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Assessing dual-role staff-interpreter linguistic competency in an integrated healthcare system.

ABSTRACT: BACKGROUND: Interpreter services for medical care increase physician-patient communication and safety, yet a "formal certification" process to demonstrate interpreter competence does not exist. Testing and training is left to individual health care facilities nationwide. Bilingual staff are often used to interpret, without any assessment of their skills. Assessing interpreters' linguistic competence and setting standards for testing is a priority. OBJECTIVE: To assess dual-role staff interpreter linguistic competence in an integrated health care system to determine skill qualification to work as medical interpreters. DESIGN: Dual-role staff interpreters voluntarily completed a linguistic competency assessment using a test developed by a language school to measure comprehension, completeness, and vocabulary through written and oral assessment in English and the second language. Pass levels were predetermined by school as not passing, basic (limited ability to read, write, and speak English and the second language) and medical interpreter level. Five staff-interpreter focus groups discussed experiences as interpreters and with language test. RESULTS: A total of 840 dual-role staff interpreters were tested for Spanish (75%), Chinese (12%), and Russian (5%) language competence. Most dual-role interpreters serve as administrative assistants (39%), medical assistants (27%), and clinical staff (17%). Two percent did not pass, 21% passed at basic level, 77% passed at medical interpreter level. Staff that passed at the basic level was prone to interpretation errors, including omissions and word confusion. Focus groups revealed acceptance of exam process and feelings of increased validation in interpreter role. CONCLUSIONS: We found that about 1 in 5 dual-role staff interpreters at a large health care organization had insufficient bilingual skills to serve as interpreters in a medical encounter. Health care organizations that depend on dual-role staff interpreters should consider assessing staff English and second language skills.

SUBMITTER: Moreno MR

PROVIDER: S-EPMC2078538 | biostudies-other | 2007 Nov

REPOSITORIES: biostudies-other

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Project description:BACKGROUND:The science of measuring and reporting on the performance of healthcare systems is rapidly evolving. In the past decade, across many jurisdictions, organisations tasked with monitoring progress towards reform targets have broadened their purview to take a more system-functioning approach. Their aim is to bring clarity to performance assessment, using relevant and robust concepts - and avoiding reductionist measures - to build a whole-of-system view of performance. Existing performance frameworks are not fully aligned with these developments. METHODS:An eight stage process to develop a conceptual framework incorporated literature review, mapping, categorisation, integration, synthesis and validation of performance constructs that have been used by organisations and researchers in order to assess, reflect and report on healthcare performance. RESULTS:A total of 19 performance frameworks were identified and included in the review. Existing frameworks mostly adopted either a logic model (inputs, outputs and outcomes), a functional, or a goal-achievement approach. The mapping process identified 110 performance terms and concepts. These were integrated, synthesised and resynthesised to produce a framework that features 12 derived constructs reflecting combinations of patients' needs and expectations; healthcare resources and structures; receipt and experience of healthcare services; healthcare processes, functions and context; and healthcare outcomes. The 12 constructs gauge performance in terms of coverage, accessibility, appropriateness, effectiveness, safety, productivity, efficiency, impact, sustainability, resilience, adaptability and equity. They reflect four performance perspectives (patient, population, delivery organisation and system). CONCLUSIONS:Internationally, healthcare systems and researchers have used a variety of terms to categorise indicators of healthcare performance, however few frameworks are based on a theoretically-based conceptual underpinning. The proposed framework incorporates a manageable number of performance domains that together provide a comprehensive assessment, as well as conceptual and operational clarity and coherence that support multifaceted measurement systems for healthcare.

Project description:ObjectiveWe assessed equity in the uptake of remote foot temperature monitoring (RTM) for amputation prevention throughout a large, integrated US healthcare system between 2019 and 2021, including comparisons across facilities and between patients enrolled and eligible patients not enrolled in RTM focusing on the Reach and Adoption dimensions of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.Material and methodsTo assess whether there was equitable use of RTM across facilities, we examined distributions of patient demographic, geographic, and facility characteristics across facility RTM use categories (e.g., no RTM use, and low, moderate, and high RTM use) among all eligible patients (n = 46,294). Second, to understand whether, among facilities using RTM, there was equitable enrollment of patients in RTM, we compared characteristics of patients enrolled in RTM (n = 1066) relative to a group of eligible patients not enrolled in RTM (n = 27,166) using logistic regression and including all covariates.ResultsRTM use increased substantially from an average of 11 patients per month to over 40 patients per month between 2019 and 2021. High-use RTM facilities had higher complexity and a lower ratio of patients per podiatrist but did not have consistent evidence of better footcare process measures. Among facilities offering RTM, enrollment varied by age, was inversely associated with Black race (vs. white), low income, living far from specialty care, and being in the highest quartiles of telehealth use prior to enrollment. Enrollment was positively associated with having osteomyelitis, Charcot foot, a partial foot amputation, BMI≥30 kg/m2, and high outpatient utilization.ConclusionsRTM growth was concentrated in a small number of higher-resourced facilities, with evidence of lower enrollment among those who were Black and lived farther from specialty care. Future studies are needed to identify and address barriers to uptake of new interventions like RTM to prevent exacerbating existing ulceration and amputation disparities.

