Breaking through barriers: the need for effective research to promote language‐concordant communication as a facilitator of equitable emergency care

Gutman, Colleen K.; Lion, K. Casey; Fisher, Carla L.; Aronson, Paul L.; Patterson, Mary; Fernandez, Rosemarie

doi:10.1002/emp2.12639

Cited by 7 publications

(15 citation statements)

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“…Education level, % (95% CI) High school or less 18 (16,21) 15 (13,17) 16 (14,18) 16 (14,17) 15 (13,17) 15 (13,17) 16 (14,18) 16 (14,18) 14 (12,16) −1.4 (−3. 2-year degree 16 (14,18) 19 (17,21) 20 (19,22) 20 (18,22) 21 (18,23) 20 (18,22) 22 (20,24) 20 (18,22) 21 (19,23) 2.1 (0.2, 4.0)…”

Section: Limitationsmentioning

confidence: 99%

“…4-year degree 14 (12,16) 14 (13,16) 14 (12,16) 16 (14,19) 16 (14,18) 18 (16,20) 15 (13,17) 17 (15,18) 18 (16,20) 3.1 (1.1, 5. 15 but it is similar to estimates from the US Bureau of Labor Statistics (approximately 261,000 EMS personnel).…”

Section: Limitationsmentioning

confidence: 99%

“… 18 Language discordance between EMS personnel and patients is also frequently cited as a barrier to providing high‐quality prehospital care. 19 , 20 Existing studies on the demographic diversity of the EMS workforce are dated, incomplete, or focus on newly certified personnel. 12 , 14 , 15…”

Section: Introductionmentioning

confidence: 99%

“…Prior research has suggested that there is an association between a diverse workplace and improved organizational resilience, 17 as well as superior patient outcomes associated with more diverse teams of health care clinicians 18 . Language discordance between EMS personnel and patients is also frequently cited as a barrier to providing high‐quality prehospital care 19,20 . Existing studies on the demographic diversity of the EMS workforce are dated, incomplete, or focus on newly certified personnel 12,14,15 …”

Section: Introductionmentioning

confidence: 99%

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Trends in demographic and employment characteristics of US emergency medical technicians and paramedics, 2011–2019

et al. 2022

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Background Describing the US emergency medical services workforce is important to understand gaps in recruitment and retention and inform efforts to improve diversity. Our objective was to describe the characteristics and temporal trends of emergency medical technicians (EMTs) and paramedics in the United States. Methods We performed a repeated cross‐sectional evaluation of US Census Bureau's American Community Survey 1‐year Public Use Microdata Sample data sets from 2011–2019. We included respondents working as an EMT or paramedic. Survey‐weighted descriptive statistics of demographic and employment characteristics were calculated. Trend analysis was conducted using joinpoint regression to estimate slope and annual percent change (APC). Results The total estimated number of EMTs and paramedics in the United States increased from 216,310 (95%CI 204,957–227,663) in 2011 to 289,830 (95%CI 276,918–302,743) in 2019 (APC 3.0%; 95%CI 1.4%, 4.7%). There was a slight increase in the proportion of females (2011, 31%; 2019, 35%). There was a significant decrease in proportion of non‐Hispanic whites (2011, 80%; 2019, 72%; APC −1.5%; 95%CI −2.0%, −0.9%) with concurrent increases in other racial/ethnic groups (e.g., Hispanics, 2011, 10%; 2019, 13%). About half worked >40 hours per week, with little change over time. Between 15% and 18% lived and worked in different states, and about 40% traveled ≥30 minutes to their workplace. Conclusions The number of EMTs and paramedics actively working in EMS as their primary paid occupation has increased over time. However, there have been only modest changes in their demographic diversity.

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Section: Limitationsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Trends in demographic and employment characteristics of US emergency medical technicians and paramedics, 2011–2019

et al. 2022

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“…Race and ethnicity will be collected using US Census Bureau categories 37. Recommended best practices for race, ethnicity and language data collection are not routinely used, which is a barrier to efforts to identify and address health disparities 38–40. In order to address the limitations of race, ethnicity and language documentation, all participating sites will be asked to report institutional practices for collecting and documenting patient demographics.…”

