Impact of Limited English Proficiency on Definitive Care in Pediatric Appendicitis

Stokes, Sarah C.; Jackson, Jordan E.; Beres, Alana L.

doi:10.1016/j.jss.2021.05.024

Cited by 13 publications

(5 citation statements)

References 23 publications

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“…Another unanticipated finding was that patient caregivers with English as a primary language had longer times to surgery compared to patients with caregivers primarily speaking languages other than English or Spanish. Several studies have reported results contrary to ours [ 20 - 23 ]. Steinberg et al found in their 48 interviews with Spanish-speaking mothers that the majority reported difficult experiences with healthcare staff resulting in barriers to care when accessing specialty care for their children [ 20 ].…”

Section: Discussioncontrasting

confidence: 99%

“…Doshi et al found in their interviews with 28 healthcare workers and social service providers that transportation, financial costs, and concerns about language services were some of the most concerning barriers for their patients [ 21 ]. In their investigation of pediatric patients with appendicitis and limited English proficiency, Stokes et al found that patients with limited English proficiency did not encounter delays, but were often discharged without a plan from their pediatrician's office or an emergency setting [ 23 ]. While our study finds that being a non-English or non-Spanish speaker was associated with decreased time intervals from the clinic to the operating room, it should be noted that the patients included in our analysis were those that were identified, referred, and underwent surgery.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Healthcare Disparities on Time to Surgery for Pediatric Urologic Patients

Schroeder¹,

Samson²,

Kerns³

et al. 2022

Cureus

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Introduction Healthcare disparities are differences in health outcomes reflecting social inequalities. We aim to identify healthcare disparities in pediatric urologic patients by analyzing the time from surgical scheduling to completion of procedure at a single center and identify variables associated with increased time to surgery. Materials and methods We reviewed all patients aged 0-18 years who underwent surgery with one of three pediatric urologists at our institution from January 1, 2018, to December 31, 2019. We collected or calculated variables including age, sex, race, ethnicity, caregivers’ primary language, insurance status, zip code, median distance to hospital, clinic visit date, and time to surgery (calculated as days between surgery request and date of surgery). Data analysis included bivariate analysis and linear regression with all variables of interest presented with 95% confidence intervals (CIs), where log-transformed time to surgery was the outcome. Because the practice at our institution is to delay elective surgeries until after six months of age, we excluded patients who were less than six months of age at the time of surgery request date. Results A total of 697 patients were included in the final analysis. Patients’ caregivers who spoke languages other than English or Spanish had a lower model-adjusted mean log-days to surgery (−0.44; 95% CI: −0.85, −0.03) relative to English-speaking caregivers. Uninsured patients had increased time to surgery compared to Medicaid patients (0.28; 95% CI: 0.03, 0.53). Income was also associated with increased time to surgery, meaning patients from higher-income backgrounds had a longer time to surgery (0.04; 95% CI: 0.00, 0.08). Conclusions In our patient population, primary language spoken and insurance status were associated with increases in time from initial evaluation to surgical intervention among pediatric patients undergoing urologic surgery. Additional research is needed to better understand variations in access to pediatric urologic surgery.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of Healthcare Disparities on Time to Surgery for Pediatric Urologic Patients

Schroeder¹,

Samson²,

Kerns³

et al. 2022

Cureus

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“…16 Similarly, pediatric patients with appendicitis were less likely to receive definitive management on initial visits to the Emergency Department if their families were of LEP. 17 The results in the present study build upon previous work in this area and provide new information about how these delays manifest within the field of otolaryngology.…”

Section: Discussionsupporting

confidence: 73%

“…Other studies have elucidated delays in care for LEP patients with conditions such as cervical cancer, where women with LEP were more likely to experience significant delays of ≥60 days 16 . Similarly, pediatric patients with appendicitis were less likely to receive definitive management on initial visits to the Emergency Department if their families were of LEP 17 . The results in the present study build upon previous work in this area and provide new information about how these delays manifest within the field of otolaryngology.…”

Section: Discussionsupporting

confidence: 66%

Longer Times to Delivery of Otolaryngology Care for Patients With Limited English Proficiency

Lopez

Gottlieb

Naples

2023

Otolaryngol.--head neck surg.

