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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 22 of 22 Research Studies DisplayedKhan A, Yin HS, Brach C
AHRQ Author: Brach C
Association between parent comfort with English and adverse events among hospitalized children.
The purpose of this study was to examine the association between parents’ limited comfort with English (LCE) and adverse events in a cohort of hospitalized children. Participants included Arabic-, Chinese-, English-, and Spanish-speaking parents of patients 17 years and younger in the pediatric units of seven North American hospitals. Findings showed that 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.
AHRQ-authored; AHRQ-funded; HS022986.
Citation: Khan A, Yin HS, Brach C .
Association between parent comfort with English and adverse events among hospitalized children.
JAMA Pediatr 2020 Dec;174(12):e203215. doi: 10.1001/jamapediatrics.2020.3215..
Keywords: Children/Adolescents, Caregiving, Cultural Competence, Clinician-Patient Communication, Communication, Adverse Events, Patient Safety, Inpatient Care, Hospitalization
Squires A, Miner S, Liang E
How language barriers influence provider workload for home health care professionals: A secondary analysis of interview data.
Increasingly, patients with limited English proficiency are accessing home health care services in the United States. Few studies have examined how language barriers influence provider role implementation or workload in the home health care setting. The objective of this study was to explore home health care professionals' perspectives about how workload changes from managing language barriers influence quality and safety in home health care.
AHRQ-funded; HS023593.
Citation: Squires A, Miner S, Liang E .
How language barriers influence provider workload for home health care professionals: A secondary analysis of interview data.
Int J Nurs Stud 2019 Nov;99:103394. doi: 10.1016/j.ijnurstu.2019.103394..
Keywords: Home Healthcare, Cultural Competence, Communication, Provider, Healthcare Delivery
Howard SD, Lee KL, Nathan AG
Healthcare experiences of transgender people of color.
Researchers investigated how transgender people of color (TPOC) healthcare experiences are shaped by both race/ethnicity and gender identity. Using interviews and focus groups with participants in the Chicago area, they found that all participants described healthcare experiences where providers responded negatively to their race/ethnicity and/or gender identity. A majority of participants sought out healthcare locations designated as lesbian, gay, bisexual, and transgender-friendly in an effort to avoid discrimination, but feared experiencing racism there. When describing positive healthcare experiences, participants were most likely to highlight providers' respect for their gender identity. The researchers concluded that TPOC have different experiences compared with white transgender or cisgender racial/ethnic minorities and recommended that providers improve understanding of intersectional experiences of TPOC to improve quality of care.
AHRQ-funded; HS023050.
Citation: Howard SD, Lee KL, Nathan AG .
Healthcare experiences of transgender people of color.
J Gen Intern Med 2019 Oct;34(10):2068-74. doi: 10.1007/s11606-019-05179-0..
Keywords: Patient Experience, Vulnerable Populations, Cultural Competence, Racial and Ethnic Minorities, Primary Care, Ambulatory Care and Surgery
Choe AY, Unaka NI, Schondelmeyer AC
Inpatient communication barriers and drivers when caring for limited english proficiency children.
The authors identified barriers to and drivers of effective interpreter service use when caring for hospitalized limited English proficiency (LEP) children from the perspectives of pediatric medical providers and interpreters. Using Group Level Assessment, they found that participants identified unique barriers and drivers that impact communication with LEP patients and their families during hospitalization. They suggested that future directions include exploring the perspective of LEP families and utilizing team-based and family-centered communication strategies to standardize and improve communication practices.
AHRQ-funded; HS025138.
Citation: Choe AY, Unaka NI, Schondelmeyer AC .
Inpatient communication barriers and drivers when caring for limited english proficiency children.
J Hosp Med 2019 Oct;14(10):607-13. doi: 10.12788/jhm.3240..
Keywords: Clinician-Patient Communication, Communication, Cultural Competence, Children/Adolescents, Inpatient Care, Patient and Family Engagement, Caregiving
Berdahl TA, Kirby JB
AHRQ Author: Berdahl TA, Kirby JB
Patient-provider communication disparities by limited English proficiency (LEP): trends from the US Medical Expenditure Panel Survey, 2006-2015.
