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Hospital discharge preparedness for patients with limited English proficiency: A mixed methods study of bedside interpreter-phones.

ABSTRACT: OBJECTIVE:Assess effects of a bedside interpreter-phone intervention on hospital discharge preparedness among patients with limited English proficiency (LEP). METHODS:Mixed-methods study compared patient-reported discharge preparedness and knowledge of medications and follow-up appointments among 189 Chinese- and Spanish-speakers before (n=94) and after (n=95) bedside interpreter-phone implementation, and examined nurse and resident-physician interpreter-phone utilization through focus groups. RESULTS:Pre-post discharge preparedness (Care Transitions Measure mean 77.2 vs. 78.5; p=0.62) and patient-reported knowledge of follow-up appointments, discharge medication administration and side effects did not differ significantly. Pre-post knowledge of medication purpose increased in bivariate (88% vs. 97%, p=0.02) and propensity score adjusted analyses [aOR (adjusted odds ratio), 4.49; 95% CI, 1.09-18.4]. Nurses and physicians reported using interpreter-phones infrequently for discharge communication, preferring in-person interpreters for complex discharges and direct communication with family for routine discharges. Post-implementation patients reported continued use of ad-hoc family interpreters (43%) or no interpretation at all (22%). CONCLUSION:Implementation of a bedside interpreter-phone systems intervention did not consistently improve patient-reported measures of discharge preparedness, possibly due to limited uptake during discharges. PRACTICE IMPLICATIONS:Hospital systems must better understand clinician preferences for discharge communication to successfully increase professional interpretation and shift culture away from using family members as interpreters.

SUBMITTER: Lee JS

PROVIDER: S-EPMC5732033 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Hospital discharge preparedness for patients with limited English proficiency: A mixed methods study of bedside interpreter-phones.

Lee Jonathan S JS Nápoles Anna A Mutha Sunita S Pérez-Stable Eliseo J EJ Gregorich Steven E SE Livaudais-Toman Jennifer J Karliner Leah S LS

Patient education and counseling 20170724 1

<h4>Objective</h4>Assess effects of a bedside interpreter-phone intervention on hospital discharge preparedness among patients with limited English proficiency (LEP).<h4>Methods</h4>Mixed-methods study compared patient-reported discharge preparedness and knowledge of medications and follow-up appointments among 189 Chinese- and Spanish-speakers before (n=94) and after (n=95) bedside interpreter-phone implementation, and examined nurse and resident-physician interpreter-phone utilization through ...[more]

PMID: 28774652

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Project description:BACKGROUND:Limited English proficiency (LEP) is associated with poor health status and worse outcomes. OBJECTIVE:To examine disparities in hypertension between National Health and Nutrition Examination Survey (NHANES) respondents with LEP versus adequate English proficiency. DESIGN:Retrospective analysis of multi-year survey data. PARTICIPANTS:Adults 18 years of age and older who participated in the NHANES survey during the period 2003-2012. MAIN MEASURES:We defined participants with LEP as anyone who completed the NHANES survey in a language other than English or with the support of an interpreter. Using logistic regression, we estimated the odds ratio for undiagnosed or uncontrolled hypertension (systolic blood pressure (SBP)?>?140 mmHg or diastolic blood pressure (DBP)?>?90 mmHg) among LEP participants relative to those with adequate English proficiency. We adjusted for sociodemographic, acculturation-related, and hypertension-related variables. KEY RESULTS:Fourteen percent (n?=?3,269) of the participants had limited English proficiency: 12.4% (n?=?2906) used a Spanish questionnaire and 1.6% (n?=?363) used an interpreter to complete the survey in another language. Those with LEP had higher odds of elevated blood pressure on physical examination (adjusted odds ratio [AOR]?=?1.47 [1.07-2.03]). This finding persisted among participants using an interpreter (AOR?=?1.88 [1.15-3.06]) but not among those using the Spanish questionnaire (AOR?=?1.32 [0.98-1.80]). In a subgroup analysis, we found that the majority of uncontrolled hypertension was concentrated among individuals with a known diagnosis of hypertension (AOR?=?1.80 [1.16-2.81]) rather than those with undiagnosed hypertension (AOR?=?1.14 [0.74-1.75]). Interpreter use was associated with increased odds of uncontrolled hypertension, especially among patients who were not being medically managed for hypertension (AOR?=?6.56 [1.30-33.12]). CONCLUSIONS:In a nationally representative sample, participants with LEP were more likely to have poorly controlled hypertension than those with adequate English proficiency. LEP is an important driver of disparities in hypertension management and outcomes.

