Primary Language Spoken Research Articles

Patient-Level Factors Influencing Palliative Care Consultation at a Safety-Net Urban Hospital

The influence of patient-level factors on palliative and hospice care is unclear. We conducted a retrospective review of 2321 patients aged ≥18 that died within 6 months of admission to our institution between 2012 and 2017. Patients were included for analysis if their chart was complete, their length of stay was ≥48 hours, and if based on their diagnoses, they would have benefited from palliative care consultation (PCC). Bayesian regression with a weakly informative prior was used to find the odds ratio (OR) and 99% credible interval (CrI) of receiving PCC based on race/ethnicity, education, language, insurance status, and income. 730 patients fit our inclusion criteria and 30% (n = 211) received PCC. The OR of receiving PCC was 1.26 (99% CrI, 0.73-2.12) for Blacks, 0.81 (99% CrI, 0.31-1.86) for Hispanics, and 0.69 (99% CrI, 0.19-2.46) for other minorities. Less than high school education was associated with greater odds of PCC (OR 2.28, 99% CrI, 1.09-4.93) compared to no schooling. Compared to English speakers, non-English speakers had higher odds of receiving PCC when cared for by medical services (OR 3.01 [99% CrI, 1.44-5.32]) but lower odds of PCC when cared for by surgical services (0.22 [99% CrI, <0.01-3.42]). Insurance status and income were not associated with differences in PCC. At our institution, we found no evidence of racial/ethnic, insurance, or income status affecting PCC while primary language spoken and educational status did. Further investigation is warranted to examine the system and provider-level factors influencing PCC's low utilization by medical and surgical specialties.

Dance and Music in Children’s Literature: A Qualitative Study of Intergenerational Solidarity Themes

Intergenerational Solidarity is consistently recognized by the United Nations as a primary focus for work being undertaken to build a society for all ages. This study utilized a qualitative methodology to examine themes of intergenerational solidarity contained within children’s literature. Specifically, this study explored intergenerational examples of dance and music shared by older adults and children. McGuire’s (2016) Growing Up and Growing Older annotated bibliography for preschool-to-third grade children, which contains over seventy pages of non-ageist children’s literature references (N= 411), served as the sample frame for this study. A sample of six story and picture books was selected after inclusion criteria and availability from two public children’s libraries considerations were met. Inclusiveness of the present sample is manifested through geographic origin of dance and music traditions as well as the age range, gender, primary spoken language, and kin relationships of the older adult and children characters. Results revealed three intergenerational solidarity themes: 1) a humanizing portrayal of an older adult, 2) common cause, 3) continuity of tradition. This study demonstrates the efficacy of the arts, specifically dance and music, for facilitating intergenerational solidarity. This study identifies three themes that primary school teachers and children's librarians can utilize when selecting reading material about intergenerational solidarity. Finally, this study contributes to decades of pioneering educational gerontology literature focused on combating ageism through development of curricula that stimulate discovery of the elder within.

Full Shelves, Good Skills?

Abstract Evidence suggests that books in the childhood home impact children’s educational and occupational attainments. Previous research finds this ‘book effect’ after conditioning on parental socio-economic status and national context. Human and cultural capital theories offer plausible explanations for this book effect. However, mechanisms underlying the book effect remain empirically illusory. Drawing on previous findings, the authors develop theoretical arguments that human and cultural capital are not the entire story behind the book effect. Designing a formal model of all these processes, the authors test their claims using immigration, language and country-context to adjudicate between mechanisms hypothesized by the theories. Using CILS4EU data in four countries and structural equation modeling to test these theories’ models against the data, the authors find the direct effect of books does not differ between native and immigrant adolescents in predicting 9th grade language aptitude scores. Moreover, this effect does not vary much by country. Reading habits and primary language spoken at home explain only part of the effect suggesting the presence of books measures something operating independently and in addition to human and cultural capital. The authors suggest books create opportunities for children whose parents are unlikely to cultivate scholarly values on average.

Patient factors affecting the proper completion of a goals-of-care form in a general medicine hospital admission.

