Association of telemedicine use with disparities in cancer distress screening for patients with limited English proficiency.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 147-147
Author(s):  
Mohana Roy ◽  
Touran Fardeen ◽  
Anna Cabot ◽  
Bianca Bruzzone ◽  
Vikashini Savadamuthu ◽  
...  
Keyword(s):  
Limited English Proficiency ◽  
English Proficiency ◽  
Completion Rate ◽  
Cancer Center ◽  
Similar Distribution ◽  
Completion Rates ◽  
Distress Screening ◽  
Interpreter Use ◽  
Professional Interpreter ◽  
Significant Difference

147 Background: Distress has a significant impact on the quality of life for patients with cancer, however, implementation of such screening is variable. There is limited data in this area for patients who have limited English proficiency (LEP). Given data suggesting worsening disparities in medical care with telemedicine use, we evaluated the completion of distress screening and interpreter use for LEP patients with telemedicine. Methods: We analyzed assigned (complete and incomplete) questionnaires from 10/2019-3/2021 at Stanford Cancer Center (n = 181,105). We defined LEP as a patient electronic health record (EHR) demographic listing either a non-English preferred language or a request for an interpreter. We defined telemedicine as any video or phone visit. Data was analyzed with Fisher's test for differences. Given limitations in EHR data, we conducted a validation subset chart review for LEP patients in Thoracic and Gastrointestinal (GI) oncology which have the two highest % of LEP patients (n = 177 patients). The subset list was obtained for the above timeframe from the interpreter services group. We analyzed EHR notes from visit day for written mention of professional vs family interpreter use. Results: Overall, 14% of our cohort had LEP, highest prevalence in the Thoracic (21%) and GI groups (16%), with a total of 48 languages represented (Spanish, Mandarin & Vietnamese as the 3 most common). There was a significant difference in the English and Non-English groups in overall completion rates of the screening questionnaire (62% in English population vs 49% for LEP, p < 0.001). Completion rates for telemedicine vs. in person visits were overall higher for both English (78.9% vs. 55%, p < 0.001) and LEP (65.1% vs. 43.7%, p < 0.001) groups respectively. The overall screening completion rate for all visits was 57%, with a 62% completion rate with telemedicine and 51% completion with in-person visits (p = 0.2). In the LEP validation subset, there were 18 languages represented with the similar distribution as the larger cohort. Of all clinical notes reviewed, 48.8% included written mention of professional interpreter use, while 25.5% noted interpretation by a family member. There was no difference in professional interpreter use between visit types (̃50%), but with higher rate of family interpretation with telemedicine (35%) vs with in person visits (21%) (p = 0.04). Conclusions: Patients who have some level of limited English proficiency complete distress screening questionnaires less frequently compared to English speaking patients, which highlights the need to improve access to distress screening and supportive care. However, we found similar completion rates with in person vs telemedicine visits, with a signal for increased use of family members as interpreter with telemedicine. This warrants further analysis of the family role and patient understanding during these virtual visits.

Improving distress screening completion rates: Does virtual robot animation make a difference?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21672-e21672
Author(s):  
Tomas Dvorak ◽  
Diane Robinson ◽  
Emily Ross ◽  
Sharlin Milliard ◽  
David Metcalf ◽  
...  
Keyword(s):  
Technology Acceptance ◽  
Patient Experience ◽  
Ease Of Use ◽  
Completion Rate ◽  
Control Group ◽  
Completion Rates ◽  
Distress Screening ◽  
Screening Programs ◽  
Significant Difference ◽  
Screening Survey

e21672 Background: Distress screening is an important part of cancer patients’ care. Programs accredited by Commission on Cancer must implement distress screening programs, based on improved doctor-patient relationships and clinical outcomes. We are interested in evaluating the use of an anthropomorphic robotic interface to improve survey completion rates and the patient experience. Methods: A validated distress screening survey was scheduled for 74 patients in 2016 in an IRB-exempt survey study. Patients were randomly assigned to fill out the survey on iPAD (N = 33), or on iPAD with a virtual robot animation (“Betty”) introducing the survey (N = 41). Patients were then asked to fill out a validated 10 question Technology Acceptance Model questionnaire (TAM) asking about ease of iPAD use. A five point Likert scale was used. Finally, two yes/no questions were asked: 1) “Were you more interested in filling out the distress screening survey because of the “Betty” animation?”, and 2) “Did the animation make filling out the distress screening survey more enjoyable?” Results: The survey completion rate was 24/33 = 73% for control and 26/41 = 63% for intervention groups (p = 0.86). Forty five patients completed the TAM questionnaire, with completion rate 92% and 88%, respectively. Average iPAD TAM score was 4.3 in the control group and 4.0 in the intervention group (p = 0.12), and none of the 10 questions showed statistically significant difference in ease of use. The last two questions evaluating “Betty” directly were answered by 17/23 and 15/23 patients, respectively. 8/17 felt they were more interested in filling out the distress screening because of “Betty”, and 7/15 felt “Betty” made the distress screening more enjoyable. Conclusions: The presence of “Betty” as part of the survey process did not negatively impact the completion rates. There was no significant difference between the groups in perceived ease of use of the iPAD on which the survey was administered. Approximately half of the patients taking the distress survey with the “Betty” animation felt they were more interested in filling out the survey and the process was more enjoyable. We are currently evaluating whether a true robot may improve completion rates and patient experience.

