评估一项质量改进干预措施，以增加电话口译的使用。

Evaluation of a quality improvement intervention to increase use of telephonic interpretation.

机构信息

Department of Pediatrics and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; and

Department of Pediatrics and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; and Center for Diversity and Health Equity, Seattle Children's Hospital, Seattle, Washington Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington;

出版信息

Pediatrics. 2015 Mar;135(3):e709-16. doi: 10.1542/peds.2014-2024.

DOI:10.1542/peds.2014-2024

PMID:25713276

Abstract

BACKGROUND

Language barriers are associated with poor health care outcomes, and barriers exist for timely in-person interpretation. Although available on-demand, telephonic interpretation remains underutilized. This study evaluates whether a quality improvement (QI) intervention was associated with rates of interpretation and parent-reported language service use at a children's hospital.

METHODS

The QI intervention was developed by a multidisciplinary team and included provider education, electronic alerts, standardized dual-handset telephones, and 1-touch dialing in all hospital rooms. Interpreter use was tracked for 12 months before, 5 months during, and 12 months after the intervention. Weekly rates of interpretation per limited English proficient (LEP) patient-day were evaluated by using segmented linear regression. LEP parents were surveyed about professional interpretation and delays in care. Responses before, during, and after the intervention were compared by using the χ(2) test for trend.

RESULTS

Telephonic interpretation rates increased by 53% after the intervention (baseline 0.38 per patient-day, increased 0.20 [0.13-0.28]). Overall (telephonic and in-person) interpretation increased by 54% (baseline 0.96, increased by 0.51 [0.38-0.64]). Parent-reported interpreter use improved, including more frequent use of professional interpreters (53.3% before, 71.8% during, 69.3% after, P trend = .001), less frequent use of ad hoc interpreters (52.4% before, 38.1% during, 41.4% after, P trend = .03), and fewer interpretation-related delays in care (13.3% before, 7.9% during, 6.0% after, P trend = .01).

CONCLUSIONS

This QI intervention was associated with increased telephonic interpreter use and improved parent-reported use of professional language services. This is a promising approach to deliver safe, timely, and equitable care for the growing population of LEP children and families.

摘要

背景

语言障碍与医疗服务质量低下有关，而及时的现场口译也存在障碍。虽然电话口译随时可用，但仍未得到充分利用。本研究评估了一项质量改进（QI）干预措施是否与一家儿童医院的口译率和家长报告的语言服务使用情况有关。

方法

QI 干预措施由一个多学科团队制定，包括提供教育、电子提醒、标准化双耳机电话以及在所有医院病房的一键拨号。在干预措施实施前的 12 个月、实施期间的 5 个月和实施后的 12 个月，对口译使用情况进行了跟踪。使用分段线性回归评估每有限英语熟练（LEP）患者天的口译率。通过问卷调查了解 LEP 家长对专业口译和医疗服务延误的看法。通过趋势 χ²检验比较干预前、干预中和干预后的回答。

结果

干预后电话口译率增加了 53%（基线为每患者天 0.38，增加了 0.20[0.13-0.28]）。总体（电话口译和现场口译）口译率增加了 54%（基线为 0.96，增加了 0.51[0.38-0.64]）。家长报告的口译使用情况有所改善，包括更频繁地使用专业口译员（干预前为 53.3%，干预期间为 71.8%，干预后为 69.3%，趋势 P 值 =.001），更频繁地使用临时口译员（干预前为 52.4%，干预期间为 38.1%，干预后为 41.4%，趋势 P 值 =.03），以及更少的口译相关医疗服务延误（干预前为 13.3%，干预期间为 7.9%，干预后为 6.0%，趋势 P 值 =.01）。