Improving linguistic health equity in prehospital emergency care

项目摘要 院前急救中的语言障碍会剥夺患者救命的临床护理，并建立不信任 与急救医疗系统的关系。当非/有限英语水平(LEP)患者拨打9-1-1时，他们 更有可能遇到延误，不太可能接收和执行提前到达的指令，并且更有可能 经历过不良的健康后果和计划外的急诊科回访比他们的英语- 说话的对应者。美国有2500万LEP患者，我们需要更好地了解 消除院前急救方面的差距，并修改这一制度，以促进在提供护理方面的卫生公平。 在医院和诊所，克服语言障碍的黄金标准是使用专业人员 口译员，这已被证明可以改善护理提供、患者满意度和健康结果。当结束的时候- 在9-1-1调度紧急情况设置中使用电话口译器(OPI)对于促进 评估和到达前指令交付，未达到最佳利用率(OPI利用率过高、过低或延迟) 可能会导致更糟糕的结果。这可能解释了研究中看到的一些差异，研究表明9-1- 1与LEP呼叫者的呼叫更频繁地导致分类错误，增加了调度响应的时间，并且 提前指令通常由LEP呼叫者延迟和/或不执行。 我们建议在Feldman-Stewart等人的指导下进行一项多方法研究。(2005)提供者-患者 通信框架，以增加我们对LEP呼叫者之间复杂交互的理解， 在紧急护理的最初关键时刻，调度员和口译员。这项研究有三个目标和 一个子目标： 1)识别与使用OPI和相关通信相关联的呼叫特征，以及 在现实生活中与LEP呼叫者进行9-1-1呼叫期间的护理交付结果。 (1A.)通过一个实例分析调度员、调用者和OPI之间的三方通信模式 西班牙语和中文(即普通话/广东话)的9-1-1呼叫与OPI。 2)确定与模拟场景中OPI的使用和时间相关的关键调度器属性 (基于在AIM#1中收集的信息开发)，使用LEP西班牙语和中国模拟呼叫者。 3)通过培训机会和政策翻译和传播研究结果 由紧急医疗服务(EMS)和社区利益攸关方确定的建议，使用 一种参与式德尔菲技术。 我们的研究小组对院前语言不平等的现有研究做出了重大贡献 关心。我们带来了在紧急情况下沟通的复杂性的广博知识和30年来 与EMS和社区合作伙伴合作了解OPI在院前护理中的使用情况 并指导将调查结果转化为政策，并就OPI在院前护理中的使用进行培训。

Project Summary Language barriers in prehospital emergency care can deny patients live-saving clinical care and build distrust with the emergency medical system. When non/limited English proficient (LEP) patients call 9-1-1, they are more likely to experience delays, less likely to receive and perform pre-arrival instructions and more likely to experience adverse health outcomes and unscheduled emergency department return visits than their English- speaking counterparts. With 25 million LEP individuals in the United States we need a better understanding of the gaps in prehospital emergency care and modify the system to promote health equity in care delivery. In hospital and clinic settings, the gold standard for overcoming language barriers is the use of professional interpreters, which has shown to improve care delivery, patient satisfaction and health outcomes. While over- the-phone interpreter (OPI) use in the 9-1-1 Dispatch emergency setting can be critical to facilitating assessment and pre-arrival instruction delivery, suboptimal utilization (over, under or delayed utilization of OPI) can result in worsened outcomes. This may explain some of the disparities seen in research showing that 9-1- 1 calls with LEP callers more frequently result in triage errors, increased time to dispatching response, and that pre-arrival instructions are often delayed and/or not performed by LEP callers. We propose a multi-method study, guided by the Feldman-Stewart et al. (2005) provider-patient communication framework, to increase our understanding of the complex interaction between LEP callers, dispatchers and interpreters during the first critical minutes of emergency care. This study has three aims and one sub-aim: 1) Identify call characteristics that are associated with use of OPI and associated communication and care delivery outcomes during real-life 9-1-1 calls with LEP callers. 1a.) analyze three-way communication patterns between dispatcher, caller and OPI in a sample of Spanish and Chinese (i.e., Mandarin/Cantonese) 9-1-1 calls with OPI. 2) Identify key dispatcher attributes associated with use of and time to OPI during simulated scenarios (developed based on information collected in Aim#1), with LEP Spanish and Chinese mock callers. 3) Translate and disseminate the results of the study via training opportunities and policy recommendations identified by emergency medical services (EMS) and community stakeholders, using a participatory Delphi technique. Our research group has contributed significantly to the existing research on linguistic inequities in prehospital care. We bring our vast knowledge of the complexity of communication in an emergency setting and a 30-year history of collaborative work with EMS and community partners to shed light on OPI use in prehospital care and guide translation of findings into policies and training on OPI use in prehospital care delivery.