scholarly journals Developing an Electronic Search Strategy Algorithm for Detecting Professional Interpreter Use among Patients with Limited English Proficiency: A Derivation and Validation Study

2020 ◽  
Author(s):  
Jalal Soleimani ◽  
Alberto Marquez ◽  
Timothy Weister ◽  
Amelia Barwise
Keyword(s):  
Limited English Proficiency ◽  
Chart Review ◽  
Search Strategy ◽  
English Proficiency ◽  
High Sensitivity ◽  
Interpreter Services ◽  
Interpreter Use ◽  
Specificity And Sensitivity ◽  
Professional Interpreter ◽  
Time Required

Abstract Background Evidence exists that disparities occur for patients with Limited English Proficiency (LEP) that impact the quality of medical services, outcomes, and patient satisfaction. Using interpreter services can reduce these negative impacts; therefore optimizing our understanding of interpreter use during patient care is important. Manual chart review is time-consuming. The objective of this study was to develop and validate a search strategy algorithm to detect patients who used professional interpreter services during their hospitalization. Methods We identified all adults who were admitted to the hospital who had at least one Intensive Care Units (ICU) admission during the hospital stay across the Mayo Clinic Enterprise between January 1, 2015, and June 30, 2020. Three random subsets of 100 patients were extracted from 60,268 patients admitted to an ICU to develop the search strategy algorithm. A physician reviewer conducted the gold standard manual chart review and these results were compared with the search strategy algorithm each time it was refined. Iterative modification of the search strategy was performed and sensitivity and specificity were calculated by comparing the results to the reference standard for both derivation cohorts and the final validation cohort. Any uncertainties were resolved by a second physician researcher. Results The first search strategy resulted in a specificity of 95.7% and a sensitivity of 93.5%. The second revised search strategy achieved a specificity of 96.7% and a sensitivity of 92.3%. The final version of the search strategy was applied to the validation subset and specificity and sensitivity were 92.6% and 100% respectively. Conclusion We successfully derived and validated a search strategy algorithm to assess interpreter use among hospitalized patients. Developing a search strategy algorithm with a high sensitivity can reduce the time required to abstract data from the medical record compared to manual chart review. This can be used to examine and understand patient needs for research and quality improvement initiatives.

Length of Stay for Patients With Limited English Proficiency in Pediatric Urgent Care

2020 ◽  
Vol 59 (4-5) ◽  
pp. 421-428
Author(s):  
Aimy T. Patel ◽  
Brian R. Lee ◽  
Ravneet Donegan ◽  
Sharon G. Humiston
Keyword(s):  
Length Of Stay ◽  
Limited English Proficiency ◽  
Chart Review ◽  
English Proficiency ◽  
Retrospective Chart Review ◽  
Urgent Care ◽  
Starting Point ◽  
Significant Difference ◽  
English Speaking ◽  
Radiological Studies

This retrospective chart review compared the length of stay (LOS) of families with limited English proficiency (LEP) versus English-speaking families seen in 3 pediatric urgent care centers (PUCCs). Visits were included for patients aged 2 months to 17 years seen between January 1, 2016, and December 31, 2016, with 1 of 5 primary diagnoses. For each LEP encounter, we randomly selected 3 English-speaking encounters within the same PUCC and diagnosis class. We compared overall LOS between LEP and English-speaking encounters. Of our entire sample, 184 (1.03%) were LEP encounters, of which 145 (78.8%) preferred Spanish. Comparing the LEP visits to 552 matched English-speaking visits, we found a significant difference in average LOS (LEP 85.5 minutes; English-speaking 76.4 minutes) and in prescriptions provided ( P = .005) but not in triaged acuity nor number of medications administered, laboratory or radiological studies, or suction treatments. This study serves as a starting point to better care for patients/families with LEP in PUCCs.

Moving From Knowledge to Action: Improving Safety and Quality of Care for Patients With Limited English Proficiency

2020 ◽  
Vol 59 (3) ◽  
pp. 266-277
Author(s):  
Miriam T. Fox ◽  
Sashini K. Godage ◽  
Julia M. Kim ◽  
Carla Bossano ◽  
Sara Muñoz-Blanco ◽  
...  
Keyword(s):  
Health Care ◽  
Focus Groups ◽  
Health Care Professionals ◽  
Limited English Proficiency ◽  
Health Care Disparities ◽  
English Proficiency ◽  
Descriptive Analysis ◽  
System Level ◽  
Knowledge To Action ◽  
Interpreter Use

