有語言障礙的家庭護理患者再住院風險較高 | 紐約大學護理學院

有語言障礙的家庭護理患者再住院風險較高 | 紐約大學護理學院

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‍Patients with language barriers who are receiving home health care are at an increased risk for hospital readmission, according to a new study published in the International Journal of Nursing Studies.

“Language preference as a social determinant of health is not a new factor in health care delivery,” said Allison Squires, PhD, RN, FAAN, associate professor at NYU Rory Meyers College of Nursing and the study’s lead author. “Our research suggests that patients with language barriers in home health care may be particularly vulnerable to poor outcomes.”  

Language barriers between patients and providers can make effective communication challenging and have been shown to have a negative impact on the quality of care and patient safety. Research shows that patients who are most comfortable speaking a language other than the dominant local language are at an increased risk for longer hospital stays, falls, and infections, among other negative outcomes.  

Language gaps may be particularly detrimental in home health care—in which health providers, primarily nurses, visit patients’ homes to deliver care—given that interpreter services can be more difficult to implement and access in the home setting. For example, many home care patients, who are often older adults over the age of 65, do not have high-speed internet access, or sometimes even a phone, which makes accessing phone or video interpreter services difficult.

A prior study by Squires found that home health care services are not meeting the demand for language services among diverse populations; that study of one large urban agency found only 20 percent of patients speaking a language other than English were visited by a provider who spoke their language. For smaller agencies, the numbers are likely far worse.

The goal of home health care services is to maintain a person’s ability to care for themselves in their home and avoid costly emergency or hospital services. As a result, hospital readmission from home health care is a key quality indicator for U.S. home health agencies.  

To determine whether a patient’s language preference influences hospital readmission risk from home health care, the researchers examined electronic health records for more than 87,000 patients living in New York City who were receiving home health care after being discharged from a hospital. The records captured what language patients preferred to communicate in; the researchers focused the study on the five most common languages spoken among the patients studied: English, Spanish, Russian, Chinese, and Korean. They then looked at who was readmitted to a hospital within 30 days.  

Home health patients who preferred a language other than English had a higher hospital readmission rate (20.4%) than English-speaking patients (18.5%). Risk of readmission also varied by language, with higher risk among Spanish and Russian speakers and lower risk among Chinese and Korean speakers.

The researchers recommend using a variety of approaches to address this disparity, including team-based care transition programs from hospital to home health care that account for patient language preferences, improving translation capabilities, and employing health care teams that speak the same languages as their patients.  

“Ensuring that patients have clinical interactions in their preferred language across the care continuum is important, as it can increase access to care at the earliest stages, reduce the risk for readmission, and improve care transitions throughout the health care system,” said Squires.

In addition to Squires, study authors include Chenjuan Ma of NYU Meyers, Sarah Miner of St. John Fisher College, Penny Feldman of Visiting Nurse Service of New York, Elizabeth Jacobs of MaineHealth, and Simon Jones of NYU Grossman School of Medicine. The research was funded by the Agency for Healthcare Research and Quality (R01-HS023593).

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全文翻譯(僅供參考)

説英語以外的語言會增加美國患者再入院的機會

       根據發表在《 國際護理研究雜誌》上的一項新研究,正在接受家庭保健的語言障礙患者再入院的風險 增加。

     “語言偏好作為健康的社會決定因素並不是醫療保健提供的新因素,”紐約大學羅裏邁耶斯護理學院副教授、該研究的主要作者Allison Squires 博士、註冊護士、FAAN説 。“我們的研究表明,在家庭醫療保健中存在語言障礙的患者可能特別容易受到不良結果的影響。”  

       患者和提供者之間的語言障礙會使有效溝通變得具有挑戰性,並且已被證明會對護理品質和患者安全産生負面影響。研究表明,最習慣説當地主要語言以外的語言的 患者住院時間延長、跌倒和感染以及其他負面結果的風險增加。 

       鋻於口譯服務在家庭環境中更難實施和獲得,在家庭醫療保健中,語言差距可能尤其有害——在這種情況下,醫療服務提供者,主要是護士,到病人家中提供護理。例如,許多家庭護理患者(通常是 65 歲以上的老年人)沒有高速網際網路接入,有時甚至沒有電話,這使得獲得電話或視頻口譯服務變得困難。

       Squires 之前的一項研究發現,家庭醫療保健服務無法滿足不同人群對語言服務的需求;對一家大型城市機構進行的這項研究發現, 只有 20% 的説英語以外語言的患者接受過會説英語以外語言的提供者的訪問。對於較小的機構,數字可能要差得多。

       家庭醫療保健服務的目標是保持一個人在家中照顧自己的能力,並避免昂貴的急診或醫院服務。因此,家庭保健再入院是美國家庭保健機構的一個關鍵品質指標。 

       為了確定患者的語言偏好是否會影響家庭醫療保健的再入院風險,研究人員檢查了居住在紐約市的 87,000 多名出院後接受家庭醫療保健的患者的電子健康記錄。這些記錄記錄了患者更喜歡用哪種語言進行交流;研究人員將研究重點放在所研究患者中最常用的五種語言上:英語、西班牙語、俄語、漢語和韓語。然後他們查看了誰在 30 天內重新入院。 

       喜歡英語以外語言的家庭健康患者的再入院率 (20.4%) 高於説英語的患者 (18.5%)。再入院風險也因語言而異,講西班牙語和俄語的人風險較高,講漢語和韓語的人風險較低。

研究人員建議使用多種方法來解決這種差異,包括考慮到患者語言偏好的基於團隊的從醫院到家庭醫療的醫療過渡計劃,提高翻譯能力,以及雇用與患者説相同語言的醫療團隊.  

     “確保患者在整個護理過程中以他們喜歡的語言進行臨床互動很重要,因為它可以在最早階段增加獲得護理的機會,降低再入院的風險,並改善整個醫療保健系統的護理過渡,”Squires 説。

       除了 Squires 之外,研究作者還包括紐約大學邁耶斯分校的馬陳娟、聖約翰費舍爾學院的莎拉·米納、紐約訪問護士服務中心的佩妮·費爾德曼、緬因州健康的伊麗莎白·雅各布斯和紐約大學格羅斯曼醫學院的西蒙·瓊斯。該研究由醫療保健研究和品質機構 (R01-HS023593) 資助。

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