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

项目摘要 2018年，美国有近6700万人在家里说英语以外的语言，其中40%的人说英语。 符合有限英语能力（LEP）标准。LEP患者在治疗期间发生不良事件的风险更高。 医疗等事实上，12名患者中就有1名因语言障碍而面临不良事件的风险 不一致，当患者和提供者不共享共同的口语时发生。手术 不同学科都对差异进行了研究，但很少有研究关注语言的影响。 了解语言和语言不一致或一致性对手术结果的影响 是提供有效、高质量患者护理的重要组成部分。我们的总体目标是改善 LEP手术患者的结局。核心假设是，社会经济和社会人口 影响LEP患者手术治疗结果的因素， 基于社会生态模型（SEM）的定量和定性研究将提供一个机会， 设计干预措施，解决这些风险因素，减少手术差异。建立在一个更深的 了解患者的经验和社会风险因素，该项目将测试使用移动的技术 直接向患者提供现场医学解释。我们试图确定这样的解决方案是否可以改善 沟通和促进患者发起的语言和谐的遭遇，从而导致更好的手术 结果。虽然一些研究表明，语言不一致的影响可能会通过使用 经过培训的口译员，合格的口译员并不可靠地用于所有LEP患者，即使在资源丰富的 健康中心。这些障碍可能会损害公平和以病人为中心的护理， 这个病人群体。在这种程度上，我们将通过追求三个具体目标来测试我们的中心假设：（1） 在一项大型回顾性手术中确定语言一致性是否与手术结局相关 患者队列;（2）确定影响使用正式口译服务治疗原发性 患有LEP的西班牙语手术患者;以及（3）评估即时口译移动的应用程序是否 使语言和谐的沟通与LEP的主要讲西班牙语的患者。同样地， 研究结构、人际和个人因素的复杂相互作用将丰富我们的理解 语言对外科护理的影响。本申请中提出的研究是 创新，因为没有人试图精确地阐明LEP如何影响手术结果， 他们是否应用了SEM，试图对弱势群体产生深远的影响。此外，通过提供 移动的解释应用程序直接向患者（除了外科医生和护士），我们希望能够授权 LEP患者作为其护理的驱动力，并提高其护理的患者为中心。最后， 这项研究的结果可以应用于其他医学领域和患者人群，以改善护理 通过减轻语言和沟通障碍，减少健康不公平现象，

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.