Objective. This study assessed safety culture and staff communication with patients with limited English proficiency (LEP) to identify system-level approaches to increasing interpreter use and reducing health care disparities. Methods. An electronic survey and 7 focus groups were conducted with health care professionals in pediatrics and obstetrics/gynecology. Survey data were examined with univariate descriptive analysis. Focus group transcripts were coded through an iterative consensus process. Results. Survey participants (n = 68) reported less confidence in their ability to communicate effectively (74%) and form therapeutic relationships (56%) with LEP patients versus English-proficient patients. Focus groups identified knowledge as a facilitator of interpreter use. Workflow constraints, supply-demand mismatch, variable interpretation quality, and gaps in communication with interpretation services management were barriers. Conclusion. Knowledge gaps may not be a primary cause of interpreter underuse. Strategies to address workflow barriers and engage with interpretation services are critical to move from knowledge to action to improve LEP patient care.

scholarly journals Patterns of Interpreter Use for Hospitalized Patients with Limited English Proficiency

2011 ◽  
Vol 26 (7) ◽  
pp. 712-717 ◽  
Author(s):  
Yael Schenker ◽  
Eliseo J. Pérez-Stable ◽  
Dana Nickleach ◽  
Leah S. Karliner
Keyword(s):  
Limited English Proficiency ◽  
English Proficiency ◽  
Hospitalized Patients ◽  
Interpreter Use

scholarly journals Comparison Of Pupils’ Completion Rate Before And During 2006/2007 School Feeding Programme In Selected Public Primary Schools In Rivers State, Nigeria

2020 ◽  
Vol 7 (3) ◽  
pp. 195-202
Author(s):  
Nnamdi Anero
Keyword(s):  
Primary Schools ◽  
Completion Rate ◽  
Completion Rates ◽  
Head Teachers ◽  
School Feeding ◽  
Significant Difference ◽  
The Government ◽  
Rural Dwellers ◽  
Rivers State ◽  
The Impact

The study titled ‘Comparison of pupils’ completion rate before and during 2006/2007 school feeding programme in selected public primary schools in Rivers State, Nigeria was carried out to determine the impact of the feeding programme on the pupils’ completion rate. The study compared the completion rate of pupils before and during the feeding programme and also investigated the completion rate on the bases of boys and girls as well as urban and rural pupils. Out of 868 schools in Rivers State, 44 schools were randomly selected for the study.  The Head teachers of the selected schools were requested to supply relevant records of the pupils’ enrolment, dropout, return and completion rates using the admission and attendance registers as well as the result schedules.  The figures generated from the records were analyzed using simple percentages. Based on the analysis, the study established that completion rate during the feeding programme was higher than when there was no feeding among pupils in Rivers State. The study further established that there was no significant difference between the completion rates of the urban and rural pupils during or before the feeding programme and also established that more males completed primary education than females during the feeding programme in Rivers State. It therefore recommended that the government should re-introduce the feeding progamme and also carry out enlightenment campaign among the rural dwellers to enable them fully utilize the opportunity as well as seek for participation of philanthropists in funding the programme in all the nooks and crannies of the state so that all and sundry shall benefit.

Outcome Disparities and Resource Utilization Among Limited English Proficient Patients After Tonsillectomy

2021 ◽  
pp. 000348942110619
Author(s):  
Michal Plocienniczak ◽  
Batsheva R. Rubin ◽  
Alekha Kolli ◽  
Jessica Levi ◽  
Lauren Tracy
Keyword(s):  
Emergency Department ◽  
Resource Utilization ◽  
Limited English Proficiency ◽  
English Proficiency ◽  
Surgical Care ◽  
Adverse Outcomes ◽  
Utilization Rate ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact

Objective: There is evidence to suggest adverse outcomes on patients’ medical and surgical care when there is language discordance in patient-physician relationships. No studies have evaluated the impact of limited English proficiency (LEP) on complications after common surgical procedures in otolaryngology. Furthermore, no studies have evaluated how patients with LEP utilize remote resources to connect with otolaryngology providers to better triage such complications. The purpose was to evaluate the incidence of post-tonsillectomy hemorrhage (PTH) comparing patients with LEP to those with English proficiency (EP). Patients with PTH were retrospectively evaluated to identify preceding telephone encounters, a marker of resource utilization. Methods: Demographics, English proficiency, and PTH management (surgical vs non-surgical) were evaluated in addition to PTH-associated triage telephone encounters with otolaryngology providers. Results: Of 2466 tonsillectomies, there were 141 episodes of reported hemorrhage (50 LEP vs 91 EP) in the 5 years studied. Rates were not significantly different between LEP and EP patients (4.9% vs 6.3%, P = .127). There was no statistically significant difference in rate of preceding telephone encounters between LEP and EP patients (24% vs 40%, P = .062). Of patients presenting directly to the Emergency Department without a triage telephone encounter, there was no difference in operative versus non-operative management when comparing LEP versus EP patients. However, patients presenting directly to the Emergency Department were nearly twice as likely to undergo operative intervention compared to patients with preceding telephone encounters (RR = 1.79). Conclusion: Patients with limited English proficiency are not at increased risk for developing PTH. There is equitable access to remote otolaryngologic triage care, although overall the utilization rate of this resource was low for both cohorts.

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