The goals-of-care (GOC) form is a resuscitation planning tool used to document informed decisions tailored for individual patients admitted to hospital. Proper and timely completion of the GOC form is essential for its effective utility. To identify patient factors which may affect the timely discussion and documentation of GOC forms in patients admitted under a general medicine unit. We performed a cross-sectional study of 2589 patients during 3093 admissions under the general medicine unit from January 2017 to July 2017 at Dandenong Hospital in Melbourne, Australia. The main outcome was the proper completion of GOC forms, defined as GOC completion within 48 h of admission and adequate discussion with the patient or substitute decision maker. We used logistic regression to determine the association between the main outcome and several patient-related independent variables. A GOC form was completed in 66% of all admissions but only 35% were considered properly completed (timely and adequately discussed). In the general multivariable logistic regression model, the variables associated with proper completion of GOC forms were age (OR = 1.58), English as the main spoken language (OR = 1.43) and readmissions (OR = 1.27). In patients 75 years and older, additional factors associated with proper GOC completion were confusion on admission (OR = 1.31) and number of comorbidities (OR = 1.27). The proper GOC form completion rates were suboptimal in general medicine admissions, particularly in younger patients with fewer comorbidities. Additional effort is needed to improve GOC completion in these patients and those whose primary spoken language is not English.

In celebration of American Pharmacists Month, a look at lives dedicated to pharmacy

In celebration of American Pharmacists Month, a look at lives dedicated to pharmacy

The Importance of Concordance Between Patients and Their Subspecialists.

Concordance, the concept of patients having shared demographic/socioeconomic characteristics with their physicians, has been associated with improved patient satisfaction and outcomes in primary care but has not been studied in subspecialty care. The objective of this study was to investigate whether patients value concordance with their specialty physicians. The authors assessed the importance of concordance in subspecialist care in 2 cohorts of participants. The first cohort consisted of patients seeking care at a multispecialty orthopedic clinic. The second cohort consisted of volunteer participants recruited from an online platform. Each participant completed a survey scored on an ordinal scale which characteristics of their physicians they find important for their primary care physician (PCP) and a specialist. The characteristics included age, sex, ethnicity, sexual orientation, primary language spoken, and religion. The difference in concordance scores for PCPs and specialists were compared with paired t tests with a Bonferroni correction. A total of 118 patients were recruited in clinic, and a total of 982 volunteers were recruited online. In the clinic cohort, the level of importance for patient-physician concordance of age, ethnicity, language, and religion was not significantly different between PCPs and specialists. In the volunteer cohort, the level of importance for concordance of age, sex, national origin, language, and religion was not significantly different between PCPs and specialists. The volunteers recruited online had significantly higher concordance scores than the patients recruited in clinic for most variables. Patients find patient-physician concordance as important in specialty care as they do in primary care. This may have similar effects on patient outcomes in specialty care. [Orthopedics. 2020;43(5):315-319.].

Factors associated with adherence to the muscle-strengthening activity guideline among adolescents

PurposeWe aimed to explore associations between guideline-concordant muscle-strengthening activity (MSA) and demographic, biological, psychosocial, and behavioral factors among Australian adolescents. MethodsWe used baseline data from the ‘Resistance Training for Teens’ cluster randomized controlled trial (collected April–June 2015). Adolescents (n = 602, mean age = 14.1 ± 0.5 years, 50% female) from 16 schools in New South Wales, Australia self-reported their sex, primary language spoken at home, postal code (for socioeconomic status), resistance training (RT) self-efficacy, motivation for RT, perceived strength, moderate-to-vigorous physical activity (MVPA), screen-time, and sleep. Participants also completed tests of height, weight, cardiorespiratory and muscular fitness, flexibility, and RT skills. MSA was self-reported and participants were dichotomized as ‘meeting’ (3–7 days) or ‘not meeting’ (0–2 days) the MSA guideline. Binary logistic regression with odds ratios (OR) was used to determine associations with adolescents' MSA. ResultsAnalyses for each variable group explained a small-to-moderate proportion of the variance in MSA. Sex, muscular fitness, RT self-efficacy, perceived strength, and total MVPA emerged as statistically significant factors. However, only RT self-efficacy (OR = 2.48 [1.37 to 4.50]) and total MVPA (OR = 1.48 [1.22 to 1.79]) were associated with guideline-concordant MSA in the full model, which explained 52% of the variance. ConclusionsOur study adds to the limited understanding of adolescents' MSA behavior. RT self-efficacy and total MVPA were independently associated with guideline-concordant MSA among Australian adolescents. The findings have implications for the design and delivery of future interventions targeting adolescents’ MSA behavior.

