While the digital divide remains a barrier, newer studies show that high motivation for CHI use exists. However, simply gaining access to technology is not sufficient to improve adoption unless CHI technology is tailored to address user needs. Future interventions should consider building larger empirical evidence on identifying CHI barriers and facilitators.
Introduction: Almost 40% of the 63 million Americans who speak a language other than English have limited English proficiency (LEP). This communication barrier can result in poor quality care and potentially adverse health outcomes. Of particular interest is that the greatest proportion of LEP adults are aged >65 years and will face barriers and delays in accessing high-quality care. Age cohort variation of LEP burden has not been widely addressed. Culturally and linguistically appropriate hospital care delivery can mitigate these barriers.Methods: In order to test whether culturally competent services reduced length-of-stay (LOS), we linked organizational cultural competence surveys across two-states (CA+FL) for comparison across Medicare acute care LOS. Using the 2013 American Hospital Association Database, and Hospital Compare Data from CMS (N=184), we compared hospital structure with culturally and linguistically appropriate services related to improved care delivery for LEP populations and aging LEP populations. We utilized Kruskal-Wallis to test group differences and a negative binomial regression to model median LOS. All analyses were conducted using SAS 9.4 (Cary, NC).Results: Median LOS across all hospitals was 4.7 days (mean 5.7, standard deviation 6.3). Most hospitals were not-for-profit (46.7%), small (<150 beds, 54.4%), Joint Commission accredited (67.9%), and in urban areas. We found shorter median LOS when hospital units identified cultural or language needs at admission (Wald χ2 3.82, P=.0506). Hospitals’ identification of these needs at discharge had no impact on LOS. Hospitals that accommodated patient cultural or ethnic dietary needs also reported lower median LOS (Wald χ2 12.93, P=.0003). Structurally, public hospitals, accredited hospitals, and hospitals that reported system membership were predictive of a lower median LOS.Discussion: Our findings demonstrate that patient outcomes are responsive to culturally and linguistically appropriate services. Further, our findings suggest understanding of culturally competent care in hospitals is lacking. A larger and multi-level sample across the United States could yield a greater understanding of the role of culturally and linguistically appropriate care for a rapidly growing population of diverse older adults. Ethn Dis. 2020;30(4):603-610; doi:10.18865/ed.30.4.603
Alzheimer’s disease and related dementias(ADRD) affects 10.3% of older Americans (65+), among these 15-30% go on to be diagnosed with cancer. The highest burden of ADRD is experienced by Latino/a (12.2%) and African-American (13.8%) older adults. Older patients with pre-existing ADRD are less likely to receive guideline-concordant cancer care due to lack of consideration of cognitive status, and underestimation of ADRD diagnosis is an issue in secondary data. Our study compares two validated algorithms for classifying ADRD in a sample of cancer patients, the NCI-Charlson and CMS-Chronic Conditions Warehouse (CCW) index. We used existing claims from NCI’s SEER-Medicare linked database (2004-2013, N=37,932). Patients were selected based on cancer diagnosis at any stage with at least 36 months of data prior to diagnosis to identify ADRD. We analyzed breast, lung, prostate, cervix, head & neck(HNC), and colorectal(CRC) cancers(CA). We found a prevalence of 2.8% (9549 cases of ADRD+CA) using the NCI-index compared with a prevalence of 5.6% (18989 cases) with the CCW-index. ADRD+CA numbers differed significantly in all cancers for all races, however, we observed the greatest magnitude of difference among Latino/a and African-American patients. The NCI index significantly underestimated prevalence compared with the CCW: 1.21% vs 3.28% Breast; 2.29% vs 4.60% CRC; 2.88% vs 6.44% Lung; 1.36% vs 8.62% Prostate, and 4.21% vs 11.61% HNC. Our findings suggest a need to develop validated algorithms for classification, using an evidence-base generated by incorporating information and decision-making theories from the expertise of clinicians currently diagnosing ADRD using clinical assessments in diverse populations.
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