Addressing virtual care disparities for patients with limited English proficiency.

During a surge of COVID-19 cases, the majority of care delivery at a large academic medical center moved to virtual care. Due to COVID-19-associated regulatory changes, virtual care is now delivered through telephone and videoconferencing platforms. Although virtual platforms allow patients to access care while socially distancing, patients with limited English proficiency (LEP) face structural barriers to these platforms, including lack of access to technology, need for medical interpreters, unfriendly patient portals, and increased privacy concerns. Strategies for increasing access to virtual platforms and technology for patients with LEP included offering patient education in multiple languages, reducing barriers to patient portal enrollment, and addressing the technology literacy gap through the use of tablets and bilingual interns. Strategies for addressing privacy concerns for patients with LEP included developing a low-literacy script and other actions that address patient concerns about Immigration and Customs Enforcement and mitigate perceived risk, as well as identifying a virtual platform that meets privacy regulations and does not require a patient to download an application to their phone or computer to join. Strategies for integrating medical interpreters into virtual visits included assessing existing virtual platforms for the ability to host a third party, changing the electronic health record software (Epic) interface, and convening directors of interpreter departments at each site to ensure comprehensive system rollout. Health care organizations that rely heavily on virtual visits to provide patient care will need to take all these challenges into consideration for patients with LEP.

The role of race, ethnicity, and language in care transitions.

OBJECTIVES: To identify areas where transition from hospital to community could be improved, with a special focus on racial, ethnic, and language differences. STUDY DESIGN: A cross-sectional survey administered by postal mail and bilingual telephone interviewers. METHODS: Patients were randomly selected within strata by race, ethnicity, and language proficiency. A total of 224 patients (response rate: 63.5%) who had recently experienced a hospital stay completed the survey. RESULTS: Overall, 1 in 4 patients were alone at discharge. More than half of patients with limited English proficiency reported lack of access to medical interpreters and translated materials. We noted significant differences by race, ethnicity, and language in technology access and in patient-reported worries in the posthospital period. Hispanic or Latino patients and patients with limited English proficiency were less likely to report access to a computer and less likely to access the Patient Gateway portal. Black or African American patients were also less likely to use the Patient Gateway portal. Asian patients were more likely to be worried about getting home health services. CONCLUSIONS: Our findings highlight the enhanced difficulties that diverse patients may experience when transitioning from hospital to community-based settings. When considering how to best address the complex needs of diverse populations, interventions must be sensitive to the presence or absence of others, potential digital divides, and medical interpretation.

Patient and clinician experiences with telehealth for patient follow-up care.

OBJECTIVES: The increasing and widespread availability of personal technology offers patients and clinicians the opportunity to utilize real-time virtual communication to enhance access to health services. Understanding the perceived value of different modes of care may help to shape the future use of technology. STUDY DESIGN: Cross-sectional surveys of patients and clinicians participating in telehealth virtual video visits (VVVs) in an academic health system. METHODS: We administered surveys to 426 unique established patients and 74 attending physicians in our hospital to measure perceptions of the comparative experience of VVVs and office visits; 254 patients and 61 physicians completed the surveys. RESULTS: When comparing VVVs and office visits, 62.6% of patients and 59.0% of clinicians reported no difference in "the overall quality of the visit." VVVs were vastly preferred to office visits by patients for convenience and travel time. A majority (52.5%) of clinicians reported higher efficiency of a VVV appointment. CONCLUSIONS: For established patients, VVVs may provide effective follow-up and enhanced convenience when compared with traditional office visits.

Residents' Experiences with Mentorship in Academic Medicine.

OBJECTIVE: Although mentorship is essential for the professional development of physicians, the literature on trainees' mentorship experiences and perceptions of effective mentoring is more limited. This descriptive study examines residents' experiences of mentoring and their perceptions about the impact of mentorship on professional development, comparing experiences in mentoring that is assigned versus self-initiated. METHODS: A web-based self-administered cross-sectional survey of all senior residents (≥PGY-3) at a major urban academic medical center was conducted from March 27 to May 31, 2015. RESULTS: Of the 327 eligible senior residents, 204 (62%) responded and completed the survey. Most residents (82%) reported multiple mentors and 65% reported that their primary mentorship relationship was self-initiated. Residents who self-initiated their primary mentorship were significantly more likely to strongly/somewhat agree that their mentor had a positive impact on publications and scholarly projects (88 vs 44%, p = 0.0063) as well as research (88 vs 55%, p = 0.0001) compared to residents with assigned mentorship, with no significant differences measured by gender, race, or ethnicity. Forty-four percent of residents indicated they had unmet needs for mentoring in at least one of several professional areas. CONCLUSIONS: Most residents perceive mentoring relationships as important to many aspects of their career development. Still 44% of residents reported unmet needs for mentoring in one or more areas, a result that needs further exploration. Since the majority of residents' primary mentoring relationships were self-initiated rather than assigned, and these were seen as more important for research and publications, programs should consider how to support the connection between residents and potential mentors.

Development and preliminary testing of the health in community survey.

OBJECTIVES: Develop and pilot test the Health in Community Survey (HCS), to collect patients' perceptions of care integration between traditional care providers and community-based services that address social determinants of health. RESEARCH DESIGN: Interviews of working-age, English-or Spanish-speaking patients with multiple chronic conditions to identify survey domains; cognitive interviews and pilot test of HCS Version 1. RESULTS: Preliminary interview subjects identified diverse care concerns. From these findings, we designed six HCS domains. Cognitive interviews identified problems relating to patients' perceptions about limited function and disability. Nearly one-third of pilot test subjects reported they did not definitely have enough resources for food, transportation, doctor and hospital bills, and medications; 41.6% said their clinicians only sometimes or never knew about their resource problems. CONCLUSIONS: Although it requires further validation, the HCS offers insights into patients' perceptions of care integration between traditional health care providers and services addressing social determinants of health.