Mobile Video interpretation to Optimize Communication Across Language barriers: mVOCAL

项目摘要 在美国，超过2500万人的英语水平有限。LEP人群 面临着高质量医疗保健的巨大障碍，导致不同的结果，例如 严重的安全事件，增加了成本，降低了理解力、满意度和忠诚度。 专业口译是一种以证据为基础的做法，以改善护理和减轻这些差异。 然而，尽管有法律和监管授权，它的使用量仍然持续较低。以前的战略是 提高使用率主要解决了个人内部障碍(通过面对面提供知识和技能 教育)或系统(简化电话口译员的使用)。教育战略得到了改进 供应商知识对口译员使用的影响未知；系统策略取得了一定的成效 使用方面的改进。然而，这些战略缺乏明确的机制或因果关系。 路径，往往作为昂贵的多方面干预措施的一部分，限制了准确的归属和可伸缩性。 在这项研究中，研究人员将比较两种离散的实施策略以进行改进 使用口译员，这是第一个强化的教育战略，主要针对个人内部障碍，但已交付 在可扩展的格式(基于网络的交互式教育模块)和第二个目标系统障碍中， 新的重点是移动视频解读(MVI)，可在提供商自己的移动设备上访问。这个 研究的具体目标是：(1)比较两种实施战略的有效性，单独实施和在 结合，以改善对LEP患者/父母的解释和理解的使用 成人/儿童初级保健环境；(2)探索MVI和教育实施战略的能力 启动假定的提供者级别的机制；以及(3)从 医疗保健组织对每个实施战略(MVI、教育、两者)的看法。要完成 为了达到这些目标，调查人员将在6个小学进行III型混合实施-有效性研究 护理诊所，使用序贯多分配随机试验(SMART)设计。已登记的提供者 (总数n=50)除了标准的口译员准入外，还将随机分配到MVI或教育单元。之后 9个月，口译员使用率较高的提供者将继续按分配；使用率较低的提供者将继续 随机化是像以前一样继续，还是增加替代的实施战略。提供商将完成 基于理论领域的调查和深入访谈，以了解口译员使用的障碍 框架。LEP患者将在登记后接受调查(n=648)和访谈(n=75) 提供方了解他们在沟通和口译方面的经验。决定这两个人是如何 可扩展的策略，单独地和顺序地，用于改善解释器的使用，它们如何做到这一点，以及在什么情况下 成本，将为解决医疗保健差距的长期原因提供关键的见解。

Project Summary Over 25 million people in the United States (US) have limited English proficiency (LEP). LEP populations face substantial barriers to high-quality healthcare, resulting in disparate outcomes such as elevated risk for serious safety events, increased costs, and decreased comprehension, satisfaction, and adherence. Professional interpretation is an evidence-based practice to improve care and mitigate these disparities. However, its use remains persistently low despite legal and regulatory mandates. Previous strategies to improve use have mainly addressed intrapersonal barriers (provider knowledge and skills, via in -person education) or the system (simplifying telephone interpreter access). Educational strategies have improved provider knowledge with unknown effect on interpreter use; systems strategies have achieved modest improvements in use. However, these strategies have lacked clearly articulated mechanisms or causal pathways, often as part of expensive, multifaceted interventions that limit precise attribution and scalability. In this study, the investigators will compare two discrete implementation strategies for improving interpreter use, the first an enhanced education strategy targeting primarily intrapersonal barriers but delivered in a scalable format (interactive web-based educational modules), and the second targeting system barriers, with a novel focus on mobile video interpretation (mVI), accessible on providers’ own mobile devices. The study’s specific aims are: (1) Compare the effectiveness of two implementation strategies, alone and in combination, to improve use of interpretation and comprehension for LEP patients/parents seen in adult/pediatric primary care settings; (2) Explore mVI and education implementation strategies’ ability to activate putative provider-level mechanisms; and (3) Determine the incremental cost effectiveness from a healthcare organization perspective of each implementation strategy (mVI, education, both). To accomplish these aims, the investigators will conduct a Type III hybrid implementation-effectiveness study in 6 primary care clinics, using a Sequential Multiple Assignment Randomized Trial (SMART) design . Enrolled providers (total n=50) will be randomized to mVI or educational modules, in addition to standard interpreter access. After 9 months, providers with high interpreter use will continue as assigned; those with lower use will be randomized to continue as before or add the alternative implementation strategy. Providers will complete surveys and in-depth interviews to understand barriers to interpreter use, based on the Theoretical Domains Framework. LEP patients will be surveyed (n=648) and interviewed (n=75) following visits with enrolled providers to understand their experiences with communication and interpretation. Determining how these two scalable strategies, alone and in sequence, perform for improving interpreter use, how they do so, and at what cost, will provide critical insights for addressing a persistent cause of healthcare disparities.