Utilization and perceptions of language assistance services by medical trainees: a pathway to language certification.

Background: Access to language assistance is a patient's right under federal law. Despite this, underuse of language services persists.

Objective: The aim of this study was to explore the interest in obtaining bilingual certification and to describe perspectives on language services by resident physicians.

COVID-19 Disruptions to Social Care Delivery: A Qualitative Study in Two Large, Safety-Net Primary Care Clinics.

Background: Social care integration refers to the incorporation of activities into health systems that assist patients with health-related social needs (HRSNs) that negatively impact the health outcomes of their patients, such as food insecurity or homelessness. Social care integration initiatives are becoming more common. The COVID-19 pandemic strained health systems while simultaneously increasing levels of unmet social needs.

2023 Inaugural Healthcare Delivery Science: Innovation and Partnerships for Health Equity Research (DESCIPHER) Symposium.

Introduction: This article provides an overview of presentations and discussions from the inaugural Healthcare Delivery Science: Innovation and Partnerships for Health Equity Research (DESCIPHER) Symposium.

Methods: The symposium brought together esteemed experts from various disciplines to explore models for translating evidence-based interventions into practice.

Results: The symposium highlighted the importance of disruptive innovation in healthcare, the need for multi-stakeholder engagement, and the significance of family and community involvement in healthcare interventions.

Implementation and Impacts of California Senate Bill 1152 on Homeless Discharge Protocols.

Introduction: In recent decades, there has been a growing focus on addressing social needs in healthcare settings. California has been at the forefront of making state-level investments to improve care for patients with complex social and medical needs, including patients experiencing homelessness (PEH). Examples include Medicaid 1115 waivers such as the Whole Person Care pilot program and California Advancing and Innovating Medi-Cal (CalAIM).

Patient perspectives on emergency department initiation of medication for alcohol use disorder.

Objective: Alcohol use disorder (AUD) is a leading cause of preventable death and is a frequent diagnosis in the emergency department (ED). Treatment in the ED, however, typically focuses on managing the sequelae of AUD, such as acute withdrawal, rather than addressing the underlying addiction. For many patients, these ED encounters are a missed opportunity to connect with medication for AUD.

Provider perspectives on emergency department initiation of medication assisted treatment for alcohol use disorder.

Background: Alcohol use disorder (AUD) is ubiquitous and its sequelae contribute to high levels of healthcare utilization, yet AUD remains undertreated. The ED encounter represents a missed opportunity to initiate medication assisted treatment (MAT) for patients with AUD. The aims of this study are to identify barriers and facilitators to the treatment of AUD in the ED, and to design interventions to address identified barriers.

A Mixed Methods Evaluation of Interventions to Meet the Requirements of California Senate Bill 1152 in the Emergency Departments of a Public Hospital System.

Unlabelled: Policy Points Clarifications to Senate Bill (SB) 1152 are necessary to address the differences between inpatient and emergency department (ED) discharge processes, determine how frequently an ED must deliver the SB 1152 bundle of services to a single patient, and establish expectations for compliance during off-hours when social services are unavailable. Because homelessness cannot be resolved in a single ED visit, the state should provide funding to support housing-focused case workers that will follow patients experiencing homelessness (PEH) through the transition from temporary shelters to permanent supportive housing. Medi-Cal could fund the delivery of the SB 1152 bundle of services to defray the costs to public hospitals that provide care for high numbers of PEH.

Paediatric emergency care at an academic referral hospital in Mozambique.

Background: Improved emergency care of children with acute illness or injuries is needed for countries in Africa to continue to reduce childhood mortality rates. Quality improvement efforts will depend on robust baseline data, but little has been published on the breadth and severity of paediatric illness seen in Mozambique.

Methods: This was a retrospective review of routinely collected provider shift summary data from the Paediatric Emergency Department (PED) at Hospital Central de Maputo (HCM), the principal academic and referral hospital in the country.

Provider and administrator-level perspectives on strategies to reduce fear and improve patient trust in the emergency department in times of heightened immigration enforcement.

Study Objectives: Heightened immigration enforcement may induce fear in undocumented patients when coming to the Emergency Department (ED) for care. Limited literature examining health system policies to reduce immigrant fear exists. In this multi-site qualitative study, we sought to assess provider and system-level policies on caring for undocumented patients in three California EDs.

Anti-immigrant Rhetoric and the Experiences of Latino Immigrants in the Emergency Department.

Introduction: Anti-immigrant rhetoric and increased enforcement of immigration laws have induced worry and safety concerns among undocumented Latino immigrants (UDLI) and legal Latino residents/citizens (LLRC), with some delaying the time to care. In this study, we conducted a qualitative analysis of statements made by emergency department (ED) patients - a majority of whom were UDLI and LLRC - participating in a study to better understand their experiences and fears with regard to anti-immigrant rhetoric, immigration enforcement, and ED utilization.

Methods: We conducted a multi-site study, surveying patients in three California safety-net EDs serving large immigrant populations from June 2017-December 2018.

A Pragmatic Assessment of Google Translate for Emergency Department Instructions.