The purpose of this study was to describe trends in patient-provider communication by limited English proficiency (LEP) from 2006 to 2015. The investigators concluded that although patient-provider communication among LEP individuals improved since 2010, linguistic disparities persist and constitute a formidable challenge to achieving healthcare equity, a long-standing US policy goal.
AHRQ-authored.
Citation: Berdahl TA, Kirby JB .
Patient-provider communication disparities by limited English proficiency (LEP): trends from the US Medical Expenditure Panel Survey, 2006-2015.
J Gen Intern Med 2019 Aug;34(8). doi: 10.1007/s11606-018-4757-3..
Keywords: Clinician-Patient Communication, Communication, Cultural Competence, Disparities, Medical Expenditure Panel Survey (MEPS)
Rodriguez JA, Davis RB, Percac-Lima S
Non-English language availability of community health center websites.
This study examined the availability of the Health Resources and Services Administration (HRSA)-supported community health center (CHC) websites that provide translated home page content. Out of 1400 CHC homepages, 34.3% provided translated information with half using Google Translate. Odds of the homepage being translated increased as the limited English-proficient (LEP) population by county increased, Internet subscription at the state level increased, or if the CHC was in a metropolitan area. Most of the homepages were translated into Spanish in counties with higher Spanish LEP populations, but this was not true for other non-Spanish language LEP populations.
AHRQ-funded; HS021495.
Citation: Rodriguez JA, Davis RB, Percac-Lima S .
Non-English language availability of community health center websites.
Med Care 2019 Jun;57 Suppl 6 Suppl 2:S121-s26. doi: 10.1097/mlr.0000000000001027..
Keywords: Communication, Cultural Competence, Education: Patient and Caregiver, Health Information Technology (HIT)
Chan B, Goldman LE, Sarkar U
High perceived social support and hospital readmissions in an older multi-ethnic, limited English proficiency, safety-net population.
This study examined the association between perceived social support and 30-day hospital readmission or death in older adults. The study used the cohort from the Support From Hospital to Home for Elders (SHHE) trial. Participants were English, Chinese and Spanish-speaking adults living in the community who were admitted to wards at an urban safety-net hospital in San Francisco. Overall readmission or death rate was 15%. Participants had a mean age of 66.2 with the majority being Asian (31.9%), then Black (24.8%), Latino (19.3%) and White (18.8%). Researchers found that those with high social support had half the odds of admission or death than those with low social support. The protection however seemed true only among minorities, and seemed to have the opposite effect among whites.
AHRQ-funded; HS022981.
Citation: Chan B, Goldman LE, Sarkar U .
High perceived social support and hospital readmissions in an older multi-ethnic, limited English proficiency, safety-net population.
BMC Health Serv Res 2019 May 24;19(1):334. doi: 10.1186/s12913-019-4162-6..
Keywords: Communication, Cultural Competence, Elderly, Hospital Readmissions, Racial and Ethnic Minorities
Khoong EC, Cherian R, Matta GY
Perspectives of English, Chinese, and Spanish-speaking safety-net patients on clinician computer use: qualitative analysis.
The goal of this study was to understand how safety-net patients, including those with limited English proficiency, view clinician electronic health record (EHR) use. Through focus groups in English, Spanish, and Cantonese, results showed that linguistically diverse patients accepted the value of EHR use during outpatient visits but desired more eye contact, verbal warnings before EHR use, and screen-sharing. Support for clinicians in completing EHR-related tasks during the visit using patient-centered strategies for all patients is recommended.
AHRQ-funded; HS022561; HS023558; HS022408.
Citation: Khoong EC, Cherian R, Matta GY .
Perspectives of English, Chinese, and Spanish-speaking safety-net patients on clinician computer use: qualitative analysis.
J Med Internet Res 2019 May 22;21(5):e13131. doi: 10.2196/13131..
Keywords: Cultural Competence, Racial and Ethnic Minorities, Patient Experience, Electronic Health Records (EHRs), Health Information Technology (HIT), Clinician-Patient Communication, Health Literacy, Communication
Milla C, Guo M, Chang A
Patient perspectives in comparing hospitals for childbirth: insights from Hawai'i.
Childbirth is a national priority area for healthcare quality improvement. Patient perspectives are increasingly valued in healthcare, yet Asian American and Pacific Islander (AAPI) perspectives of healthcare quality are often understudied, particularly from individuals with limited English proficiency (LEP). In this study, the goal was to understand factors that consumers in Hawai'i, including AAPI and those with LEP, used to compare patient care in hospitals, especially for childbirth.
