Improving linguistic health equity in prehospital emergency care

项目摘要 院前急救护理中的语言障碍会使患者无法获得挽救生命的临床护理， 紧急医疗系统。当非/有限的英语熟练（LEP）患者拨打9-1-1时， 更有可能遇到延误，不太可能收到和执行到达前的指示，更有可能 经历不良的健康结果和不定期的急诊室回访比他们的英语- 说话的同行。美国有2500万LEP患者，我们需要更好地了解 在院前急救护理方面的差距，并修改系统，以促进保健服务的公平性。 在医院和诊所环境中，克服语言障碍的金标准是使用专业语言。 口译员，这已被证明可以改善护理服务，病人满意度和健康结果。在结束时- 在9-1-1调度应急设置中使用电话口译员（OPI）对于促进 评估和抵达前指示的交付，次优利用（OPI利用率过高、过低或延迟） 会导致更糟糕的结果这可能解释了研究中发现的一些差异，这些差异表明，9-1- 与LEP呼叫者的1呼叫更频繁地导致分流错误，增加了调度响应的时间，并且 到达前指令通常被延迟和/或不由LEP呼叫者执行。 我们提出了一项多方法研究，由Feldman-Stewart et al.（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， 在紧急护理的第一个关键时刻，调度员和翻译。本研究有三个目的， 一个次级目标： 1)识别与使用OPI和相关通信相关的呼叫特征， 在现实生活中与LEP呼叫者的9-1-1呼叫期间的护理交付结果。 1a.）在一个示例中分析调度程序、调用程序和OPI之间的三方通信模式 西班牙语和中文（即，普通话/广东话）9-1-1电话与OPI。 2)在模拟场景中，确定与OPI的使用和时间相关的关键调度员属性 （根据目标1中收集的信息开发），与LEP西班牙语和中文模拟呼叫者。 3)通过培训机会和政策翻译和传播研究结果 紧急医疗服务（EMS）和社区利益相关者确定的建议，使用 参与式德尔菲技术。 我们的研究小组对现有的关于院前语言不平等的研究做出了重大贡献 在乎我们将我们对紧急情况下通信复杂性的丰富知识和30年的 与EMS和社区合作伙伴的合作历史，以阐明OPI在院前护理中的应用 并指导将研究结果转化为关于OPI在院前护理交付中的使用的政策和培训。

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.