Bedside Interpreter Intervention, Hospital Outcomes of Older LEP Patients

描述（由申请人提供）：美国人口众多且老龄化，英语熟练程度有限（LEP）。这些患者经历了严重的沟通障碍，这导致了在获取、利用、结果和满意度方面的差异。这些障碍对老年人来说更加复杂，他们经常依赖于不会说英语的非正式护理人员，特别是在从医院到家庭的护理过渡期间。老年LEP住院患者获得专业医疗口译对于有效沟通和提供高质量护理至关重要。然而，即使在有专业口译人员的医疗中心，住院病人也很少有机会获得专业口译人员。部分原因是由于许多互动频繁而短暂，时间压力，需要提前安排现场口译员，以及医院护理的24小时性质。为了克服这些障碍，我们开发了床边翻译干预：在每个LEP患者的床边使用双手持翻译电话。我们医院的日常护理沟通包括在工作时间安排专人翻译，在大多数护理站有一到三台双听筒翻译电话。即时可用性，床边位置和24小时访问允许任何临床医生使用双手持翻译电话，即使是最简短的互动。本建议的基本假设是，与常规护理相比，床边口译干预将改善与住院老年LEP患者的沟通。我们将从三个角度检验这一假设：医疗保健系统（目标1，行政数据），患者和护理人员（目标2，结构化访谈）和临床医生（目标3，焦点小组）。首先（目的1），我们将使用中断时间序列设计，使用管理数据切换重复，比较UCSF医学中心收治的两名老年（50岁）LEP患者样本的医院结局。第一个样本的数据收集将集中在2008年实施床边口译干预之前的18个月内和实施后的12个月内入院的普通医学楼患者。然后，我们将收集在该楼层实施干预前18个月和实施干预后12个月（2012年）入住心脏病学楼层的额外患者样本的数据。接下来，（目标2），我们将评估床边口译干预对LEP患者及其非正式护理人员的有用性和可接受性，方法是前瞻性地收集主要数据，采用结构化访谈的方式，对在心脏病学楼实施干预前6个月和实施干预后6个月期间入院的老年中文和西班牙语LEP患者及其非正式护理人员进行结构化访谈。我们将在两个时间点对患者进行调查——在医院当面调查和出院后一个月通过电话调查——并在出院后一个月对他们的非正式护理人员进行一次调查。在干预之前和之后，我们将比较口译员的使用模式和访问的便利性；患者与照护者对沟通的满意度；以及接收和了解出院指示。我们还将研究这些患者报告的因素作为Aim 1中医院结果的中介。最后（目标3），我们将进行一项定性研究，利用医生和护士的焦点小组来评估他们使用床边口译干预的经验和模式，确定最适合这项技术的临床互动类型，并评估持续存在的最佳沟通障碍。如果有效，床边口译干预将成为全国医院的一个模式，以减少对日益增长的老年LEP患者的护理差异。

DESCRIPTION (provided by applicant): The United States has a large and aging population of limited English proficient (LEP) individuals. These patients experience significant communication barriers, which lead to disparities in access, utilization, outcomes and satisfaction. These barriers are compounded for the elderly who frequently rely on non-English speaking informal caregivers, particularly during transitions of care from hospital to home. Access to professional medical interpreters for older LEP hospitalized patients is critical to effective communication and the delivery of high quality care. However, even in medical centers with professional staff interpreters, hospitalized patients rarely have access to professional interpreters. This is in part because of the frequent and brief nature of many interactions, time pressures, the need for advance scheduling for in-person interpreters, and the twenty-four hour nature of hospital care. To overcome these barriers, we have developed the bedside interpreter intervention: use of dual- handset interpreter phones at the bedside of every LEP patient. Usual care communication in our hospital includes in-person staff interpreters who can be scheduled during business hours, and one to three dual handset interpreter phones at most nursing stations. Immediate availability, bedside location and 24 hour access allow for use of the dual-handset interpreter phone by any clinician for even the briefest interaction. The underlying hypothesis of this proposal is that the bedside interpreter intervention will improve communication with older hospitalized LEP patients compared to usual care. We will test this hypothesis from three perspectives: the health care system (Aim 1, administrative data), the patient and caregiver (Aim 2, structured interviews), and the clinician (Aim 3, focus groups). First (Aim 1), we will use an interrupted time series design with switching replications using administrative data to compare hospital outcomes for two patient samples of older (e50 years) LEP patients admitted to the UCSF Medical Center. The data collection for the first sample will focus on patients admitted to the general Medicine floor in the 18 months which preceded the implementation of the bedside interpreter intervention in 2008 and in the 12 months after implementation. We will then collect data for an additional sample of patients admitted to the Cardiology floor in the 18 months before and in the 12 months after implementation of the intervention on that floor (in 2012). Next, (Aim 2), we will assess the usefulness and acceptability of the bedside interpreter intervention to LEP patients and their informal caregivers by prospectively collecting primary data using structured interviews with older Chinese- and Spanish-speaking LEP patients admitted to the Cardiology floor and their informal caregivers recruited during 6 months pre- and 6 months post-implementation of the intervention on the Cardiology floor. We will survey patients at two time points - in-person in the hospital and one month post-discharge by telephone - and their informal caregivers once at one month post-discharge. Before and after the intervention, we will compare patterns of interpreter use and ease of access; patient and caregiver satisfaction with communication; and receipt and knowledge of discharge instructions. We will also examine these patient-reported factors as mediators for the hospital outcomes from Aim 1. Finally (Aim 3), we will conduct a qualitative study utilizing focus groups of physicians and nurses to evaluate their experience with and patterns of use of the bedside interpreter intervention, identify the types of clinical interactions best suited to this technology, and assess persisting barriers to optimal communication. If effective, the bedside interpreter intervention will be a model for hospitals across the nation to reduce disparities in care for the growing population of older LEP patients. PUBLIC HEALTH RELEVANCE: This project will evaluate the effect of increasing access to professional interpreters via bedside interpreter telephones compared to usual care communication for older limited English proficient (LEP) hospitalized patients. By demonstrating this intervention's impact on health care utilization outcomes, and collecting detailed information about patient and caregiver satisfaction and knowledge and clinician utilization patterns, this proposal will provide the necessary information both to disseminate the bedside interpreter intervention locally and to serve as a model of language access for older hospitalized LEP patients across the nation.