AHRQ-funded; HS021903.
Citation: Milla C, Guo M, Chang A .
Patient perspectives in comparing hospitals for childbirth: insights from Hawai'i.
Hawaii J Med Public Health 2019 Mar;78(3):89-97..
Keywords: Labor and Delivery, Pregnancy, Hospitals, Quality Improvement, Quality of Care, Cultural Competence, Women
Johnston FM, Neiman JH, Parmley LE
Stakeholder perspectives on the use of community health workers to improve palliative care use by African Americans with cancer.
This study focused on the issue of lack of palliative care for African-Americans with cancer. Stakeholder interviews and focus groups were conducted with cancer patients, caregivers, health care administrators, oncologists, and community health workers (CHWs). Participants felt that CHWs could play a central role in bridging patients with their providers, information and resources. They also felt that CHWs should either come from the community, or be familiar with the history, culture, and norms of the communities from which they operate.
AHRQ-funded; HS024736.
Citation: Johnston FM, Neiman JH, Parmley LE .
Stakeholder perspectives on the use of community health workers to improve palliative care use by African Americans with cancer.
J Palliat Med 2019 Mar;22(3):302-06. doi: 10.1089/jpm.2018.0366..
Keywords: Access to Care, Cancer, Healthcare Delivery, Healthcare Utilization, Cultural Competence, Disparities, Palliative Care, Racial and Ethnic Minorities
Lion KC, Kieran K, Desai A
Audio-recorded discharge instructions for limited English proficient parents: a pilot study.
Parents with limited English proficiency (LEP) demonstrate lower comprehension of discharge instructions. This study was conducted to (1) determine the feasibility of providing a greeting card with language-specific, audio-recorded discharge instructions to LEP parents; (2) describe use of and satisfaction with the cards; and (3) evaluate card effect on instruction comfort with home care and comprehension. The authors concluded that providing language-concordant, audio-recorded discharge instructions was feasible, and parents reported high satisfaction with and frequent use of the cards with multiple caregivers.
AHRQ-funded; HS024299.
Citation: Lion KC, Kieran K, Desai A .
Audio-recorded discharge instructions for limited English proficient parents: a pilot study.
Jt Comm J Qual Patient Saf 2019 Feb;45(2):98-107. doi: 10.1016/j.jcjq.2018.06.001..
Keywords: Hospital Discharge, Cultural Competence, Clinician-Patient Communication, Communication, Education: Patient and Caregiver
Schnierle J, Christian-Brathwaite N, Louisias M
Implicit bias: what every pediatrician should know about the effect of bias on health and future directions.
This article discusses the role in implicit bias and its effect on health outcomes. The most highly regarded tool to measure implicit bias is the Implicit Association Test (IAT). While there is limited evidence showing an association between implicit bias and health outcomes, existing publications do show clear associations. The authors discuss the need for future research that relies on pre- and post-IAT measurements to examine the effect of bias training among healthcare providers.
AHRQ-funded; HS022986.
Citation: Schnierle J, Christian-Brathwaite N, Louisias M .
Implicit bias: what every pediatrician should know about the effect of bias on health and future directions.
Curr Probl Pediatr Adolesc Health Care 2019 Feb;49(2):34-44. doi: 10.1016/j.cppeds.2019.01.003..
Keywords: Children/Adolescents, Provider: Physician, Racial and Ethnic Minorities, Cultural Competence
Chopra V, Harrod M, Winter S
Focused ethnography of diagnosis in academic medical centers.
J Hosp Med 2018 Oct;13(10):668-72. doi: 10.12788/jhm.2966.
This ethnographic study focused on the progress of teaching diagnosis to trainees in academic teaching hospitals. Trainees at 2 academic medical centers were observed to understand the barriers and facilitators to diagnosis. A total of 4 teaching teams between January and May 2016 were observed. Four key themes were identified and can be used to inform future interventions.
This ethnographic study focused on the progress of teaching diagnosis to trainees in academic teaching hospitals. Trainees at 2 academic medical centers were observed to understand the barriers and facilitators to diagnosis. A total of 4 teaching teams between January and May 2016 were observed. Four key themes were identified and can be used to inform future interventions.
