectiveness; Enrollment; Event; Evidence based practice; Face; Family; Goals; Infrastructure; Interview; Knowledge; Language; Learning Module; Legal; Limited English Proficiency; Link; Medical; Methods; Modeling; Online Systems; Outcome; Parents; Pathway interactions; Patients; Persons; Population; Primary Health Care; Production; Provider; Randomized; Research Personnel; Risk; Safety; Sequential Multiple Assignment Randomized Trial; Site; Surveys; System; Telephone; Testing; Theoretical Domains framework; Time; Uncertainty; United States; Video Recording; Visit; base; behavior change; compare effectiveness; cost; cost effective; disparity reduction; effectiveness implementation study; effectiveness study; experience; handheld mobile device; health care disparity; health care quality; health care service organization; health care settings; implementation strategy; improved; improved outcome; incremental cost-effectiveness; insight; multi-component intervention; novel; patient subsets; pressure; primary care setting; primary outcome; provider behavior; satisfaction; skills; trial design; wireless

Project Summary Over 25 million people in the United States (US) have limited English proficiency (LEP). LEP populations face substantial barriers to high-quality healthcare, resulting in disparate outcomes such as elevated risk for serious safety events, increased costs, and decreased comprehension, satisfaction, and adherence. Professional interpretation is an evidence-based practice to improve care and mitigate these disparities. However, its use remains persistently low despite legal and regulatory mandates. Previous strategies to improve use have mainly addressed intrapersonal barriers (provider knowledge and skills, via in -person education) or the system (simplifying telephone interpreter access). Educational strategies have improved provider knowledge with unknown effect on interpreter use; systems strategies have achieved modest improvements in use. However, these strategies have lacked clearly articulated mechanisms or causal pathways, often as part of expensive, multifaceted interventions that limit precise attribution and scalability. In this study, the investigators will compare two discrete implementation strategies for improving interpreter use, the first an enhanced education strategy targeting primarily intrapersonal barriers but delivered in a scalable format (interactive web-based educational modules), and the second targeting system barriers, with a novel focus on mobile video interpretation (mVI), accessible on providers’ own mobile devices. The study’s specific aims are: (1) Compare the effectiveness of two implementation strategies, alone and in combination, to improve use of interpretation and comprehension for LEP patients/parents seen in adult/pediatric primary care settings; (2) Explore mVI and education implementation strategies’ ability to activate putative provider-level mechanisms; and (3) Determine the incremental cost effectiveness from a healthcare organization perspective of each implementation strategy (mVI, education, both). To accomplish these aims, the investigators will conduct a Type III hybrid implementation-effectiveness study in 6 primary care clinics, using a Sequential Multiple Assignment Randomized Trial (SMART) design . Enrolled providers (total n=50) will be randomized to mVI or educational modules, in addition to standard interpreter access. After 9 months, providers with high interpreter use will continue as assigned; those with lower use will be randomized to continue as before or add the alternative implementation strategy. Providers will complete surveys and in-depth interviews to understand barriers to interpreter use, based on the Theoretical Domains Framework. LEP patients will be surveyed (n=648) and interviewed (n=75) following visits with enrolled providers to understand their experiences with communication and interpretation. Determining how these two scalable strategies, alone and in sequence, perform for improving interpreter use, how they do so, and at what cost, will provide critical insights for addressing a persistent cause of healthcare disparities.

项目概要 美国 (US) 超过 2500 万人的英语水平 (LEP) 有限。 LEP 人群 面临高质量医疗保健的巨大障碍，导致不同的结果，例如风险增加 严重的安全事件、成本增加以及理解力、满意度和依从性下降。 专业口译是一种基于证据的实践，旨在改善护理并减少这些差异。 然而，尽管有法律和监管规定，其使用率仍然很低。之前的策略 改善使用主要解决了个人内部障碍（通过面对面提供知识和技能） 教育）或系统（简化电话口译员访问）。教育策略有所改善 提供者的知识对口译员的使用影响未知；系统战略已取得一定成效 使用方面的改进。然而，这些策略缺乏明确的机制或因果关系 途径，通常作为昂贵的多方面干预措施的一部分，限制了精确归因和可扩展性。 在本研究中，研究人员将比较两种离散的实施策略以改进 口译员的使用，第一个强化教育战略，主要针对个人内部障碍，但已交付 以可扩展的格式（基于网络的交互式教育模块），以及第二个目标系统障碍， 其新颖的重点是移动视频解读 (mVI)，可通过提供商自己的移动设备进行访问。这 研究的具体目标是：（1）比较两种实施策略单独和联合实施的有效性 结合起来，以提高对 LEP 患者/家长的解释和理解的使用 成人/儿童初级保健机构； (2) 探索 mVI 和教育实施策略的能力 激活假定的提供者级别机制； (3) 确定增量成本效益 医疗保健组织对每个实施策略的看法（mVI、教育，两者）。为了完成 为了实现这些目标，研究人员将在 6 个主要国家进行 III 类混合实施有效性研究 护理诊所，采用序贯多重分配随机试验 (SMART) 设计。注册提供者 （总共 n=50）除了标准口译员访问之外，还将被随机分配到 mVI 或教育模块。后 9 个月内，口译员使用率较高的提供者将继续按指定分配；那些使用率较低的将 随机继续像以前一样或添加替代实施策略。提供商将完成 基于理论领域的调查和深入访谈，以了解口译员使用的障碍 框架。 LEP 患者将在就诊后接受调查 (n=648) 和访谈 (n=75) 提供者了解他们的沟通和口译经验。确定这两个如何 可扩展的策略，单独或按顺序，可以改善口译员的使用、如何做到这一点以及在什么方面 成本，将为解决医疗保健差异的持续原因提供重要见解。