Availability Of Interpreter Services Research Articles

Abstract WP89: Listen: Language Impact On Stroke Time To Evaluation And Intervention

Introduction: Previous reports raised concerns that time dependent treatments in acute ischemic stroke (AIS) might be delayed on non-English speaking patients. Here we report an analysis of patients after AIS stratified by primary language who were admitted to two large comprehensive stroke centers in California. The purpose of this analysis was to examine the impact of primary language on treatment times, frequency and causes of not using thrombolysis. Methods: We included all patients admitted between 12/2019-4/2022 who presented to a Comprehensive Stroke Center (CSC) using the electronic medical record (EMR). Language preference was identified as English (ES) or Non-English (NES). We compared comorbidities, demographics, baseline NIHSS, stroke time metrics [stroke onset to arrival (LTD), arrival to CT (DTC), arrival to tPA (DTN)], frequency of tPA administration and exclusion for last known normal (LKN) > 4.5 hours between ES and NES. We utilized Chi-squared, t-test, ANOVA as appropriate and a p value of <0.05 was significant. Results: We identified 1815 patients, ES n=1489, NES n=326. There was no significant difference in the mean age between groups (ES 67±16; NES 66±16, p=0.93). There was no significant difference in mean LTD between groups (NES 99.3±58.9 minutes (min); ES 83.6±52 min). There was no significant difference in mean DTC between groups (NES 13.2±8.5 min; ES 12±10.2 min). There was no significant difference in mean DTN between groups (NES 54.4±23.3 min; ES 53.8±27.9 min). There was a significant difference in ambulance arrival (p=0.001), HTN (p=0.01), DM (p=0.001), drug/alcohol use (p=.001), and smoking (p=.001). There was no significant difference in LKW to door (p=.12), DTC (p=.44), DTN (p=0.88). Conclusion: Primary language did not affect acute stroke time metrics at this academic CSC. This is likely due to the 24/7 availability of interpreter services at this CSC. Further studies must assess the impact of language preference on stroke time metrics and outcome in a heterogenous sample of healthcare settings. Communicating in patients’ preferred language is vital to rapid care and patient engagement in the acute stroke setting.

Perspective of asylum-seeking caregivers on the quality of care provided by a Swiss paediatric hospital: a qualitative study

ObjectivesThis study investigated the perspective of asylum-seeking caregivers on the quality of healthcare delivered to their children in a qualitative in-depth interview study. The health of asylum-seeking children is of...

Providers’ Perceptions of Medical Interpreter Services and Limited English Proficiency (LEP) Patients

Patient’s ability to understand and effectively communicate health information facilitates disease prevention, self-management of illness, the adoption of healthy behaviors, and their ability to act on important public health information. However, patients who have limited English proficiency (LEP) are significantly disadvantaged. Previous studies have shown the benefit of medical interpreter services in bridging the health communication gap between patients and providers. This qualitative study, focusing on medical interpreter utilization within obstetrical and neonatal services, provides perspectives from multiple types of providers to further explore the role of medical interpreter services and specific barriers to the use of such services. Five separate focus groups were conducted with postpartum nurses, labor and delivery/triage nurses, obstetrics and gynecology (OBGYN) resident physicians, neonatal intensive-care unit (NICU) nurses, and faculty physicians, nurse practitioners, and midwives. The data show that barriers to the utilization of professional medical interpreters can be categorized by distinct but related institutional- and individual-level factors. Further interpretation of the barriers, however, suggests that providers’ use/non-use of interpreter services is merely one piece of a much “bigger picture” regarding difficulties and challenges in delivering care to a growing culturally diverse patient population, and that these cultural challenges, not just the availability of interpreter services, may affect providers’ ability to deliver effective and efficient care. It is argued that simply adding additional communication-based resources may not be sufficient to impact providers’ attitudes and behaviors or the overarching organizational culture regarding LEP patients.

Cultural competency assessment tool for hospitals: evaluating hospitals' adherence to the culturally and linguistically appropriate services standards.

The U.S. national standards for culturally and linguistically appropriate services (CLAS) in health care provide guidelines on policies and practices aimed at developing culturally competent systems of care. The Cultural Competency Assessment Tool for Hospitals (CCATH) was developed as an organizational tool to assess adherence to the CLAS standards. First, we describe the development of the CCATH and estimate the reliability and validity of the CCATH measures. Second, we discuss the managerial implications of the CCATH as an organizational tool to assess cultural competency. We pilot tested an initial draft of the CCATH, revised it based on a focus group and cognitive interviews, and then administered it in a field test with a sample of California hospitals. The reliability and validity of the CCATH were evaluated using factor analysis, analysis of variance, and Cronbach's alphas. Exploratory and confirmatory factor analyses identified 12 CCATH composites: leadership and strategic planning, data collection on inpatient population, data collection on service area, performance management systems and quality improvement, human resources practices, diversity training, community representation, availability of interpreter services, interpreter services policies, quality of interpreter services, translation of written materials, and clinical cultural competency practices. All the CCATH scales had internal consistency reliability of .65 or above, and the reliability was .70 or above for 9 of the 12 scales. Analysis of variance results showed that not-for-profit hospitals have higher CCATH scores than for-profit hospitals in five CCATH scales and higher CCATH scores than government hospitals in two CCATH scales. The CCATH showed adequate psychometric properties. Managers and policy makers can use the CCATH as a tool to evaluate hospital performance in cultural competency and identify and target improvements in hospital policies and practices that undergird the provision of CLAS.

Equitable access to dental care for an at‐risk group: a review of services for Australian refugees

Despite the poor dental health of refugees, few specific services are available. This review maps public dental services for refugees across Australian jurisdictions, identifies gaps in provision, identifies barriers to accessing dental care, and provides recommendations for improving access and oral health promotion for this group. Data were sought from the State and Territory services for: a) the survivors of torture; b) oral health care units; and c) auditors-general reports of dental services. Eligibility criteria and estimated waiting times for general dental services, criteria for access to emergency care and availability of interpreter services were reviewed. Marked variation exists across Australian jurisdictions in available dental services and criteria for access to public dental care for refugees. There is limited priority access to general dental services for refugees. Waiting times for public dental treatment in most, if not all, jurisdictions are unacceptably long (range 13-58 months). Few interpreter services exist for refugees seeking to access dental services. Access to dental services for refugees across Australia remains fragmented and limited, particularly in rural and regional areas. Refugees are not using services because of several barriers, including long waiting times, variation in assessment criteria, different eligibility criteria and limited interpreter services. Consequently, their pattern of service use does not accurately reflect their needs. Australia needs better co-ordinated, more extensive dental services that are easily accessible for this very high risk group. Identification of refugees as a special needs group and provision of targeted interventions addressing barriers to care are needed to establish adequate dental care.