Tools to Improve Discharge Equity (TIDE) at Hospital Discharge for Patients With Limited English Proficiency: A Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 104
- 试验地点
- 2
- 主要终点
- Patient understanding of primary diagnosis of hospitalization
研究概览
简要总结
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:
- test the effectiveness of a linguistically appropriate toolkit for improving patient understanding of discharge instruction content
- Assess the feasibility and fidelity of the intervention in anticipation of a multi-site implementation trial
- assess the feasibility and appropriateness of the linguistically appropriate toolkit to nurses and in-person interpreters
- to assess the acceptability of the intervention to patients and their satisfaction with it
- to collect data on implementation context in anticipation for a multi-site trial
- to collect preliminary data on the toolkit's impact on clinical outcomes including medication adherence and hospital re-utilization.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •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
排除标准
- •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
- •Family/Visitors
结局指标
主要结局
Patient understanding of primary diagnosis of hospitalization
时间窗: 1-2 weeks post discharge
Determined by two physician adjudicators (1=poor, 4 = near perfect). Higher scores demonstrate better understanding.
Patient understanding of discharge instructions
时间窗: 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.
次要结局
- Implementation effectiveness(18 months)
- Hospital re-utilization(30 days)
- Number of participants with completion of primary care follow-up(30 days)
- Participant participation in discharge teaching(1-2 weeks)