Abstract C111: Identifying barriers to screening mammography use among low-income women in a public hospital setting in Los Angeles

Abstract Background: Mammography remains the most effective method for early detection of breast cancer. The Affordable Care Act requires that screening mammography be fully covered without any out-of-pocket expense for all patients. Still, disparities in mammography use persist, with the lowest rates reported for women of Hispanic ethnicity and those with Medicaid-based insurance coverage. The aim of this study was to administer a phone survey to better understand the barriers to mammography use among racially diverse low-income women with Medicaid coverage. Methods: All female patients age 50 to 74 at our facility that had not had a screening mammogram in the recent 24 months were identified. Data were collected from the electronic medical record (EMR) including race/ethnicity, primary language spoken, having had a PCP visit in the previous 12 months, having had a prior mammogram, history of depression, personal history of breast or other cancer, zip code (to estimate median household income), and marital status. Three attempts were made to contact these patients by phone to administer a phone survey that asked them to (1) state in their own words the primary reason for not getting a mammogram and (2) to complete a survey based on the Health Belief Model (HBM) subcategories: issues with self-efficacy (SE), perceived barriers (PBa), perceived benefits (PBe), perceived susceptibility (PS) and cues to action (CA). Barriers were assessed by race and characteristics collected from the EMR as well as survey responses. Results: There were 810 women due for mammography screening, 333(41%) of which were Hispanic, 146(18%) Black; 112(14%) Asian, 61(8%) Non-Hispanic White, and 158(20%) listed as ‘Other’. Data were collected from the EMR for all 810 women, and 339 (42%) were reached and agreed to participate in the survey. There were 320(40%) patients that did not speak English as their primary language, 441(54%) had not had a prior mammogram, 177(22%) had never visited a primary care physician in the system, and 237 (29%) had not visited one within the last 12 months. The most common self-stated reason Hispanic patients did not get a mammogram was due to lack of knowledge about insurance coverage of mammography; for Black women it was being busy with work related or personal and family illnesses; for Asian a language barrier; and for White/Non-Hispanic it was occupation with illness. The most commonly identified barrier for all races based off of the additional survey questions was limited mammography hours. Conclusion: In an underserved, predominantly Hispanic population who has Medicaid coverage, health professionals should better educate Hispanic patients on their insurance coverage, provide educational material that includes Asian languages, and consider that extended hours could help patients of all races find time to schedule a mammogram as efforts to minimize barriers will ultimately serve to decrease racial health disparities in breast cancer outcomes. Citation Format: Janell Holloway, Isabel del Canto, Kenny Morales, Gianna Ramos, Ashkan Moazzez, Griselda Gutierrez, Carmen Mendez, Junko Ozao-Choy, Christine Dauphine. Identifying barriers to screening mammography use among low-income women in a public hospital setting in Los Angeles [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C111.

A survey of adult preferences regarding recruitment for pediatric research

ObjectiveAlthough subject recruitment is one of the most critical aspects of human subject research, there is a lack of studies prospectively examining the recruitment preferences of adults for research involving children. MethodsThis was a cross-sectional study of adults accompanying patients at an otolaryngology clinic in a pediatric medical center. Anonymous questionnaires were distributed in English and Spanish to one adult for every patient. Questions assessed the respondent's preferences for research recruitment including contact method preferences, contact preferences for medical profession type, and whether they would expect a child to receive a small gift for participating in a research study. Fisher's exact tests were used to assess the association between the primary predictor, language, and each outcome. Results566 surveys were collected. 505 (89.1%) were completed in English and 61 (10.7%) were completed in Spanish. Spanish-speaking respondents were more likely to prefer talking to a doctor (76.7%) than English-speaking respondents (40.1%, p < 0.05). Spanish-speaking respondents were more likely to prefer talking over the phone (48.3%) than English-speaking respondents (17.3%, p < 0.05). Spanish-speaking respondents were more likely to prefer communicating via text messaging (41.7%) than English-speaking respondents (16.3%, p < 0.05). English-speaking respondents were more likely to prefer communicating through the patient portal of an electronic health record (EHR) (19%) than Spanish-speaking respondents(3.3%, p < 0.05). Mothers were more likely to prefer talking to a nurse/physician's assistant (20%) than fathers (10%, p < 0.05). Mothers were more likely to prefer talking to research staff (20%) than fathers (9%, p < 0.05). Mothers were more likely to prefer communication via text-message (22%) than fathers (6%, p < 0.05). Spanish-speaking respondents were more likely to prefer pediatric patients receiving a small monetary gift for participating in clinical research (70%) than English-speaking respondents (30%, p < 0.05). ConclusionThere was a significant association between preference for recruitment method and primary language spoken by the respondent. Further inquiry is required to understand these differences between English and Spanish speakers.