AHRQ-funded; HS024385; HS022835.
Citation: Chopra V, Harrod M, Winter S .
Focused ethnography of diagnosis in academic medical centers.
J Hosp Med 2018 Oct;13(10):668-72. doi: 10.12788/jhm.2966..
Keywords: Education: Continuing Medical Education, Education: Academic, Diagnostic Safety and Quality, Cultural Competence
Rosas LG, Lv N, Lewis MA
A Latino patient-centered, evidence-based approach to diabetes prevention.
Cultural tailoring of evidence-based diabetes prevention program (DPP) interventions is needed to effectively address obesity and its related chronic diseases among Latinos in primary care. This article described the patient-centered process used to adapt the DPP and reported cultural adaptations. The investigators concluded that the 2-stage approach actively engaging patients, family members, providers, and health care system leaders reinforced the cultural congruence of the existing intervention while further strengthening it with adaptations promoting Latino family and community support.
AHRQ-funded; HS022702.
Citation: Rosas LG, Lv N, Lewis MA .
A Latino patient-centered, evidence-based approach to diabetes prevention.
J Am Board Fam Med 2018 May-Jun;31(3):364-74. doi: 10.3122/jabfm.2018.03.170280..
Keywords: Cultural Competence, Diabetes, Evidence-Based Practice, Patient and Family Engagement, Patient-Centered Healthcare, Racial and Ethnic Minorities
Purnell TS, Marshall JK, Olorundare I
Provider perceptions of the organization's cultural competence climate and their skills and behaviors targeting patient-centered care for socially at-risk populations.
As part of a cultural competence needs assessment study at a large academic health care system, the study authors conducted a survey among 1,220 practicing physicians to assess their perceptions of the organization's cultural competence climate and their skills and behaviors targeting patient-centered care for culturally and socially diverse patients.
AHRQ-funded; HS024600.
Citation: Purnell TS, Marshall JK, Olorundare I .
Provider perceptions of the organization's cultural competence climate and their skills and behaviors targeting patient-centered care for socially at-risk populations.
J Health Care Poor Underserved 2018;29(1):481-96. doi: 10.1353/hpu.2018.0032..
Keywords: Cultural Competence, Patient-Centered Healthcare, Provider, Vulnerable Populations
Leung LB, Vargas-Bustamante A, Martinez AE
Disparities in diabetes care quality by English language preference in community health centers.
Researchers conducted a parallel analysis of disparities in diabetes care quality among Latino and Asian community health center (CHC) patients by English language preference. After adjusting for socioeconomic and health characteristics, disparities in patient experiences by English language preference were found only among Asian patients. There were no significant differences in glycemic control by language for either Latino or Asian patients.
AHRQ-funded; HS020120.
Citation: Leung LB, Vargas-Bustamante A, Martinez AE .
Disparities in diabetes care quality by English language preference in community health centers.
Health Serv Res 2018 Feb;53(1):509-31. doi: 10.1111/1475-6773.12590.
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Keywords: Community-Based Practice, Cultural Competence, Diabetes, Disparities, Racial and Ethnic Minorities
Ragavan MI, Fikre T, Millner U
The impact of domestic violence exposure on South Asian children in the United States: perspectives of domestic violence agency staff.
The goal of this study was to examine the needs of South Asian children subjected to domestic violence, from the perspective of staff in domestic violence agencies across the U.S. in order to determine if the children required culture-specific resources. Thirty interviews were conducted; participants described factors important to understanding the impact of domestic violence on South Asian children and discussed the development of culturally tailored resources. The findings suggests that framing South Asian children's experiences within the context of interweaving South Asian and American cultural values, with attention focused on how potential culture clashes may impact the way children that process trauma, is important. The authors recommend that further work triangulate these themes between children, parents, and extended family and in collaboration with domestic violence agencies.
AHRQ-funded; HS022242.
Citation: Ragavan MI, Fikre T, Millner U .
The impact of domestic violence exposure on South Asian children in the United States: perspectives of domestic violence agency staff.
Child Abuse Negl 2018 Feb;76:250-60. doi: 10.1016/j.chiabu.2017.11.006..
Keywords: Access to Care, Children/Adolescents, Cultural Competence, Domestic Violence, Family Health and History, Racial and Ethnic Minorities, Vulnerable Populations
Davis CM, Guo M, Miyamura J
Key factors in obstetric delivery decision-making among Asian and Pacific Islander women by English proficiency.
