Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
JAMA Pediatr. 2020 Dec 1;174(12):e203215. doi: 10.1001/jamapediatrics.2020.3215. Epub 2020 Dec 7.
Children of parents expressing limited comfort with English (LCE) or limited English proficiency may be at increased risk of adverse events (harms due to medical care). No prior studies have examined, in a multicenter fashion, the association between language comfort or language proficiency and systematically, actively collected adverse events that include family safety reporting.
To examine the association between parent LCE and adverse events in a cohort of hospitalized children.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter prospective cohort study was conducted from December 2014 to January 2017, concurrent with data collection from the Patient and Family Centered I-PASS Study, a clinician-family communication and patient safety intervention study. The study included 1666 Arabic-, Chinese-, English-, and Spanish-speaking parents of general pediatric and subspecialty patients 17 years and younger in the pediatric units of 7 North American hospitals. Data were analyzed from January 2018 to May 2020.
Language-comfort data were collected through parent self-reporting. LCE was defined as reporting any language besides English as the language in which parents were most comfortable speaking to physicians or nurses.
The primary outcome was adverse events; the secondary outcome was preventable adverse events. Adverse events were collected using a systematic 2-step methodology. First, clinician abstractors reviewed patient medical records, solicited clinician reports, hospital incident reports, and family safety interviews. Then, review and consensus classification were completed by physician pairs. To examine the association of LCE with adverse events, a multivariable logistic regression was conducted with random intercepts to adjust for clustering by site.
Of 1666 parents providing language-comfort data, 1341 (80.5%) were female, and the mean (SD) age of parents was 35.4 (10.0) years. A total of 147 parents (8.8%) expressed LCE, most of whom (105 [71.4%]) preferred Spanish. Children of parents who expressed LCE had higher odds of having 1 or more adverse events compared with children whose parents expressed comfort with English (26 of 147 [17.7%] vs 146 of 1519 [9.6%]; adjusted odds ratio, 2.1; 95% CI, 1.2-3.7), after adjustment for parent race and education, complex chronic conditions, length of stay, site, and the intervention period. Similarly, children whose parents expressed LCE were more likely to experience 1 or more preventable adverse events (adjusted odds ratio, 2.3; 95% CI, 1.2-4.2).
Hospitalized children of parents expressing LCE were twice as likely to experience harms due to medical care. Targeted strategies are needed to improve communication and safety for this vulnerable group of children.
父母对英语表达能力（LCE）或英语熟练程度有限的孩子可能面临更多的不良事件（因医疗护理而产生的危害）风险。之前没有研究以多中心的方式检查过语言舒适度或语言熟练程度与系统、积极收集的不良事件之间的关联，这些不良事件包括家庭安全报告。
在住院儿童队列中检查父母 LCE 与不良事件之间的关联。
设计、地点和参与者：这是一项多中心前瞻性队列研究，于 2014 年 12 月至 2017 年 1 月进行，同时进行了患者和家庭为中心的 I-PASS 研究的数据收集，这是一项临床医生-家庭沟通和患者安全干预研究。该研究纳入了来自 7 家北美的儿科医院儿科病房的 1666 名讲阿拉伯语、中文、英语和西班牙语的 17 岁及以下的一般儿科和专科患者的父母。数据分析于 2018 年 1 月至 2020 年 5 月进行。
通过父母自我报告收集语言舒适度数据。LCE 被定义为报告除英语以外的任何语言是父母与医生或护士交流时最舒服的语言。
主要结果是不良事件；次要结果是可预防的不良事件。不良事件通过系统的两步法进行收集。首先，临床医生摘要员审查了患者的医疗记录，征求了临床医生的报告、医院事件报告和家庭安全访谈。然后，由医生二人组进行审查和共识分类。为了检验 LCE 与不良事件的关联，采用多变量逻辑回归进行分析，并对因地点而产生的聚类进行随机截距调整。
在提供语言舒适度数据的 1666 位父母中，有 1341 位（80.5%）为女性，父母的平均（SD）年龄为 35.4（10.0）岁。共有 147 位父母（8.8%）表示 LCE，其中大多数人（105 位[71.4%]）更喜欢西班牙语。与父母表达英语舒适感的孩子相比，表达 LCE 的父母的孩子发生 1 次或更多次不良事件的可能性更高（147 位中的 26 位[17.7%] vs 1519 位中的 146 位[9.6%]；调整后的优势比，2.1；95%置信区间，1.2-3.7），调整了父母的种族和教育程度、复杂慢性疾病、住院时间、地点和干预期间等因素后。同样，表达 LCE 的父母的孩子更有可能经历 1 次或更多次可预防的不良事件（调整后的优势比，2.3；95%置信区间，1.2-4.2）。
表达 LCE 的父母的住院孩子因医疗护理而遭受伤害的可能性是其他孩子的两倍。需要采取有针对性的策略来改善这一弱势群体儿童的沟通和安全。
