Bedside Interpreter Intervention, Hospital Outcomes of Older LEP Patients

床边口译员干预、老年 LEP 患者的医院结果

• 批准号: 8023558
• 负责人: LEAH S KARLINER
• 金额: $ 38.03万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-15 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8023558
• 关键词: Academic Medical Centers; Accident and Emergency department; Adverse event; Age-Years; Aging; Businesses; Cardiology; Caregivers; Caring; Chinese People; Clinical; Communication; Communication Barriers; Communities; Data; Data Collection; Discipline of Nursing; Elderly; Floor; Focus Groups; Healthcare Systems; Home environment; Hospitalization; Hospitals; Hour; Individual; Instruction; Intervention; Interview; Knowledge; Language; Lead; Leadership; Length of Stay; Location; Mediator of activation protein; Medical; Medical center; Medicine; Modeling; Nature; Nurses; Nursing Staff; Older Population; Outcome; Outcome Study; Patients; Pattern; Persons; Physicians; Qualitative Methods; Quality of Care; Recruitment Activity; Reporting; Research Personnel; Resources; Sampling; Schedule; Series; Structure; Surveys; Technology; Telephone; Testing; Time; United States; Visit; aging population; cohort; design; experience; health care service utilization; improved; intervention effect; pressure; satisfaction; skills; treatment as usual; trend

DESCRIPTION (provided by applicant): The United States has a large and aging population of limited English proficient (LEP) individuals. These patients experience significant communication barriers, which lead to disparities in access, utilization, outcomes and satisfaction. These barriers are compounded for the elderly who frequently rely on non-English speaking informal caregivers, particularly during transitions of care from hospital to home. Access to professional medical interpreters for older LEP hospitalized patients is critical to effective communication and the delivery of high quality care. However, even in medical centers with professional staff interpreters, hospitalized patients rarely have access to professional interpreters. This is in part because of the frequent and brief nature of many interactions, time pressures, the need for advance scheduling for in-person interpreters, and the twenty-four hour nature of hospital care. To overcome these barriers, we have developed the bedside interpreter intervention: use of dual- handset interpreter phones at the bedside of every LEP patient. Usual care communication in our hospital includes in-person staff interpreters who can be scheduled during business hours, and one to three dual handset interpreter phones at most nursing stations. Immediate availability, bedside location and 24 hour access allow for use of the dual-handset interpreter phone by any clinician for even the briefest interaction. The underlying hypothesis of this proposal is that the bedside interpreter intervention will improve communication with older hospitalized LEP patients compared to usual care. We will test this hypothesis from three perspectives: the health care system (Aim 1, administrative data), the patient and caregiver (Aim 2, structured interviews), and the clinician (Aim 3, focus groups). First (Aim 1), we will use an interrupted time series design with switching replications using administrative data to compare hospital outcomes for two patient samples of older (e50 years) LEP patients admitted to the UCSF Medical Center. The data collection for the first sample will focus on patients admitted to the general Medicine floor in the 18 months which preceded the implementation of the bedside interpreter intervention in 2008 and in the 12 months after implementation. We will then collect data for an additional sample of patients admitted to the Cardiology floor in the 18 months before and in the 12 months after implementation of the intervention on that floor (in 2012). Next, (Aim 2), we will assess the usefulness and acceptability of the bedside interpreter intervention to LEP patients and their informal caregivers by prospectively collecting primary data using structured interviews with older Chinese- and Spanish-speaking LEP patients admitted to the Cardiology floor and their informal caregivers recruited during 6 months pre- and 6 months post-implementation of the intervention on the Cardiology floor. We will survey patients at two time points - in-person in the hospital and one month post-discharge by telephone - and their informal caregivers once at one month post-discharge. Before and after the intervention, we will compare patterns of interpreter use and ease of access; patient and caregiver satisfaction with communication; and receipt and knowledge of discharge instructions. We will also examine these patient-reported factors as mediators for the hospital outcomes from Aim 1. Finally (Aim 3), we will conduct a qualitative study utilizing focus groups of physicians and nurses to evaluate their experience with and patterns of use of the bedside interpreter intervention, identify the types of clinical interactions best suited to this technology, and assess persisting barriers to optimal communication. If effective, the bedside interpreter intervention will be a model for hospitals across the nation to reduce disparities in care for the growing population of older LEP patients. PUBLIC HEALTH RELEVANCE: This project will evaluate the effect of increasing access to professional interpreters via bedside interpreter telephones compared to usual care communication for older limited English proficient (LEP) hospitalized patients. By demonstrating this intervention's impact on health care utilization outcomes, and collecting detailed information about patient and caregiver satisfaction and knowledge and clinician utilization patterns, this proposal will provide the necessary information both to disseminate the bedside interpreter intervention locally and to serve as a model of language access for older hospitalized LEP patients across the nation.

