Project Summary

What is this research about?
Federal law requires patients with language barriers to have meaningful access to healthcare. But studies show that meaningful access does not happen for patients who don’t speak English. For instance, providers update these patients/families less and don’t always use interpreters. For these reasons, patients with language barriers have more adverse events (AEs), or harms due to healthcare. In 2014, a team of parents, nurses, and physicians created Patient and Family Centered I-PASS (PFC I-PASS). PFC I-PASS changed how doctors and nurses talk to patients and families on rounds when they’re admitted to the hospital. (Rounds are when a team of doctors visit patients every morning to do a checkup and make a plan for the day.) Rounds used to happen in a way that left out patients and families. Doctors talked at, not with patients, used big words and medical talk, and left nurses out. PFC I-PASS changed rounds by including families and nurses, using simple non-medical words, and talking in an organized way so nothing is left out. When  PFC I-PASS was put into place in 7 hospitals, patients had fewer AEs and better hospital experience. But it didn’t focus on how to talk with patients with language barriers. So PFC I-PASS was modified to make it better and focus on the special needs of patients with language barriers. We call this new intervention PFC I-PASS+. PFC I-PASS+ includes all parts of PFC I-PASS plus having interpreters  present during and after rounds and training doctors about communication and cultural humility. (Cultural humility is how to partner respectfully with people from different backgrounds.)

What is the research team doing?
The goal of  the study is to compare the new intervention, PFC I-PASS+, with regular PFC I-PASS and compare both with usual care (how hospitals normally care for patients with language barriers). Patients will be recruited from 8 hospitals across the country. All study outcomes will include patient/family reports. The primary outcome is adverse events (harms due to healthcare) that happen in the hospital. Secondary outcomes will include: patient experience, communication, and discrimination. We will measure AEs through family safety reporting and reviewing patient charts throughout hospitalization. Other outcomes will be measured by patient/family survey before discharge from the hospital.  The research team has partnered with parents, nurses, physicians, social workers, and hospital leaders to make sure that every aspect of this project is guided by stakeholders who are involved in caring for patients with language barriers. Most importantly, patients and families with language barriers themselves have been included as partners and advisors. An innovative approach was also developed to coach families with language barriers, who are also new to advising, so they become more comfortable in their new roles and can even train other families in the future. This model for engaging families with language and other barriers is a unique one that can change how families are involved in projects and family advisory councils (since many families on these councils are privileged and English-speaking).

Who can this research help?
Findings from this study will help patients and families with language barriers as well as medical providers make decisions about how to best communicate in the hospital. The study can improve patient safety, patient experience, communication, discrimination, and disparities in how hospitals care for patients from different backgrounds. This research can change how hospitals and providers communicate with patients with language barriers to make sure patients actually get the meaningful access to care the law requires.

Research methods at a glance

  • Design: Cluster Randomized Controlled Trial
  • Population: Children and families with limited English proficiency who are admitted to general pediatric units as well as children and families with English proficiency (so we can compare the two groups)
  • Interventions/Comparators:
    • PFC I-PASS: A family-centered rounds intervention emphasizing structured communication, health literacy, and family and nurse engagement
    • PFC I-PASS+: PFC I-PASS + standardized interpreter use during and after rounds + cultural humility and patient-provider communication training
    • Usual care: Unstructured communication and unstandardized use of interpreter services
  • Outcomes:
    • Primary: AEs
    • Secondary: Hospital experience, safety climate, communication, discrimination
  • Timeframe:
    • AEs and communication: measured throughout hospitalization
    • Other outcomes: surveys before discharge

Project Information

Alisa Khan, MD, MPH
The Children's Hospital Corporation
$7,045,952 *

Key Dates

60 months *
2022

*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.

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Last updated: August 5, 2022