Section: Methods and Analysismentioning

confidence: 99%

Disparities and implicit bias in the management of low-risk febrile infants: a mixed methods study protocol

et al. 2022

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IntroductionThe management of low-risk febrile infants presents a model population for exploring how implicit racial bias promotes inequitable emergency care for children who belong to racial, ethnic and language minority groups. Although widely used clinical standards guide the clinical care of febrile infants, there remains substantial variability in management strategies. Deviations from recommended care may be informed by the physician’s assessment of the family’s values, risk tolerance and access to supportive resources. However, in the fast-paced emergency setting, such assessments may be influenced by implicit racial bias. Despite significant research to inform the clinical care of febrile infants, there is a dearth of knowledge regarding health disparities and clinical guideline implementation. The proposed mixed methods approach will (1) quantify the extent of disparities by race, ethnicity and language proficiency and (2) explore the role of implicit bias in physician–patient communication when caring for this population.Methods and analysisWith 42 participating sites from the Pediatric Emergency Medicine Collaborative Research Committee, we will conduct a multicenter, cross-sectional study of low-risk febrile infants treated in the emergency department (ED) and apply multivariable logistic regression to assess the association between (1) race and ethnicity and (2) limited English proficiency with the primary outcome, discharge to home without lumbar puncture or antibiotics. We will concurrently perform an interpretive study using purposive sampling to conduct individual semistructured interviews with (1) minority parents of febrile infants and (2) paediatric ED physicians. We will triangulate or compare perspectives to better elucidate disparities and bias in communication and medical decision-making.Ethics and disseminationThis study has been approved by the University of Florida Institutional Review Board. All participating sites in the multicenter analysis will obtain local institutional review board approval. The results of this study will be presented at academic conferences and in peer-reviewed publications.

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Language Barriers in Care for Low-Risk Febrile Neonates

Portillo,

Ellison

2024

JAMA Pediatr

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The management of febrile neonates has evolved as clinical evidence and disease epidemiology have instructed updated guidelines and practice patterns. 1 While there has been extensive investigation of clinical determinants to identify neonates at low risk for invasive bacterial infection (IBI), 2 there has been little investigation into the impact of sociodemographic characteristics on management of this population. The study by Gutman et al 3 in JAMA Pediatrics examines the impact of race, ethnicity, and language for care on interventions performed for well-appearing febrile infants at low risk for IBI by clinical criteria in pediatric emergency departments (EDs). Among 4042 well-appearing, clinically low-risk febrile infants, 969 (24%) had at least 1 unnecessary intervention, such as lumbar puncture, antibiotic administration, and/or hospitalization. The investigators found that language for care was significantly associated with at least 1 nonindicated intervention in clinically low-risk neonates. Infants of families that use a language other than English (LOE) had higher odds of inter vention overall (adjusted odds ratio = 1.16 [95% CI, 1.01-1.33]) and of hospital admission (adjusted odds ratio = 1.25 [95% CI, 1.08-1.46]) when compared with the grand mean.Gutman and colleagues were thoughtful in their use of statistical methods, centering comparisons on the grand mean (the average of averages, in other words) rather than on the experience of non-Hispanic White and English-speaking patients and families. Their subanalyses also provided some clarity in the complex interplay between race, ethnicity, and language, as they found that Hispanic patients (the majority of whom used English) were less likely to be hospitalized, and patients who used LOE (the majority of whom were Hispanic and used Spanish) were more likely to be hospitalized. There was no overall association between race and ethnicity and the primary outcome.Based on their findings, Gutman and colleagues conclude that inequitable care provision may stem from actual and perceived communication barriers, but they also point out that there is a solution for overcoming these barriers: the use of professional medical interpretation. Patients who need interpreters but do not have access to them experience compromised quality of care. 4 Conversely, care quality, satisfaction, and outcomes are all i m p r o v e d w i t h i m p r o v e d a c c e s s t o p r o f e s s i o n a l interpretation. 4,5 Despite these benefits, studies show that professional interpretation is underused across pediatric EDs. [4][5][6] Single-site efforts have endeavored to improve professional interpreter use, 7 but challenges remain in overcom-

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Breaking through barriers: the need for effective research to promote language‐concordant communication as a facilitator of equitable emergency care

Cited by 7 publications

References 73 publications

Trends in demographic and employment characteristics of US emergency medical technicians and paramedics, 2011–2019

Trends in demographic and employment characteristics of US emergency medical technicians and paramedics, 2011–2019

Disparities and implicit bias in the management of low-risk febrile infants: a mixed methods study protocol

Language Barriers in Care for Low-Risk Febrile Neonates

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