Recommendations for Systematizing Transplant Education Within a Care Delivery System for Patients With Chronic Kidney Disease Stages 3 to 5.

Early tailored transplant education could help patients make informed transplant choices. We interviewed 40 patients with chronic kidney disease (CKD) stages 3 to 5, 13 support persons, and 10 providers at Kaiser Permanente Southern California to understand: (1) barriers to transplant education and (2) transplant educational preferences and recommendations based on CKD stage and primary language spoken. A grounded theory analysis identified central themes related to transplant education barriers, preferences, and recommendations. Barriers included confusion about diagnosis and when transplant may be necessary, concerns about transplant risks, families' lack of transplant knowledge, financial burdens, transportation and scheduling, and the emotional overload of chronic illness. Hispanic and Spanish-speaking participants reported difficulty in understanding transplant education and medical mistrust. Recommendations included providing general education, earlier introduction to transplant, wait-listing information, transplant education for support persons, living donation education for patients and potential donors, opportunities to meet living donors and kidney recipients, information on the benefits of transplant, recovery, and available financial resources, flexible class scheduling, online and print resources, and more provider follow-up. Spanish-speaking and Hispanic participants recommended using bilingual educators, print, video, and online resources in Spanish, and culturally responsive education. Patients with CKD stages 3 to 4 wanted information on slowing disease progression and avoiding transplant. Increasing access to culturally responsive transplant education in multiple languages, pairing appropriate content to the disease stage, and increasing system-wide follow-up as the disease progresses might help patients make more informed choices about transplant.

Contraceptive Attitudes and beliefs Among Hmong Young Adults

Introduction: While different contraceptive attitudes have been reported among different ethnic groups inthe US, little if any research has been conducted to understand the reproductive health needs and attitudesamong Hmong young adults. To our knowledge, this is the first study to investigate the relationship amongcontraceptive perception of this community. Objective: The purpose of this research was to identify attitudesthat influence Hmong college students’ contraceptive practices. Methods: A campus-wide online survey wasused as part of the data collection at a midsize institution in Central California. The questionnaire was a 32-items scale instrument called Contraceptive Attitude Scale (CAS), developed by Dr. Black. Results: Three hundred and forty-four students successfully completed the 32-items scale instrument CAS, which measured general contraceptive attitudes among Hmong young adults in rural California. The data reveals a high prevalence of unmarried (85%) Hmong college students reporting being sexually active (67%), with 62% having at least one sexual partner over the past 12 months; however, only 36% reported to use condom compared to 58% who did not use condoms during the last time of sexual intercourse. Conclusion: The findings indicated statistically significant differences between groups on the characteristics of sexual partners, contraceptive methods, marital status, birthplace, primary language spoken at home, years spent in college and years lived in the United States. The findings greatly contribute to the understanding of factors that influence contraceptive choices among the Hmong college population. More importantly, the information is crucial in designing programs to promote contraceptive knowledge and practices that are specific to the Hmong.

Health Literacy, Language, and Cancer-Related Needs in the First 6 Months After a Breast Cancer Diagnosis.

Low health literacy (HL) and language negatively affect cancer screening and prevention behaviors; less is known about how they affect the patient's experience during cancer treatment. This study explores associations among HL, spoken language, and dimensions of cancer-related needs within 6 months of receiving a breast cancer diagnosis. Women speaking English, Spanish, or Haitian Creole, enrolled in a patient navigation study at diagnosis, completed a survey in their primary spoken language at baseline and 6 months to characterize their cancer-related needs. HL was measured using the Brief Health Literacy Screening Tool. Outcomes included the Cancer Needs Distress Inventory (CaNDI; n = 38 items) and the Communication and Attitudinal Self-Efficacy scale (CASE-Cancer) for cancer (n = 12 items). Linear regressions measured the impact of HL and language on total CaNDI and CASE-Cancer scale for cancer scores and subscales, adjusted for demographics. At baseline, 262 women participated and 228 (87%) followed up at 6 months. Of these, 38% had adequate HL, 33% had marginal HL, and 29% had inadequate HL. Women with inadequate or marginal HL had higher median baseline CaNDI scores (P = .02) and lower self-efficacy scores (P = .008), relative to those with adequate HL. Haitian-Creole speakers had significantly lower CANDI scores at baseline (P = .03). Adjusting for demographics, differences in CaNDI scores at baseline remained significant for those with lower HL and Haitian-Creole speakers. At 6 months, differences in self-efficacy persisted for Haitian-Creole speakers. Findings suggest that interventions oriented to mitigating HL and language barriers might reduce distress at the time of diagnosis and improve self-efficacy over the course of treatment.

