Hospital Discharge
Conditions
Keywords
Limited English proficiency, Hospital Discharge Teaching, Spanish speaking, Haitian Creole speaking, Cape Verdean Creole speaking, Vietnamese speaking
Brief summary
The investigators will test the impact of a package of linguistically appropriate discharge teaching tools against current standard of care for patients with Limited English proficiency (LEP) in an unblinded randomized controlled trial. The tools include an expanded medication calendar in English and the patients' preferred language, pictographics to illustrate return precautions (what signs/symptoms require further evaluation), an audio recording of the nurse reviewing the After Visit Summary (composed by providers) to allow for review by patients and caretakers after discharge. The investigators will evaluate the effectiveness of the package of discharge teaching tools on patients' understanding/recall, key implementation outcomes, and secondary clinical outcomes via a structured interview 1-2 weeks after discharge and chart review 30 days after discharge. The objectives of this research study are: 1. test the effectiveness of a linguistically appropriate toolkit for improving patient understanding of discharge instruction content 2. Assess the feasibility and fidelity of the intervention in anticipation of a multi-site implementation trial 3. assess the feasibility and appropriateness of the linguistically appropriate toolkit to nurses and in-person interpreters 4. to assess the acceptability of the intervention to patients and their satisfaction with it 5. to collect data on implementation context in anticipation for a multi-site trial 6. to collect preliminary data on the toolkit's impact on clinical outcomes including medication adherence and hospital re-utilization.
Interventions
OTHERToolkit to improve discharge equity
Linguistically appropriate discharge teaching aids: a medication calendar, pictographics added to the after visit summary (AVS), and an audio recording of the discharge teaching.
Sponsors
Boston Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Block randomization stratified by language and level of care (observation unit versus inpatient floor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients * Labeled in medical record as preferring one of the following four languages: Spanish, Haitian Creole, Cape Verdean Creole, or Vietnamese * Admitted to medicine team at BMC * Age 18 years or older * Being discharged home (to the community) * Admitted to Boston Medical Center (BMC) hospital units (Menino 7 East, 7 West, and Menino Observation) Nurses and Interpreters * Caring for patient enrolled in trial Family/Visitors * Present at time of discharge for patient enrolled in trial
Exclusion criteria
Patients * On airborne infections precautions * On clostridium difficile (C diff) precautions * On suicide precautions * Nurse report of participant displaying cognitive impairment, delirium, or aggression * Enrolled in trial during a prior admission Nurses and Interpreters * None Family/Visitors * None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Patient understanding of discharge instructions | 1-2 weeks post discharge | Assessed by a composite score of six key domains of discharge instructions (primary diagnosis, self-care instructions, return precautions, medication changes, medication indications, follow-up) as determined by two physician adjudicators (1=poor, 4 = near perfect). Higher scores demonstrate better understanding. |
| Patient understanding of primary diagnosis of hospitalization | 1-2 weeks post discharge | Determined by two physician adjudicators (1=poor, 4 = near perfect). Higher scores demonstrate better understanding. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Implementation effectiveness | 18 months | Effectiveness will be assessed by observations of and comments from patients, nurses and visitors from qualitative interviews related to the adoption, acceptability, appropriateness, and feasibility of the discharge process |
| Hospital re-utilization | 30 days | Assessed by a combined outcome of admission or emergency department (ED) visit within 30 days of index discharge |
| Number of participants with completion of primary care follow-up | 30 days | Assessed from participants' medical records |
| Participant participation in discharge teaching | 1-2 weeks | Participants are observed by a research team member during discharge teaching and will document the number of questions asked. |
Countries
United States
Outcome results
None listed