Project description:BACKGROUND:Language barriers disrupt communication and impede informed consent for patients with limited English proficiency (LEP) undergoing healthcare procedures. Effective interventions for this disparity remain unclear. OBJECTIVE:Assess the impact of a bedside interpreter phone system intervention on informed consent for patients with LEP and compare outcomes to those of English speakers. DESIGN:Prospective, pre-post intervention implementation study using propensity analysis. SUBJECTS:Hospitalized patients undergoing invasive procedures on the cardiovascular, general surgery or orthopedic surgery floors. INTERVENTION:Installation of dual-handset interpreter phones at every bedside enabling 24-h immediate access to professional interpreters. MAIN MEASURES:Primary predictor: pre- vs. post-implementation group; secondary predictor: post-implementation patients with LEP vs. English speakers. Primary outcomes: three central informed consent elements, patient-reported understanding of the (1) reasons for and (2) risks of the procedure and (3) having had all questions answered. We considered consent adequately informed when all three elements were met. KEY RESULTS:We enrolled 152 Chinese- and Spanish-speaking patients with LEP (84 pre- and 68 post-implementation) and 86 English speakers. Post-implementation (vs. pre-implementation) patients with LEP were more likely to meet criteria for adequately informed consent (54% vs. 29%, p?=?0.001) and, after propensity score adjustment, had significantly higher odds of adequately informed consent (AOR 2.56; 95% CI, 1.15-5.72) as well as of each consent element individually. However, compared to post-implementation English speakers, post-implementation patients with LEP had significantly lower adjusted odds of adequately informed consent (AOR, 0.38; 95% CI, 0.16-0.91). CONCLUSIONS:A bedside interpreter phone system intervention to increase rapid access to professional interpreters was associated with improvements in patient-reported informed consent and should be considered by hospitals seeking to improve care for patients with LEP; however, these improvements did not eliminate the language-based disparity. Additional clinician educational interventions and more language-concordant care may be necessary for informed consent to equal that for English speakers.

Project description:BACKGROUND:Early readmission amongst older safety-net hospitalized adults is costly. Interventions to prevent early readmission have had mixed success. The role of perceived social support is unclear. We examined the association of perceived social support in 30-day readmission or death in older adults admitted to a safety-net hospital. METHODS:This is an observational cohort study derived from the Support From Hospital to Home for Elders (SHHE) trial. Participants were community-dwelling English, Spanish and Chinese speaking older adults admitted to medicine wards at an urban safety-net hospital in San Francisco. We assessed perceived social support using the Multidimensional Scale of Perceived Social Support (MSPSS). We defined high social support as the highest quartile of MSPSS. We ascertained 30-day readmission and mortality based on a combination of participant self-report, hospital and death records. We used multiple/multivariable logistic regression to adjust for patient demographics, health status, and health behaviors. We tested for whether race/ethnicity modified the effect high social support had on 30-day readmission or death by including a race-social support interaction term. RESULTS:Participants (n?=?674) had mean age of 66.2 (SD 9.0), with 18.8% White, 24.8% Black, 31.9% Asian, and 19.3% Latino. The 30-day readmission or death rate was 15.0%. Those with high social support had half the odds of readmission or death than those with low social support (OR?=?0.47, 95% CI 0.26-0.88). Interaction analyses revealed race modified this association; higher social support was protective against readmission or death among minorities (AOR?=?0.35, 95% CI 0.16-0.76) but increased likelihood of readmission or death among Whites (AOR?=?3.7, 95% CI 1.07-12.9). CONCLUSION:In older safety-net patients nearing discharge, high perceived social support may protect against 30-day readmission or death among minorities. Assessing patients' social support may aid targeting of transitional care resources and intervention design. How perceived social support functions across racial/ethnic groups in health outcomes warrants further study. TRIAL REGISTRATION:NIH trials registry number ClinicalTrials.gov: NCT01221532 .

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Hospital discharge preparedness for patients with limited English proficiency: A mixed methods study of bedside interpreter-phones.

Publications

Hospital discharge preparedness for patients with limited English proficiency: A mixed methods study of bedside interpreter-phones.

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