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: 10630872
• 负责人: Katherine Casey Lion
• 金额: $ 80.76万
• 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/10630872
• 关键词: Address; Adherence; Adopted; Adult; Affect; Articulation; Caring; Childhood; Clinic; Clinic Visits; Communication; Comprehension; Diagnosis; Disparity; Disparity population; Education; Effectiveness; Enrollment; Equity; Event; Evidence based practice; Face; Family; Goals; Inequity; Infrastructure; Interview; Knowledge; Language; Learning Module; Legal; Limited English Proficiency; Link; Medical; Methods; Modeling; Online Systems; Outcome; Parents; Pathway interactions; Patients; Persons; Population; Primary Care; Production; Provider; Randomized; Research Personnel; Risk; Safety; Sequential Multiple Assignment Randomized Trial; Site; Surveys; System; Technology; Telephone; Testing; Theoretical Domains framework; Time; Uncertainty; United States; Video Recording; Visit; behavior change; compare effectiveness; cost; cost effective; disparity reduction; effectiveness/implementation 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; outcome disparities; patient subsets; pressure; primary care clinic; 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.

项目摘要 在美国，超过2500万人的英语水平有限（LEP）。LEP人群 在获得高质量医疗保健方面面临巨大障碍，导致不同的结果，例如 严重的安全事件，成本增加，理解、满意度和依从性下降。 专业口译是一种以证据为基础的做法，以改善护理和减轻这些差异。 然而，尽管有法律的和监管规定，其使用率仍然很低。以前的战略， 改进使用主要解决了个人内部障碍（提供者的知识和技能，通过亲自 教育）或系统（简化电话口译员的访问）。教育战略得到改善 提供者知识对口译员使用的影响未知;系统战略取得了适度的 使用上的改进。然而，这些战略缺乏明确的机制或因果关系， 这些途径往往是昂贵的多方面干预措施的一部分，限制了精确的归因和可扩展性。 在这项研究中，调查人员将比较两个离散的实施策略，以改善 口译员的使用，第一个强化教育战略，主要针对个人内部的障碍，但交付 以可扩展的形式（基于网络的交互式教育模块），以及第二目标系统障碍， 新的重点是移动的视频解释（mVI），可在提供商自己的移动的设备上访问。的 研究的具体目的是：（1）比较两种实施策略的有效性，单独和在 联合使用，以改善LEP患者/父母的解释和理解， 成人/儿科初级保健环境;（2）探索mVI和教育实施策略的能力， 激活假定的供应商级机制;（3）确定增量成本效益， 每个实施策略（mVI、教育、两者）的医疗保健组织视角。完成 为了实现这些目标，研究人员将在6个主要的 护理诊所，使用序贯多重分配随机试验（SMART）设计。注册提供者 （共n=50）将被随机分配到mVI或教育模块，以及标准的口译员访问。后 9个月，口译使用率高的提供者将继续按分配工作;口译使用率低的提供者将被 随机化继续如前或添加替代实施策略。供应商将完成 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患者将接受调查（n=648）和访问（n=75）后，招募 提供者了解他们的沟通和解释经验。确定这两个人 可扩展的策略，单独和顺序，执行改善解释器的使用，他们如何做到这一点，以及在什么 成本，将为解决医疗保健差异的持久原因提供重要的见解。