Understanding (1) how expectant mothers gather information to decide where to give birth, and (2) who helps make that decision, provides critical health communication and decision-making insights. This survey found that the top three health decision-makers for both those Asian American and Pacific Islanders (AAPIs) with limited English proficiency and English-proficient AAPIs were themselves, their obstetrician, and their spouse, which did not differ significantly by language proficiency.
AHRQ-funded; HS021903.
Citation: Davis CM, Guo M, Miyamura J .
Key factors in obstetric delivery decision-making among Asian and Pacific Islander women by English proficiency.
Hawaii J Med Public Health 2017 Oct;76(10):279-86.
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Keywords: Healthcare Delivery, Cultural Competence, Decision Making, Pregnancy, Racial and Ethnic Minorities
Yasui M, Pottick KJ, Chen Y
Conceptualizing culturally infused engagement and its measurement for ethnic minority and immigrant children and families.
The authors systematically reviewed 119 existing instruments that measure the multi-dimensional and developmental process of engagement for ethnic minority and immigrant children and families. Its findings highlight the variety of tools that are used to measure behavioral and attitudinal dimensions of engagement, showing the limitations of their application for ethnic minority and immigrant children and families.
AHRQ-funded; HS023007.
Citation: Yasui M, Pottick KJ, Chen Y .
Conceptualizing culturally infused engagement and its measurement for ethnic minority and immigrant children and families.
Clin Child Fam Psychol Rev 2017 Sep;20(3):250-332. doi: 10.1007/s10567-017-0229-2.
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Keywords: Children/Adolescents, Cultural Competence, Behavioral Health, Patient and Family Engagement, Patient-Centered Healthcare
Squires A
Evidence-based approaches to breaking down language barriers.
This article provides background information about language barriers between nurses and patients and some strategies for addressing these gaps. After detailing how these barriers affect patient outcomes, practice-based strategies are offered to improve outcomes and reduce readmissions. Although the article doesn’t address barriers to communicating with patients with hearing loss, many of the same principles apply to these patients.
AHRQ-funded; HS023593.
Citation: Squires A .
Evidence-based approaches to breaking down language barriers.
Nursing 2017 Sep;47(9):34-40. doi: 10.1097/01.NURSE.0000522002.60278.ca.
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Keywords: Communication, Cultural Competence, Evidence-Based Practice, Nursing, Clinician-Patient Communication
Squires A, Peng TR, Barrón-Vaya Y
An exploratory analysis of patient-provider language-concordant home health care visit patterns.
In a 2-year period, this study showed that among the 238,513 visits with 18,132 limited English proficiency patients, only 20 percent of visits were language concordant. The study suggests that home health care services may not be meeting the demand for language services, but more research is needed to determine the right “dose” of bilingual home care visits to optimize home care outcomes and establish a standard for care.
AHRQ-funded; HS023593.
Citation: Squires A, Peng TR, Barrón-Vaya Y .
An exploratory analysis of patient-provider language-concordant home health care visit patterns.
Home Health Care Management & Practice 2017 Aug 1;29(3):161-67. doi: 10.1177/1084822317696706.
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Keywords: Cultural Competence, Home Healthcare, Clinician-Patient Communication, Racial and Ethnic Minorities, Urban Health
Carlson AE, Aronson BD, Unzen M
Apathy and type 2 diabetes among American Indians: exploring the protective effects of traditional cultural involvement.
In this study researchers examined relationships between traditional cultural factors, apathy, and health-related outcomes among a sample of American Indian adults with type 2 diabetes. Their model revealed significant direct effects from cultural participation to apathy, and apathy to both health-related outcomes. Cultural participation had a negative indirect effect through apathy on high blood sugar and positive indirect effects on health-related quality of life.
AHRQ-funded; HS024180.
Citation: Carlson AE, Aronson BD, Unzen M .
Apathy and type 2 diabetes among American Indians: exploring the protective effects of traditional cultural involvement.
J Health Care Poor Underserved 2017;28(2):770-83. doi: 10.1353/hpu.2017.0073.
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Keywords: Cultural Competence, Diabetes, Racial and Ethnic Minorities, Patient-Centered Outcomes Research, Racial and Ethnic Minorities