有语言障碍的家庭护理患者再住院风险较高 | 纽约大学护理学院
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作者：NursingResearch护理研究前
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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).
全文翻译（仅供参考）
说英语以外的语言会增加美国患者再入院的机会
根据发表在《 国际护理研究杂志》上的一项新研究，正在接受家庭保健的语言障碍患者再入院的风险 增加。
“语言偏好作为健康的社会决定因素并不是医疗保健提供的新因素，”纽约大学罗里迈耶斯护理学院副教授、该研究的主要作者Allison Squires 博士、注册护士、FAAN说 。“我们的研究表明，在家庭医疗保健中存在语言障碍的患者可能特别容易受到不良结果的影响。”
患者和提供者之间的语言障碍会使有效沟通变得具有挑战性，并且已被证明会对护理质量和患者安全产生负面影响。研究表明，最习惯说当地主要语言以外的语言的 患者住院时间延长、跌倒和感染以及其他负面结果的风险增加。
鉴于口译服务在家庭环境中更难实施和获得，在家庭医疗保健中，语言差距可能尤其有害——在这种情况下，医疗服务提供者，主要是护士，到病人家中提供护理。例如，许多家庭护理患者（通常是 65 岁以上的老年人）没有高速互联网接入，有时甚至没有电话，这使得获得电话或视频口译服务变得困难。
Squires 之前的一项研究发现，家庭医疗保健服务无法满足不同人群对语言服务的需求；对一家大型城市机构进行的这项研究发现， 只有 20% 的说英语以外语言的患者接受过会说英语以外语言的提供者的访问。对于较小的机构，数字可能要差得多。
家庭医疗保健服务的目标是保持一个人在家中照顾自己的能力，并避免昂贵的急诊或医院服务。因此，家庭保健再入院是美国家庭保健机构的一个关键质量指标。
为了确定患者的语言偏好是否会影响家庭医疗保健的再入院风险，研究人员检查了居住在纽约市的 87,000 多名出院后接受家庭医疗保健的患者的电子健康记录。这些记录记录了患者更喜欢用哪种语言进行交流；研究人员将研究重点放在所研究患者中最常用的五种语言上：英语、西班牙语、俄语、汉语和韩语。然后他们查看了谁在 30 天内重新入院。
喜欢英语以外语言的家庭健康患者的再入院率 (20.4%) 高于说英语的患者 (18.5%)。再入院风险也因语言而异，讲西班牙语和俄语的人风险较高，讲汉语和韩语的人风险较低。
研究人员建议使用多种方法来解决这种差异，包括考虑到患者语言偏好的基于团队的从医院到家庭医疗的医疗过渡计划，提高翻译能力，以及雇用与患者说相同语言的医疗团队.
“确保患者在整个护理过程中以他们喜欢的语言进行临床互动很重要，因为它可以在最早阶段增加获得护理的机会，降低再入院的风险，并改善整个医疗保健系统的护理过渡，”Squires 说。
除了 Squires 之外，研究作者还包括纽约大学迈耶斯分校的马陈娟、圣约翰费舍尔学院的莎拉·米纳、纽约访问护士服务中心的佩妮·费尔德曼、缅因州健康的伊丽莎白·雅各布斯和纽约大学格罗斯曼医学院的西蒙·琼斯。该研究由医疗保健研究和质量机构 (R01-HS023593) 资助。
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