Comparison of a video to a pictorial brochure in improving HIV/AIDS and HIV testing knowledge and increasing HIV testing motivation and behavioral skills among adult emergency department patients.

ObjectivesWe sought to determine if a pictorial brochure improves HIV/AIDS and HIV testing knowledge and increases HIV testing motivation and behavioral skills as well as a video among adult emergency department patients, regardless of language spoken and health literacy level.MethodsED patients were stratified by primary language spoken (English or Spanish) and health literacy level (lower or higher) and randomly assigned to watch the study video or review the content‐matched pictorial brochure. HIV/AIDS and HIV testing knowledge, motivation for HIV testing, and behavioral skills for HIV testing were assessed using study instruments before and after watching the video or reviewing the pictorial brochure.ResultsOf the 712 English‐ and 655 Spanish‐speaking ED patients, HIV/AIDS and HIV testing knowledge improved more among participants in the video than the pictorial brochure arm (∆ 0.43; 95% confidence interval [CI]: 0.07, 0.79). This improvement was more pronounced among those with lower (∆ 0.60; 95% CI: 0.06, 1.13) than higher health literacy (∆ 0.27; 95% CI: −0.22, 0.76). HIV testing motivation was high before the intervention and did not increase differentially between arms. Confidence in recognizing when to be tested for HIV was slightly greater in the video than pictorial brochure arm (∆ 0.15; 95% CI: 0.01, 0.28), but did not differ by language spoken or health literacy level.ConclusionsA video improved HIV/AIDS and HIV testing knowledge slightly more than a pictorial brochure. Other considerations (eg, patient volume, staffing, space, and video access) should guide EDs on how best to provide information about HIV testing to ED patients.

An Evaluation of Risk Factors for Patient "No Shows" at an Urban Joint Arthroplasty Clinic.

Patient physical health and provider financial health are both affected when patients are unable to attend scheduled clinic appointments. The purpose of this study is to identify risk factors for patients missing appointments to better target interventions to improve appointment attendance. We reviewed scheduled arthroplasty appointments at an urban academic orthopaedic clinic over a 3-year period. We collected information including sex, race, distance to clinic, language, insurance, median income of home zip code, appointment day, time, precipitation, and temperature. Mixed-level multiple logistic regression was used to model the odds of missing appointments in Stata v14. Overall, 8,185 visits for 3,081 unique patients were reviewed and 90.7% of appointments were attended. After controlling for time and day of appointment, distance from the clinic, and the primary language spoken, patients with government insurance were two times as likely to miss an appointment compared with privately insured patients. White patients were two times as likely to attend scheduled appointments compared with black/Hispanic patients. Younger patients (<50 years) and older patients (>73 years) were 2.7 times and 1.8 times, respectively, more likely to miss appointments compared with those aged between 65 and 72 years. Appointments on the most temperate days were more likely to be missed, and those on the coldest days (14°F to 36°F) and warmest days (69°F to 89°F) were less likely to be missed. Appointment no shows are associated with sociodemographic and environmental factors. This information is valuable to help better delineate novel ways to better serve these patient populations.