Background: Because many hospitals have no mechanism for written translation, ED providers resort to the use of automated translation software, such as Google Translate (GT) for patient instructions. A recent study of discharge instructions in Spanish and Chinese suggested that accuracy rates of Google Translate (GT) were high.

Study Objective: To perform a pragmatic assessment of GT for the written translation of commonly used ED discharge instructions in seven commonly spoken languages.

An Implementation Science Approach Improves Language Access in the Emergency Department.

Background: The underuse of interpreters for limited English proficiency (LEP) patient encounters is pervasive, particularly in the emergency department (ED).

Objective: To measure the outcome of strategies to improve the use of interpreters by ED providers.

Methods: Pre- and post- intervention evaluation of the unmet need for language assistance (LA) in a public ED.

HarborBot: A Chatbot for Social Needs Screening.

Accessing patients' social needs is a critical challenge at emergency departments (EDs). However, most EDs do not have extra staff to administer screeners, and without personnel administration, response rates are low especially for low health literacy patients. To facilitate engagement with such low health literacy patients, we designed a chatbot - HarborBot for social needs screening.

Language Assistance for the Care of Limited English Proficiency (LEP) Patients in the Emergency Department: A Survey of Providers and Staff.

Many ED patients have limited English proficiency (LEP). Under Title VI of the 1964 Civil Rights Act, LEP patients are entitled to language assistance, however, multiple studies demonstrate that language assistance is underutilized. We aimed to characterize the knowledge, practice patterns, and preferences of ED providers and staff regarding language assistance for LEP patients.

Declared impact of the US President's statements and campaign statements on Latino populations' perceptions of safety and emergency care access.

Statements about building walls, deportation and denying services to undocumented immigrants made during President Trump's presidential campaign and presidency may induce fear in Latino populations and create barriers to their health care access. To assess how these statements relate to undocumented Latino immigrants' (UDLI) and Latino legal residents/citizens' (LLRC) perceptions of safety and their presentations for emergency care, we conducted surveys of adult patients at three county emergency departments (EDs) in California from June 2017 to December 2018. Of 1,684 patients approached, 1,337 (79.

Undocumented Patients in the Emergency Department: Challenges and Opportunities.

In the United States, undocumented residents face unique barriers to healthcare access that render them disproportionately dependent on the emergency department (ED) for care. Consequently, ED providers are integral to the health of this vulnerable population. Yet special considerations, both clinical and social, generally fall outside the purview of the emergency medicine curriculum.

Building Immigration-Informed, Cross-Sector Coalitions: Findings from the Los Angeles County Health Equity for Immigrants Summit.

In December 2017, the Los Angeles County Office of Immigrant Affairs and Board of Supervisors, alongside local health care and legal providers, convened the Health Equity for Immigrants and Families Summit to advance a vision for immigrant health. We describe the four critical concepts identified by stakeholders to address the varied needs of immigrants in an increasingly anti-immigrant political environment: (1) Recognizing immigration status as a modifiable social determinant of health; (2) Adopting the concept of "Immigration-Informed Care" within health care institutions; (3) Establishing immigration-focused medical-legal partnerships; and (4) Building coordinated systems based on knowledge of local stakeholders, policies, and funding mechanisms.

Barriers to the Right to Health Among Patients of a Public Emergency Department After Implementation of the Affordable Care Act.

Emergency physicians are witnesses to the impact of socioeconomic determinants of health on physical and psychiatric illness. Understanding structural barriers to the right to health (RTH) serves as a foundation for interventions to promote health equity. This study was performed to determine self-described barriers to fulfillment of the RTH among a public emergency department (ED) patient population.

Hospital and Health System-Level Interventions to Improve Care for Limited English Proficiency Patients: A Systematic Review.

Objective: Although federal legislation mandates the provision of qualified interpreters for limited English proficiency (LEP) patients, language services are consistently underutilized by health care providers even when readily available. The objective of this study was to systematically review the literature and summarize evidence for interventions at the hospital or health system level that improve communication with, quality of care for, or health outcomes of LEP patients.

Methods: The literature was systematically reviewed according to PRISMA guidelines to answer the following question: "For patients with limited English proficiency, which interventions at the hospital or health system level will result in improved communication, quality of care, or health outcomes?"

Results: The search yielded an initial 16,686 references, 19 of which met the inclusion criteria.

Advancing the Biosocial Perspective in the Clinical Training Environment: Surmounting the Barriers and Constructing the Framework.

Calls for integrating the biosocial perspective into medical education are abundant. The core curricula of most of health professions education, however, have yet to fully integrate this concept. In this Invited Commentary, the authors describe barriers to implementation-the lack of a shared vocabulary, core curriculum, and clinical metrics-and propose a framework for implementing curricula in social medicine and structural competence.

Language assistance for limited English proficiency patients in a public ED: determining the unmet need.

Background: Many patients who present to public Emergency Departments (EDs) have Limited English Proficiency (LEP). LEP patients have worse understanding of their conditions and high rates of ED recidivism. LEP patients are entitled to language assistance under Title IV of the 1964 Civil Rights Act.