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ObjectiveLimited English proficiency (LEP) is known to contribute to poorer health outcomes and delays in management. However, to our knowledge, no other studies have explored the impact of LEP on delays to care within otolaryngology. This study aims to investigate the relationship between LEP and the time to delivery of otolaryngology care.MethodsWe retrospectively reviewed 1125 electronic referrals to an otolaryngologist from primary care providers at 2 health centers in the greater Boston area, between January 2015 and December 2019. Multivariable logistic regression analyses were conducted to determine if patient LEP status (preferred language non‐English and language interpreter use) has an impact on total time to appointment (TTTA).ResultsPatients with non‐English preferred languages were 2.6 times more likely to experience extended TTTA (odds ratio [OR] = 2.61, 95% confidence interval [CI] = 1.99‐3.42, p < .001) relative to English‐speaking patients. Patients who required interpreter use were 2.4 times more likely to experience extended TTTA (OR = 2.42, 95% CI = 1.84‐3.18, p < .001) relative to patients who did not require an interpreter. There was no difference in age, sex, insurance type, education level, or marital status. TTTA did not vary by diagnosis category (p = .09).DiscussionLEP is an important factor that influences the time to appointment in our cohort. Notably, the impact of LEP on appointment wait times was independent of diagnosis.Implications for PracticeClinicians should recognize LEP as a factor that can impact the overall delivery of care in otolaryngology. Specifically, mechanisms to streamline care for LEP patients should be considered.

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“… 2 , 3 , 4 In pediatric emergency care (PEC), children from communities that are marginalized based on race, ethnicity, or language (such as Black and Hispanic or Latino communities) experience myriad inequities in care, including longer wait times, 5 , 6 assignment of lower triage acuity, 7 , 8 , 9 inadequate pain treatment, 10 , 11 , 12 , 13 and fewer diagnostic imaging tests. 14 Patients with a language for care other than English are at greater risk for missed diagnoses, 15 , 16 delayed treatment for pain, 17 and unexpected return visits. 18 Determining the root causes of the many racial, ethnic, and language-based disparities in PEC is complex because of layered effects of long-standing structural racism 19 , 20 and individual factors, including implicit and explicit bias.…”

Section: Introductionmentioning

confidence: 99%

Research Priorities for Pediatric Emergency Care to Address Disparities by Race, Ethnicity, and Language

Portillo,

Rees,

Hartford

et al. 2023

JAMA Netw Open

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ImportanceHealth care disparities are well-documented among children based on race, ethnicity, and language for care. An agenda that outlines research priorities for disparities in pediatric emergency care (PEC) is lacking.ObjectiveTo investigate research priorities for disparities in PEC among medical personnel, researchers, and health care–affiliated community organizations.Design, Setting, and ParticipantsIn this survey study, a modified Delphi approach was used to investigate research priorities for disparities in PEC. An initial list of research priorities was developed by a group of experienced PEC investigators in 2021. Partners iteratively assessed the list through 2 rounds of electronic surveys using Likert-type responses in late 2021 and early 2022. Priorities were defined as achieving consensus if they received a score of highest priority or priority by at least 60% of respondents. Asynchronous engagement of participants via online web-conferencing platforms and email correspondence with electronic survey administration was used. Partners were individuals and groups involved in PEC. Participants represented interest groups, research and medical personnel organizations, health care partners, and laypersons with roles in community and family hospital advisory councils. Participants were largely from the US, with input from international PEC research networks.OutcomeConsensus agenda of research priorities to identify and address health care disparities in PEC.ResultsPEC investigators generated an initial list of 27 potential priorities. Surveys were completed by 38 of 47 partners (80.6%) and 30 of 38 partners (81.1%) in rounds 1 and 2, respectively. Among 30 respondents who completed both rounds, there were 7 family or community partners and 23 medical or research partners, including 4 international PEC research networks. A total of 12 research priorities achieved the predetermined consensus threshold: (1) systematic efforts to reduce disparities; (2) race, ethnicity, and language data collection and reporting; (3) recognizing and mitigating clinician implicit bias; (4) mental health disparities; (5) social determinants of health; (6) language and literacy; (7) acute pain–management disparities; (8) quality of care equity metrics; (9) shared decision-making; (10) patient experience; (11) triage and acuity score assignment; and (12) inclusive research participation.Conclusions and RelevanceThese results suggest a research priority agenda that may be used as a guide for investigators, research networks, organizations, and funding agencies to engage in and support high-priority disparities research topics in PEC.

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Impact of Limited English Proficiency on Definitive Care in Pediatric Appendicitis

Cited by 13 publications

References 23 publications

Impact of Healthcare Disparities on Time to Surgery for Pediatric Urologic Patients

Impact of Healthcare Disparities on Time to Surgery for Pediatric Urologic Patients

Longer Times to Delivery of Otolaryngology Care for Patients With Limited English Proficiency

Research Priorities for Pediatric Emergency Care to Address Disparities by Race, Ethnicity, and Language

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