A Biopsychosocial Approach to Analyzing Inpatient Falls

Purpose: While research exists identifying factors that contribute to inpatient falls, patients in hospitals continue to fall. We suggest this is influenced by a lack of consistency in the implementation and documentation of evidence-based fall precautions, and that existing fall screens and protocols do not consistently identify potential fallers or prevent falls. This study examines biopsychosocial factors not commonly investigated that may affect falls. We analyzed patient mobility level, polypharmacy, mental status, language spoken, insurance type, and substance use on fall incidence and fall precaution protocol implementation in an urban, academic health care system. Materials/Methods: Using the incident reporting system, postfall huddles and electronic medical records, a comprehensive aggregate database was created of 217 inpatient fall incidents and 100 randomized nonincidents. Variables included insurance type, primary spoken language, history of substance use, mental status, polypharmacy, mobility level, and whether the fall precaution protocol was implemented. Chi-square tests, z tests of proportions, and absolute risk reduction (ARR) and increase (ARI) were calculated to assess associated fall potential for each predictor. Results: 55.2% of patients screened to be at risk for falls did not have a fall precaution protocol in place when they fell. The predictor with the largest effect (ARI 30%) on fall incidence was whether the fall precaution protocol was missing. Patients requiring Supervision through Minimal Assist for mobility were associated with an ARI of 18%; nonintact mental status (ARI 20%) and history of substance use (ARI 10%) were also associated with fall incidences. Having a history of substance use or having Medicaid insurance each reduced fall precaution protocol implementation by 15%. Conclusions: Novel results suggest that patients requiring less assistance for mobility experienced higher incidences of falls, and patients with a history of substance use and Medicaid insurance had a higher risk for not having fall precaution protocols implemented. Patients would benefit if physical therapists and nurses shared mobility assessment tools and communication methods, potentially improving mobilization triaging between the professions.

Are We All Speaking the Same Language? Exploring Language Interactions in the Homes of Young Latino DLLs Living in the U.S.

ABSTRACT Research Findings: The Latino population within the U.S. is heterogeneous with diversity in education level, country of origin, and English language fluency. Latino children often enter school with limited English language skills. In the current study, we surveyed 448 Latino families of Cuban, Mexican, and Puerto Rican descent regarding their home language use providing an in-depth look at the language interactions within Latino families residing in the U.S. Adults were matched on the language used with each other and with the target child. Six main findings are reported: (1) Mother–father language matched in 94% of the homes. Frequency distributions and cross-tab analysis identified Spanish as the primary language spoken in 56% of the homes, (2) Children and parents matched in language spoken in less than 21% of the homes, (3) Fathers play an important role in language use at home, (4) Approximately half of the mothers report no English fluency, (5) Latino children prefer to speak English at home, and (6) Maternal English fluency is related to overall language use. Practice or Policy: Early Childhood professionals should carefully structure language experiences in the classroom to aid the language acquisition of DLLs while promoting bilingualism. In addition, programs must take into consideration language spoken at home when establishing communication with the families.

Medical Student Workshop Improves Student Confidence in Working With Trained Medical Interpreters.

Introduction:Many physicians care for patients whose primary spoken language is not English, and these interactions present challenges in physician-patient communication. These challenges contribute to the significant health disparities experienced by populations with limited English proficiency (LEP). Using trained medical interpreters is an important step in addressing this problem, as it improves communication outcomes. Despite this, many medical education programs have little formal instruction on how to work effectively with interpreters.Methods:To address this gap, we created an interactive workshop led by professional trained interpreters and faculty facilitators for medical students in their clinical years. Students were asked to evaluate the session based on relevance to their clinical experiences and helpfulness in preparing them for interactions with patients with LEP.Results:Immediately after the session, students reported that the clinical scenarios presented were similar those seen on their clinical clerkships. They also reported increased confidence in their ability to work with interpreters. On later follow-up, students reported that the instruction helped prepare them for subsequent patient interactions that involved interpreters.Conclusion:A workshop is an effective method for improving medical student comfort and confidence when working with interpreters for populations with LEP.

Evaluating Disparities Affecting Time from Emergency Department Door to Electrocardiogram in Chest Pain Patients

