Pediatric Intensive Care Unit Mortality Among Latino Children Before and After a Multilevel Health Care Delivery Intervention

Anand, K.J.S.; Sepanski, Robert; Giles, Kimberley; Shah, Samir; Juárez, Paul D.

doi:10.1001/jamapediatrics.2014.3789

Cited by 45 publications

(31 citation statements)

References 53 publications

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“…Such barriers could cause delays in antibiotic administration. Of note, delays in seeking emergency care and barriers to high‐quality health care, including intensive care, have been demonstrated in this population . A prospective study documenting the average time between the onset of fever and antibiotic administration may help to explore the concept of “delay of care” as a potential reason for an increased risk of infection‐related death in Hispanics.…”

Section: Discussionmentioning

confidence: 99%

“…A prospective study documenting the average time between the onset of fever and antibiotic administration may help to explore the concept of “delay of care” as a potential reason for an increased risk of infection‐related death in Hispanics. Of note, one study has documented a decrease in PICU mortality among Latino children using a multilevel healthcare delivery intervention . Similar interventions may prove beneficial for Hispanic pediatric oncology patients as well.…”

Section: Discussionmentioning

confidence: 99%

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Infection‐related mortality in Hispanic and non‐Hispanic children with cancer

Smits-Seemann

Pettit

et al. 2017

Pediatric Blood & Cancer

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Infection‐related mortality in Hispanic and non‐Hispanic children with cancer

Smits-Seemann

Pettit

et al. 2017

Pediatric Blood & Cancer

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“…Profound improvements in health care processes and outcomes can be attained when language-related barriers are addressed, such as a reduction in pediatric intensive care mortality following a linguistically and culturally appropriate bundle of interventions. 34 Prior initiatives have also expanded the use of telephonic interpretation to increase access. 22 Additionally, care coordination, which is paramount to minimize the impact of missing work and optimize clinic attendance, was increased in the center studied through care managers.…”

Section: Discussionmentioning

confidence: 99%

Spanish-Speaking Parents’ Experiences Accessing Academic Medical Center Care: Barriers, Facilitators and Technology Use

Flower

Wurzelmann

Tucker

et al. 2021

Academic Pediatrics

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Background and Objective Children of Spanish-speaking caregivers face multiple barriers to care in academic medical centers. This study identified barriers and facilitators of health care, and described use of health information technology in order to guide interventions and optimize services. Methods In-depth, audiotaped interviews were conducted with monolingual Spanish-speaking caregivers (N=28) of children receiving care in academic medical center clinics using a structured interview guide. Interviews were transcribed in Spanish, and key themes were identified using thematic analysis. Illustrative quotes for each theme were translated into English. Results Language-specific barriers included: arrival/registration occurring in English, lack of bilingual personnel, heavy reliance on interpreters, long wait times, and challenging phone communication. Non-language-specific barriers included: medical center size and complexity, distance to services, lack of convenient and coordinated appointments, missing work/school, and financial barriers including insurance coverage or lack of citizenship. Caregivers identified interpreters, bilingual physicians and staff, and written materials in Spanish as facilitators of care. Most caregivers had internet access and expressed interest in health information technology, including patient portals, to communicate about their children's health. Conclusions Caregivers of Spanish-speaking children encounter many language-specific barriers, which are compounded by non-language-specific barriers arising from complex health systems and social needs. Caregivers with limited resources described working hard to meet children's complex health care needs despite these barriers. Most caregivers had internet access and interest in patient portals. Academic medical centers may need multifaceted interventions that improve the availability of bilingual staff and interpreters and also address caregivers' social and informational needs.

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“…In one recent study, the implementation of multilevel interventions aimed at increasing cultural competence and language support appeared to preferentially decrease mortality rates for Latino patients admitted to the PICU. 27 Given that LEP families often may not speak up for themselves, it is important for PICU providers to have heightened awareness of potential cultural differences to ultimately improve a family’s understanding of the information delivered.…”

Section: Discussionmentioning

confidence: 99%

Communication With Limited English-Proficient Families in the PICU

Zurca¹,

Fisher²,

Flor

et al. 2017

Hospital Pediatrics

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OBJECTIVE Health care disparities have been described for children of limited English-proficient (LEP) families compared with children of English-proficient (EP) families. Poor communication with the medical team may contribute to these worse health outcomes. Previous studies exploring communication in the PICU have excluded LEP families. We aimed to understand communication experiences and preferences in the 3 primary communication settings in the PICU. We also explored LEP families’ views on interpreter use in the PICU. PATIENTS AND METHODS EP and Spanish-speaking LEP families of children admitted to the PICU of a large tertiary pediatric hospital completed surveys between 24 hours and 7 days of admission. RESULTS A total of 161 of 184 families were surveyed (88% response rate); 52 were LEP and 109 EP. LEP families were less likely to understand the material discussed on rounds (odds ratio [OR] 0.32, 95% confidence interval [CI] 0.11–0.90), to report that PICU nurses spent enough time speaking with them (OR 0.15, 95% CI 0.05–0.41), and to report they could rely on their nurses for medical updates (OR 0.07, 95% CI 0.02–0.25) controlling for covariates, such as education, insurance type, presence of a chronic condition, PICU length of stay, and mortality index. LEP families reported 53% of physicians and 41% of nurses used an interpreter “often.” CONCLUSIONS Physician and nurse communication with LEP families is suboptimal. Communication with LEP families may be improved with regular use of interpreters and an increased awareness of the added barrier of language proficiency.

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Pediatric Intensive Care Unit Mortality Among Latino Children Before and After a Multilevel Health Care Delivery Intervention

Cited by 45 publications

References 53 publications

Infection‐related mortality in Hispanic and non‐Hispanic children with cancer

Infection‐related mortality in Hispanic and non‐Hispanic children with cancer

Spanish-Speaking Parents’ Experiences Accessing Academic Medical Center Care: Barriers, Facilitators and Technology Use

Communication With Limited English-Proficient Families in the PICU

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