描述(由申请人提供)：美国有一个庞大的人口老龄化人口有限的英语水平(LEP)的个人。这些患者经历了严重的沟通障碍，导致在获取、利用、结果和满意度方面存在差异。对于经常依赖非英语非正式照顾者的老年人来说，这些障碍更加严重，特别是在从医院到家庭的护理过渡期间。为老年LEP住院患者提供专业的医疗翻译对有效沟通和提供高质量的护理至关重要。然而，即使在拥有专业翻译人员的医疗中心，住院患者也很少能找到专业翻译。这在一定程度上是因为许多互动的频繁和简短的性质，时间压力，需要提前安排面对面的口译员，以及医院护理的24小时性质。为了克服这些障碍，我们开发了床边口译员干预：在每个LEP患者的床边使用双手机口译员电话。我们医院的日常护理沟通包括可以在工作时间安排的面对面工作人员翻译，以及大多数护理站的一到三部双手机翻译电话。即时可用性、床边位置和24小时访问允许任何临床医生使用双手机口译电话进行即使是最短的互动。这项建议的基本假设是，与常规护理相比，床边口译员干预将改善与住院老年LEP患者的沟通。我们将从三个角度检验这一假设：医疗保健系统(目标1，管理数据)、患者和照顾者(目标2，结构化访谈)和临床医生(目标3，焦点小组)。首先(目标1)，我们将使用使用管理数据的切换重复的中断时间序列设计来比较加州大学旧金山分校医学中心收治的两个老年(e50岁)LEP患者样本的住院结果。第一个样本的数据收集将侧重于在2008年实施床边口译员干预之前的18个月和实施后的12个月内住进普通科病房的患者。然后，我们将收集另一组患者的数据，这些患者是在心脏病科实施干预措施之前的18个月和实施干预措施后的12个月(2012年)入院的。接下来，(目标2)，我们将评估床边口译员干预对LEP患者及其非正式照顾者的有效性和可接受性，方法是前瞻性地收集主要数据，采用结构化访谈的方式，对心内科入院的讲中文和西班牙语的老年LEP患者及其非正式照顾者在实施干预前6个月和实施干预后6个月招募的他们进行调查。我们将在两个时间点对患者进行调查-在医院和出院后一个月通过电话-以及他们的非正式护理人员在出院后一个月一次。在干预前后，我们将比较口译员的使用模式和接触的便捷性；患者和照顾者对沟通的满意度；以及对出院指示的接收和了解。我们还将检查这些患者报告的因素作为目标1的医院结果的中介。最后(目标3)，我们将进行一项定性研究，利用医生和护士的焦点小组来评估他们在床边口译员干预方面的经验和使用模式，确定最适合这项技术的临床互动类型，并评估最优沟通的持续障碍。如果有效，床边翻译干预将成为全国医院减少老年LEP患者日益增长的护理差距的典范。 公共卫生相关性：该项目将评估与老年有限英语水平(LEP)住院患者的日常护理沟通相比，通过床边口译员电话更多地获得专业口译的效果。通过展示这一干预措施对医疗保健利用结果的影响，并收集有关患者和照顾者满意度以及知识和临床医生利用模式的详细信息，该提案将提供必要的信息，既可以在当地传播床边口译干预，也可以作为全国住院老年LEP患者语言获取的模式。