Improving Outcomes for Spanish-Speaking Surgical Patients with Limited English Proficiency

改善英语水平有限的西班牙语外科患者的治疗效果

• 批准号: 10624862
• 负责人: Gezzer Ortega
• 金额: $ 17.27万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-19 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10624862
• 关键词: Acceleration; Address; Adverse event; Affect; Award; Bypass; Caring; Certification; Clinical; Communication; Communication Barriers; Communities; Complex; Complication; Continuity of Patient Care; Data; Discipline; Disparity; Emergency Situation; Equity; Evaluation; Family; Funding; Future; Gestures; Goals; Health; Healthcare; Healthcare Systems; Home; Hospitals; Individual; Inequity; Institution; Institutional Racism; Intervention; Interview; Language; Legal; Length of Stay; Limited English Proficiency; Link; Medical; Medicine; Mentors; Mission; Modeling; National Institute on Minority Health and Health Disparities; Nurses; Operative Surgical Procedures; Outcome; Participant; Patient Care; Patient-Centered Care; Patient-Focused Outcomes; Patients; Persons; Physicians; Play; Policies; Provider; Public Health; Qualifying; Qualitative Evaluations; Qualitative Research; Quantitative Evaluations; Research; Research Methodology; Resources; Risk Factors; Scientist; Services; Structure; Surgeon; Surgical Specialties; Technology; Testing; Training; Translations; United States; United States National Institutes of Health; Vulnerable Populations; adverse event risk; career; cohort; data registry; design; direct application; empowerment; experience; health data; health disparity; health inequalities; health information technology; health outcome disparity; high risk; hospital readmission; implementation science; improved; improved outcome; innovation; mobile application; mobile computing; nonEnglish language; patient oriented; patient population; patient-clinician communication; readmission rates; skills; social; social factors; social health determinants; sociodemographic factors; socioeconomics; surgery outcome; surgical disparities; therapy design

Project Summary In 2018, nearly 67 million people in the US spoke a language other than English at home and, among them, 40% met criteria for limited English proficiency (LEP). People with LEP are at higher risk of adverse events during medical care. In fact, 1 in 12 patients is at risk for adverse events because of barriers created by language discordance, which occurs when the patient and provider do not share a common spoken language. Surgical disparities have been studied in various disciplines, but very few studies have focused on the impact of language. Understanding the impact that language and language discordance or concordance have on surgical outcomes represents a vital component of providing effective, high-quality patient care. Our overall objective is to improve outcomes for surgical patients with LEP. The central hypothesis is that socioeconomic and sociodemographic factors impact outcomes of surgical care for patients with LEP and that identifying those factors through quantitative and qualitative research rooted in a social ecological model (SEM) will provide an opportunity to design interventions that address these risk factors and reduce surgical disparities. Building on a deeper understanding of patient experiences and social risk factors, this project will test the use of a mobile technology for live medical interpretation provided directly to patients. We seek to determine if such a solution can improve communication and promote patient-initiated language concordant encounters, thereby leading to better surgical outcomes. While some research suggests the effects of language discordance may be mitigated by the use of trained interpreters, qualified interpreters are not reliably used for all patients with LEP, even at resource-rich health centers. These barriers threaten to compromise the provision of equitable and patient-centered care for this patient population. To that extent, we will test our central hypothesis by pursing three specific aims: (1) Determine whether language concordance is associated with surgical outcomes in a large retrospective surgical patient cohort; (2) Identify the social factors that influence the use of formal interpreter services to treat primary Spanish-speaking surgical patients with LEP; and (3) Evaluate if an immediate interpreter mobile application enables language concordant communication for primary Spanish-speaking patients with LEP. Likewise, studying the complex interaction of structural, interpersonal, and individual factors will enrich our understanding of the impact of language across the continuum of surgical care. The research proposed in this application is innovative because no one has sought to elucidate precisely how LEP may influence surgical outcomes and nor have they applied the SEM in an attempt to have a profound impact for vulnerable populations. Also, by providing the mobile interpretation application directly to patients (in addition to surgeons and nurses), we hope to empower patients with LEP to serve as drivers of their care and improve the patient-centeredness of their care. Ultimately, the findings of this study could be applied to other fields of medicine and patient populations to improve the care of millions of patients by mitigating language and communication barriers to reduce health inequities.

项目总结