Introduction: For patients presenting to an emergency department with a chief complaint of chest pain, current American Heart Association guidelines recommend that time from emergency department arrival to completion of electrocardiogram be 10 minutes or less. The aim of this study is to evaluate if differences still exist amongst a diverse patient population presenting to a busy urban emergency department with a chief complaint of chest pain. Methods: This retrospective study looked at 3,419 patients who presented to the Emergency Department with any complaint of chest pain during the medical screening examination. Arrival time and time of first electrocardiogram along with age, gender, race, ethnicity and primary language were extracted from electronic health records. Results: For all patients, the mean time to electrocardiogram was 12.5 minutes (95% CI: 12.1-12.7) and 49.9% of all patients received an electrocardiogram within 10 minutes of arrival. Mean time for men was 11.6 minutes and for women 13.3 minutes (P&lt;0.0001); in addition 54% of men and 44.4% of women had electrocardiogram done within 10 minutes of arrival (P&lt;0.0001). No differences were found with regards to primary language, race or ethnicity of patients. Mean time to electrocardiogram for patients less than 40 years old was 14.6 minutes, which was significantly longer than patients equal or older than 40 years, who’s mean time was 11.9 minutes (p&lt;0.0001). The effect of age was observed across gender, race, ethnicity and primary language spoken by the patients. Conclusions: Patient presenting to the emergency department with chest pain are subject to several biases that potentially create health disparities. In this study we show that younger patients and women had a delay in time to electrocardiogram showing biases are still an issue.

Evaluating disparities affecting time from emergency department door to electrocardiogram in chest pain patients

Author(s): Boge, Laurie A.; Wyatt, Charles; Sherman, Dana R.; Cecilia, Michael; Cubeddu, Luigi X.; Goldszer, Robert C.; Farcy, David A. | Abstract: Introduction: For patients presenting to an emergency department with a chief complaint of chest pain, current American Heart Association guidelines recommend that time from emergency department arrival to completion of electrocardiogram be 10 minutes or less. The aim of this study is to evaluate if differences still exist amongst a diverse patient population presenting to a busy urban emergency department with a chief complaint of chest pain. Methods: This retrospective study looked at 3,419 patients who presented to the Emergency Department with any complaint of chest pain during the medical screening examination. Arrival time and time of first electrocardiogram along with age, gender, race, ethnicity and primary language were extracted from electronic health records. Results: For all patients, the mean time to electrocardiogram was 12.5 minutes (95% CI: 12.1-12.7) and 49.9% of all patients received an electrocardiogram within 10 minutes of arrival. Mean time for men was 11.6 minutes and for women 13.3 minutes (Pl0.0001); in addition 54% of men and 44.4% of women had electrocardiogram done within 10 minutes of arrival (Pl0.0001). No differences were found with regards to primary language, race or ethnicity of patients. Mean time to electrocardiogram for patients less than 40 years old was 14.6 minutes, which was significantly longer than patients equal or older than 40 years, who’s mean time was 11.9 minutes (pl0.0001). The effect of age was observed across gender, race, ethnicity and primary language spoken by the patients.n Conclusions: Patient presenting to the emergency department with chest pain are subject to several biases that potentially create health disparities. In this study we show that younger patients and women had a delay in time to electrocardiogram showing biases are still an issue.

Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program.

To identify demographic predictors of patients undergoing cochlear implantation evaluation and surgery. Consecutive adult patients between 2009 and 2018 who underwent cochlear implantation evaluation at a university cochlear implantation program were retrospectively identified to determine (1) cochlear implantation qualification rate and (2) pursuit of surgery rate with respect to age, gender, race, primary spoken language, marital status, insurance type, and distance to the cochlear implantation center. A total of 823 cochlear implantation evaluations were analyzed. Overall, 76.3% of patients qualified for cochlear implantation and 61.5% of these patients pursued surgery. Age was the only independent predictor for cochlear implantation qualification, such that, for each year younger, the odds of qualifying for cochlear implantation increased by 2.5% (OR 0.98; 95% CI: 0.96-0.99). Age, race, marital status, and insurance type were each independent predictors of the decision to pursue surgery. The odds of pursuing surgery increased by 2.8% for each year younger (OR 1.03; 95% CI: 1.01-1.05). Compared to White patients, non-Whites were half as likely to pursue surgery (OR 0.47; 95% CI: 0.25-0.88). Single (OR 0.49; 95% CI: 0.26-0.94) and widowed patients (OR 0.46; 95% CI: 0.23-0.95) were about half as likely to pursue surgery as compared to married patients. Patients with military insurance were 13 times more likely to pursue surgery as compared to patients with Medicare (OR 13.0; 95% CI: 1.67-101.4). Younger age is an independent predictor for a higher cochlear implantation qualification rate, suggesting the possibility for delayed candidacy referral. Rate of surgical pursuit in qualified cochlear implantation candidates is lower for racial minorities, single and widowed patients, and older patients.