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Association of Patient and Family Reports of Hospital Safety Climate With Language Proficiency in the US.

Publication ,  Journal Article
Khan, A; Parente, V; Baird, JD; Patel, SJ; Cray, S; Graham, DA; Halley, M; Johnson, T; Knoebel, E; Lewis, KD; Liss, I; Romano, EM; Trivedi, S ...
Published in: JAMA Pediatr
August 1, 2022

IMPORTANCE: Patients with language barriers have a higher risk of experiencing hospital safety events. This study hypothesized that language barriers would be associated with poorer perceptions of hospital safety climate relating to communication openness. OBJECTIVE: To examine disparities in reported hospital safety climate by language proficiency in a cohort of hospitalized children and their families. DESIGN, SETTING, AND PARTICIPANTS: This cohort study conducted from April 29, 2019, through March 1, 2020, included pediatric patients and parents or caregivers of hospitalized children at general and subspecialty units at 21 US hospitals. Randomly selected Arabic-, Chinese-, English-, and Spanish-speaking hospitalized patients and families were approached before hospital discharge and were included in the analysis if they provided both language proficiency and health literacy data. Participants self-rated language proficiency via surveys. Limited English proficiency was defined as an answer of anything other than "very well" to the question "how well do you speak English?" MAIN OUTCOMES AND MEASURES: Primary outcomes were top-box (top most; eg, strongly agree) 5-point Likert scale ratings for 3 Children's Hospital Safety Climate Questionnaire communication openness items: (1) freely speaking up if you see something that may negatively affect care (top-box response: strongly agree), (2) questioning decisions or actions of health care providers (top-box response: strongly agree), and (3) being afraid to ask questions when something does not seem right (top-box response: strongly disagree [reverse-coded item]). Covariates included health literacy and sociodemographic characteristics. Logistic regression was used with generalized estimating equations to control for clustering by site to model associations between openness items and language proficiency, adjusting for health literacy and sociodemographic characteristics. RESULTS: Of 813 patients, parents, and caregivers who were approached to participate in the study, 608 completed surveys (74.8% response rate). A total of 87.7% (533 of 608) of participants (434 [82.0%] female individuals) completed language proficiency and health literacy items and were included in the analyses; of these, 14.1% (75) had limited English proficiency. Participants with limited English proficiency had lower odds of freely speaking up if they see something that may negatively affect care (adjusted odds ratio [aOR], 0.26; 95% CI, 0.15-0.43), questioning decisions or actions of health care providers (aOR, 0.19; 95% CI, 0.09-0.41), and being unafraid to ask questions when something does not seem right (aOR, 0.44; 95% CI, 0.27-0.71). Individuals with limited health literacy (aOR, 0.66; 95% CI, 0.48-0.91) and a lower level of educational attainment (aOR, 0.59; 95% CI, 0.36-0.95) were also less likely to question decisions or actions. CONCLUSIONS AND RELEVANCE: This cohort study found that limited English proficiency was associated with lower odds of speaking up, questioning decisions or actions of providers, and being unafraid to ask questions when something does not seem right. This disparity may contribute to higher hospital safety risk for patients with limited English proficiency. Dedicated efforts to improve communication with patients and families with limited English proficiency are necessary to improve hospital safety and reduce disparities.

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Published In

JAMA Pediatr

DOI

EISSN

2168-6211

Publication Date

August 1, 2022

Volume

176

Issue

8

Start / End Page

776 / 786

Location

United States

Related Subject Headings

  • Pediatrics
  • Organizational Culture
  • Male
  • Language
  • Humans
  • Hospitals, Pediatric
  • Female
  • Communication Barriers
  • Cohort Studies
  • Child
 

Citation

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Khan, A., Parente, V., Baird, J. D., Patel, S. J., Cray, S., Graham, D. A., … West, D. C. (2022). Association of Patient and Family Reports of Hospital Safety Climate With Language Proficiency in the US. JAMA Pediatr, 176(8), 776–786. https://doi.org/10.1001/jamapediatrics.2022.1831
Khan, Alisa, Victoria Parente, Jennifer D. Baird, Shilpa J. Patel, Sharon Cray, Dionne A. Graham, Monique Halley, et al. “Association of Patient and Family Reports of Hospital Safety Climate With Language Proficiency in the US.JAMA Pediatr 176, no. 8 (August 1, 2022): 776–86. https://doi.org/10.1001/jamapediatrics.2022.1831.
Khan A, Parente V, Baird JD, Patel SJ, Cray S, Graham DA, et al. Association of Patient and Family Reports of Hospital Safety Climate With Language Proficiency in the US. JAMA Pediatr. 2022 Aug 1;176(8):776–86.
Khan, Alisa, et al. “Association of Patient and Family Reports of Hospital Safety Climate With Language Proficiency in the US.JAMA Pediatr, vol. 176, no. 8, Aug. 2022, pp. 776–86. Pubmed, doi:10.1001/jamapediatrics.2022.1831.
Khan A, Parente V, Baird JD, Patel SJ, Cray S, Graham DA, Halley M, Johnson T, Knoebel E, Lewis KD, Liss I, Romano EM, Trivedi S, Spector ND, Landrigan CP, Patient and Family Centered I-PASS SCORE Scientific Oversight Committee, Bass EJ, Calaman S, Fegley AE, Knighton AJ, O’Toole JK, Sectish TC, Srivastava R, Starmer AJ, West DC. Association of Patient and Family Reports of Hospital Safety Climate With Language Proficiency in the US. JAMA Pediatr. 2022 Aug 1;176(8):776–786.

Published In

JAMA Pediatr

DOI

EISSN

2168-6211

Publication Date

August 1, 2022

Volume

176

Issue

8

Start / End Page

776 / 786

Location

United States

Related Subject Headings

  • Pediatrics
  • Organizational Culture
  • Male
  • Language
  • Humans
  • Hospitals, Pediatric
  • Female
  • Communication Barriers
  • Cohort Studies
  • Child