Jimenez Manuel E, Martinez Alcaraz Emmanuel, Williams Jerome, Strom Brian L
*Departments of Pediatrics and Family Medicine and Community Health, Robert Wood Johnson Medical School, Rutgers Biomedical Health Sciences, Newark, NJ; †Robert Wood Johnson Medical School, Rutgers Biomedical Health Sciences, New Brunswick, NJ; ‡Department of Marketing, Rutgers Business School, Rutgers, The State University of New Jersey, Newark, NJ; §Office of the Chancellor, Rutgers Biomedical Health Sciences, Newark, NJ.
J Dev Behav Pediatr. 2017 Apr;38(3):228-232. doi: 10.1097/DBP.0000000000000427.
To determine a national average wait time for developmental pediatric evaluations and to understand differences in access based on whether an appointment is requested by an English or Spanish-speaking caller.
We conducted a mystery shopper study in which a bilingual research assistant called developmental pediatrics programs affiliated with US children's hospitals listed on a public directory requesting an appointment for his simulated child experiencing a developmental problem. If an appointment was not provided, a wait time estimate was requested. Programs that provided an estimate in English were called within 24 hours using a translated script. We excluded programs that did not include a developmental pediatrician, only accepted referrals from within their health system or plan, focused on specific disorders, or did not conduct initial evaluations.
Of 244 hospitals listed, 140 unique programs were identified and called in English. One hundred four programs were reached. Ninety programs met inclusion criteria, 75 provided an estimated wait time. The mean estimate was 5.4 months (standard deviation: 4.5). Among these 75 programs, 62 were reached in Spanish but only 55% provided a wait time estimate; 31% did not provide language accommodations. The difference between average estimates obtained in English and Spanish was not statistically significant.
Among a national sample of US children's hospitals, we identified barriers to evaluations conducted by developmental pediatricians including long wait times and inadequate Spanish language accommodations at some programs. More work is needed to identify optimal strategies to connect children with developmental concerns to evaluations when necessary.
确定全国发育儿科评估的平均等待时间，并了解根据来电者是说英语还是西班牙语来预约而产生的就诊机会差异。
我们开展了一项神秘顾客研究，一名双语研究助理致电公共目录中列出的与美国儿童医院相关的发育儿科项目，为其模拟的有发育问题的孩子预约就诊。如果未提供预约，就要求给出等待时间估计。对那些用英语给出估计时间的项目，在24小时内使用翻译后的脚本来致电。我们排除了那些没有发育儿科医生、只接受其医疗系统或计划内转诊、专注于特定疾病或不进行初始评估的项目。
在列出的244家医院中，确定了140个不同的项目并以英语致电。联系上了104个项目。90个项目符合纳入标准，75个提供了等待时间估计。平均估计时间为5.4个月（标准差：4.5）。在这75个项目中，62个能用西班牙语联系上，但只有55%提供了等待时间估计；31%没有提供语言服务。用英语和西班牙语获得的平均估计时间差异无统计学意义。
在美国儿童医院全国样本中我们发现发育儿科医生进行评估存在障碍，包括等待时间长以及一些项目的西班牙语服务不足。需要做更多工作来确定最佳策略，以便在必要时将有发育问题的儿童与评估联系起来。
