有语言障碍的患者发生医院安全事件的风险更高。这项研究假设语言障碍将与与沟通开放性有关的医院安全氛围的较差认知有关。
在一组住院儿童及其家庭中,通过语言熟练程度检查报告的医院安全氛围的差异。
这项队列研究于2019年4月29日至2020年3月1日进行,纳入了21家美国医院普通和亚专科单位的儿科患者和住院儿童的父母或照顾者。随机选择阿拉伯-,中国人-,English-,在出院前与讲西班牙语的住院患者和家属联系,如果他们提供了语言能力和健康素养数据,则将他们纳入分析.参与者通过调查自我评估语言能力。有限的英语水平被定义为对“你的英语说得有多好?”这个问题的回答,除了“非常好”之外,
主要结果是顶框(最重要的;例如,强烈同意)3个儿童医院安全气候问卷的5点李克特量表评分沟通开放性项目:(1)如果您看到可能对护理产生负面影响的事情,请自由发言(顶框回答:强烈同意),(2)质疑医疗保健提供者的决定或行动(机顶盒回应:强烈同意),和(3)害怕问问题时,事情似乎不正确(顶框响应:强烈不同意[反向编码项目])。协变量包括健康素养和社会人口统计学特征。逻辑回归与广义估计方程一起使用,以控制按站点进行聚类,以对开放性项目与语言能力之间的关联进行建模。根据健康素养和社会人口学特征进行调整。
813名患者中,父母,以及被接洽参与研究的护理人员,608项完成的调查(74.8%的回应率)。共有87.7%(608人中的533人)的参与者(434人[82.0%]女性)完成了语言能力和健康素养项目,并被纳入分析;其中,14.1%(75)的英语水平有限。英语水平有限的参与者如果看到可能对护理产生负面影响的事情,他们自由发言的几率较低(调整后的优势比[aOR],0.26;95%CI,0.15-0.43),质疑医疗保健提供者的决定或行动(AOR,0.19;95%CI,0.09-0.41),当某事看起来不对劲时,不怕问问题(aOR,0.44;95%CI,0.27-0.71)。健康素养有限的个人(AOR,0.66;95%CI,0.48-0.91)和较低的教育程度(AOR,0.59;95%CI,0.36-0.95)也不太可能质疑决策或行动。
这项队列研究发现,有限的英语水平与说话的几率较低有关。质疑提供者的决定或行动,当事情看起来不对劲时,不怕问问题。这种差异可能会导致英语水平有限的患者面临更高的医院安全风险。必须致力于改善与英语水平有限的患者和家庭的沟通,以提高医院安全性并缩小差距。
Patients with language barriers have a higher risk of experiencing hospital safety events. This study hypothesized that language barriers would be associated with poorer perceptions of hospital safety climate relating to communication openness.
To examine disparities in reported hospital safety climate by language proficiency in a cohort of hospitalized children and their families.
This cohort study conducted from April 29, 2019, through March 1, 2020, included pediatric patients and parents or caregivers of hospitalized children at general and subspecialty units at 21 US hospitals. Randomly selected Arabic-, Chinese-, English-, and Spanish-speaking hospitalized patients and families were approached before hospital discharge and were included in the analysis if they provided both language proficiency and health literacy data. Participants self-rated language proficiency via surveys. Limited English proficiency was defined as an answer of anything other than \"very well\" to the question \"how well do you speak English?\"
Primary outcomes were top-box (top most; eg, strongly agree) 5-point Likert scale ratings for 3 Children\'s Hospital Safety Climate Questionnaire communication openness items: (1) freely speaking up if you see something that may negatively affect care (top-box response: strongly agree), (2) questioning decisions or actions of health care providers (top-box response: strongly agree), and (3) being afraid to ask questions when something does not seem right (top-box response: strongly disagree [reverse-coded item]). Covariates included health literacy and sociodemographic characteristics. Logistic regression was used with generalized estimating equations to control for clustering by site to model associations between openness items and language proficiency, adjusting for health literacy and sociodemographic characteristics.
Of 813 patients, parents, and caregivers who were approached to participate in the study, 608 completed surveys (74.8% response rate). A total of 87.7% (533 of 608) of participants (434 [82.0%] female individuals) completed language proficiency and health literacy items and were included in the analyses; of these, 14.1% (75) had limited English proficiency. Participants with limited English proficiency had lower odds of freely speaking up if they see something that may negatively affect care (adjusted odds ratio [aOR], 0.26; 95% CI, 0.15-0.43), questioning decisions or actions of health care providers (aOR, 0.19; 95% CI, 0.09-0.41), and being unafraid to ask questions when something does not seem right (aOR, 0.44; 95% CI, 0.27-0.71). Individuals with limited health literacy (aOR, 0.66; 95% CI, 0.48-0.91) and a lower level of educational attainment (aOR, 0.59; 95% CI, 0.36-0.95) were also less likely to question decisions or actions.
This cohort study found that limited English proficiency was associated with lower odds of speaking up, questioning decisions or actions of providers, and being unafraid to ask questions when something does not seem right. This disparity may contribute to higher hospital safety risk for patients with limited English proficiency. Dedicated efforts to improve communication with patients and families with limited English proficiency are necessary to improve hospital safety and reduce disparities.