Harnessing Health Information Technology to Promote Equitable Care for Patients with Limited English Proficiency and complex care needs

项目摘要/摘要 随着2500万英语水平有限(阅读能力有限， 说、写或懂英语)年龄，有复杂护理需求的人数预计将上升。病人 英语水平有限(LEP)和复杂的护理需求(例如在危重医疗期间遇到的情况 疾病、限制生命的慢性病和生命末期)结局更差，接受的护理质量更差 而不是精通英语的病人。造成这种差异的原因是沟通不够理想。遗憾的是， 尽管有证据表明口译员改善了沟通，以及对护理和临床的满意度 在实际工作中，口译员没有得到充分利用。缺乏增加口译员使用的机制，但 研究表明，促进口译员使用的系统可能会获得临床医生的支持并实现 比其他方法更容易成功。这项提议的目标是满足这一迫切需要 通过以下具体目标：(A)让利益攸关方参与测试和验证健康信息- 基于筛查工具或“嗅探器”，以可靠地识别患有LEP和复杂护理需求的患者；1)参与 利益相关者设计有效流程，主动接触有未得到满足的口译员需求的患者 在他们住院的早期；2)检查所开发的干预措施对 在有复杂护理需求的LEP患者中使用口译员和使用口译员的时间 楔形整群随机试验。Aim 1a利用我们调查小组之前的工作开发了一个 基于人工智能的算法，以识别将从姑息护理咨询中受益的患者，以 建立类似的预测模型，以识别患有LEP和复杂护理需求的患者。目标1b从事不同的工作 利益相关者共同设计和开发有效的流程，将口译服务与确定的患者联系起来 及时采取行动。目标2将使用务实的临床试验设计来评估联合预测 识别和连接患有LEP和复杂护理需求的患者的模式和流程(干预) 比目前的标准做法更快、更频繁地将口译员带到床边。长期的 首席调查员的目标是促进对LEP患者和复杂护理的公平护理 通过制定有效应对不同语言、社会和文化因素的战略，满足不同的需求。这个 调查员队伍和研究环境适合实现提案的目的，结合内容 关于LEP患者在沟通、决策、护理和建模方面存在差异的专业知识 在治疗LEP患者的大容量学术中心的信息学研究方法论经验 和复杂的护理需求。该研究将为R01在未来的应用提供必要的基础数据 哪些后续研究评估了干预对医疗保健利用、患者和家庭的影响 对决策、后续护理和临床医生沟通质量的满意度。

PROJECT SUMMARY/ABSTRACT As the growing population of 25 million people with Limited English Proficiency (having a limited ability to read, speak, write, or understand English) ages, the number with complex care needs is projected to rise. Patients with Limited English Proficiency (LEP) and complex care needs (such as those encountered during critical illness, life-limiting chronic illness, and at end-of-life) suffer worse outcomes and receive poorer quality care than patients who are English-proficient. This disparity is due to suboptimal communication. Regrettably, despite evidence that interpreters improve communication, as well as satisfaction with care and clinical outcomes, interpreters are under-utilized in practice. Mechanisms to increase interpreter use are lacking, but research suggests that systems that facilitate interpreter use are likely to garner clinician support and achieve success more readily than other approaches. The objective of this proposal is to address this critical need through the following specific aims: 1a)To engage stakeholders in testing and validating a health information- based screening tool or “sniffer” to reliably identify patients with LEP and complex care needs; 1b) To engage stakeholders in designing an effective process for proactively reaching patients with unmet interpreter needs early in their hospitalization; 2) To examine the preliminary effectiveness of the developed intervention on interpreter use and time to interpreter use among patients with LEP and complex care needs using a stepped- wedge cluster randomized trial. Aim 1a leverages our investigator group’s previous work developing an artificial intelligence-based algorithm to identify patients who would benefit from a palliative care consult, to build a similar predictive model to identify patients with LEP and complex care needs. Aim 1b engages different stakeholders to co-design and develop an effective process to link interpreter services to the identified patients in a timely manner. Aim 2 will use a pragmatic clinical trial design to evaluate whether the combined predictive model and process (intervention) for identifying and connecting patients with LEP and complex care needs brings interpreters to the bedside more quickly and frequently than current standard practice. The long-term objectives of the primary investigator are to promote equitable care for patients with LEP and complex care needs by developing strategies that address diverse linguistic, social, and cultural factors effectively. The investigator team and research environment is suited to achieve the aims of the proposal, combining content expertise about disparities in communication, decision making, care among patients with LEP and modelling and informatics research methodology experience at a high-volume academic center treating patients with LEP and complex care needs. The research will provide essential foundational data for a future R01 application in which subsequent studies assess the impact of the intervention on healthcare utilization, patient and family satisfaction with decision making, and subsequent care and clinician quality of communication.