Project description:BackgroundThe increased use of health information systems and information technology (IT) in healthcare heightens the risk of security and privacy breaches. Necessary measures such as effective IT training and education are required to meet the challenges of protecting patient information.PurposeThe objective of the study was to determine the effectiveness of existing educational and awareness modules in delivering the key messages around IT security and privacy.MethodsThe study was conducted in a large healthcare organization in Western Canada from September 2016 to March 2017. Using proportionate stratified random sampling, an online survey was distributed to all professional groups including clinical and non-clinical staff. In total, 586 participants responded to questions pertaining to whether or not they were aware of the IT education material, common potential breaches, and knowledge in preventing IT security and privacy breaches. Data were analyzed in SPSS version 19.ResultsThe study found that most of the participants (80.9%) completed the online IT training. Staff perceived the online training as effective (57.5%). There was a significant positive correlation between staff perception about the effectiveness of IT security educational material and satisfaction with IT security in the organization (r=0.34, P<0.01). Those who completed the training were 4.2-times (CI=2.0-8.8) more likely to correctly report the action upon receiving spam emails than those who had not completed the training. The most common type of breach stated was not knowing how to encrypt emails when sending emails outside the organization. Only a small proportion of clinical (25.5%) and non-clinical staff (30.4%) reported knowing how to encrypt emails. Also, participants identified various strategies for improving the module content and compliance.ConclusionOnline training provides a basic understanding of IT security and privacy concepts to prevent potential breaches. The training should be an integral part of healthcare staff continuing education to protect patient information.

Project description:IntroductionSocial and Behavior Change Communication (SBCC) plays a critical role in improving behavior and health outcomes across the continuum of healthcare. Failing to implement tailored SBCC strategies continues to pose a risk of ill health, increase disease burden, and impact the quality life of people. In Ethiopia, front-line healthcare system actors' knowledge and skills about SBCC have not been rigorously assessed. Thus, the current study aimed to assess healthcare system actors' competencies in designing, implementing, monitoring, and evaluating SBCC interventions in Ethiopia.MethodsA cross-sectional study was conducted between 01 August and 31 October, 2020. Five hundred twenty-eight frontline healthcare system actors in SBCC in Ethiopia were included using simple random sampling technique. Data was collected using a self-administered structured questionnaire adopted from Communication for Change; SBCC capacity assessment tool. Descriptive analysis frequencies, percentages, mean, median, standard deviation (SD), interquartile range (IQR) were employed. Besides correlations and linear regression with robust standard errors were carried out. A 95% confidence interval and a p-value of less than 0.05 were used to declare significant statistical association.ResultsA total of 488 frontline workers participated in the study, with a response rate of 92.4%. The mean SBCC knowledge score was 13.2 ± standard deviation (SD) 3.99 and 59.2% scored below 60% of the expected maximum score. The standard mean score of overall skill in SBCC intervention was 2.36 (SD ± 0.98) and 52.6% of them scored below mean score. The SBCC knowledge was significantly predicted by the service year and the regional variation. On the other hand, SBCC skills was significantly predicted by sex, service year, profession, regional variation, and SBCC knowledge. The regional variation was the main predictor of both knowledge and skill on SBCC. The regression models explained 23.1% and 50.2% of the variance in knowledge and skill of SBCC, respectively.ConclusionFront-line healthcare system actors in Ethiopia has low knowledge and skills in SBCC. Variations in SBCC knowledge and skill were observed based on demographic and professionals experience related characteristics. Hence, continuous capacity building activities need to be given to frontline healthcare system actors to enhance their knowledge and skill on SBCC program and achieve the intended health results.

Project description:The brain is thought to combine linguistic knowledge of words and nonlinguistic knowledge of their referents to encode sentence meaning. However, functional neuroimaging studies aiming at decoding language meaning from neural activity have mostly relied on distributional models of word semantics, which are based on patterns of word co-occurrence in text corpora. Here, we present initial evidence that modeling nonlinguistic "experiential" knowledge contributes to decoding neural representations of sentence meaning. We model attributes of peoples' sensory, motor, social, emotional, and cognitive experiences with words using behavioral ratings. We demonstrate that fMRI activation elicited in sentence reading is more accurately decoded when this experiential attribute model is integrated with a text-based model than when either model is applied in isolation (participants were 5 males and 9 females). Our decoding approach exploits a representation-similarity-based framework, which benefits from being parameter free, while performing at accuracy levels comparable with those from parameter fitting approaches, such as ridge regression. We find that the text-based model contributes particularly to the decoding of sentences containing linguistically oriented "abstract" words and reveal tentative evidence that the experiential model improves decoding of more concrete sentences. Finally, we introduce a cross-participant decoding method to estimate an upper bound on model-based decoding accuracy. We demonstrate that a substantial fraction of neural signal remains unexplained, and leverage this gap to pinpoint characteristics of weakly decoded sentences and hence identify model weaknesses to guide future model development.SIGNIFICANCE STATEMENT Language gives humans the unique ability to communicate about historical events, theoretical concepts, and fiction. Although words are learned through language and defined by their relations to other words in dictionaries, our understanding of word meaning presumably draws heavily on our nonlinguistic sensory, motor, interoceptive, and emotional experiences with words and their referents. Behavioral experiments lend support to the intuition that word meaning integrates aspects of linguistic and nonlinguistic "experiential" knowledge. However, behavioral measures do not provide a window on how meaning is represented in the brain and tend to necessitate artificial experimental paradigms. We present a model-based approach that reveals early evidence that experiential and linguistically acquired knowledge can be detected in brain activity elicited in reading natural sentences.

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Assessing dual-role staff-interpreter linguistic competency in an integrated healthcare system.

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