Eric Hardt

Trained Medical Interpreters in the Emergency Department: Effects on Services, Subsequent Charges, and Follow-up

The study was conducted to investigate the impact of an Interpreter Service on intensity of Emergency Department (ED) services, utilization, and charges. This study describes the effects of language barriers on health care service delivery for the index ED visit and a subsequent 90-day period. In all 26,573 ED records from July to November, 1999, resulted in a data set of 500 patients with similar demographic characteristics, chief complaint, acuity, and admission rate. Noninterpreted patients (NIPs) who did not speak English had the shortest ED stay (LOS) and the fewest tests, IVs and medications; English-speaking patients had the most ED services, LOS, and charges. Subsequent clinic utilization was lowest for NIPs. Among discharged patients, return ED visit and ED visit charges were lowest for interpreted patients (IPs). Use of trained interpreters was associated with increased intensity of ED services, reduced ED return rate, increased clinic utilization, and lower 30-day charges, without any simultaneous increase in LOS or cost of visit.

The exclusion of non-english-speaking persons from research

AbstractOBJECTIVE: We sought to determine how often non-English-speaking (NES) persons are excluded from medical research. DESIGN: Self-administered survey. PARTICIPANTS: A Medline search identified all original investigations on provider-patient relations published in major U.S. journals from 1989 through 1991, whose methodologies involved direct interaction between researcher and subject (N=216). Each study’s corresponding author was surveyed; 81% responded. MEASUREMENTS AND MAIN RESULTS: Of the 172 respondents, 22% included NES persons; among theseincluders, 16% had not considered the issue during the study design process, and 32% thought including the NES had affected their study results. Among the 40% who excluded the NES (excluders), the most common reason was not having thought of the issue (51%), followed by translation issues and recruitment of bilingual staff. The remaining 35% (others) indicated that there were no NES persons in their study areas. CONCLUSIONS: NES persons are commonly excluded from provider-patient communication studies appearing in influential journals, potentially limiting the generalizability of study findings. Because they are often excluded through oversight, heightened awareness among researchers and granting institutions, along with the development of valid instruments in varied languages, may increase representation of non-English-speaking subjects in research.

The core content of a generalist curriculum for general internal medicine, family practice, and pediatrics

The authors analyzed the educational content of the curricula developed for teaching in the generalist disciplines of pediatrics, family medicine, and general internal medicine. Fifteen educational components that constitute the core content shared by the three generalist disciplines are identified, described, and referenced. Tailoring the generalist curriculum for students and residents at the different stages of learning is reviewed, along with the refinement of the curriculum to meet the special needs of each generalist discipline. The success of a generalist curriculum will ultimately be measured by generalist career choices, quality of care, and both patient and professional satisfaction. The curricular determinants of success require institutional commitment to an educational philosophy that embraces the generalist disciplines, a core curriculum that provides education and training that are correlated with the demands of clinical practice, and generalist faculty who serve as role models, mentors, and teachers.

Treating and precepting with RESPECT: a relational model addressing race, ethnicity, and culture in medical training.

BACKGROUNDIn 2000 a diverse group of clinicians/educators at an inner-city safety-net hospital identified relational skills to reduce disparities at the point of care.DESCRIPTIONThe resulting interviewing and precepting model helps build trust with patients as well as with learners. RESPECT adds attention to the relational dimension, addressing documented disparities in respect, empathy, power-sharing, and trust while incorporating prior cross-cultural models. Specific behavioral descriptions for each component make RESPECT a concrete, practical, integrated model for teaching patient care.CONCLUSIONSPrecepting with RESPECT fosters a safe climate for residents to partner with faculty, address challenges with patients at risk, and improve outcomes.

Giant pilomatrix carcinoma : report and review of the literature

Abstract We report a case of giant pilomatrix carcinoma and review the literature on this rare tumor.

Multisite geriatrics clerkship for fourth-year medical students: a successful model for teaching the Association of American Medical Colleges' core competencies.

As the population ages, it is important that graduating medical students be properly prepared to treat older adults, regardless of their chosen specialty. To this end, the Association of American Medical Colleges (AAMC) and the John A. Hartford Foundation convened a consensus conference to establish core competencies in geriatrics for all graduating medical students. An ambulatory geriatric clerkship for fourth‐year medical students that successfully teaches 24 of the 26 AAMC core competencies using an interdisciplinary, team‐based approach is reported here. Graduating students (N=158) reported that the clerkship was successful at teaching the core competencies, as evidenced by positive responses on the AAMC Graduation Questionnaire (GQ). More than three‐quarters (80–93%) of students agreed or strongly agreed that they learned the seven geriatrics concepts asked about on the GQ, which cover 14 of the 26 core competencies. This successful model for a geriatrics clerkship can be used in many institutions to teach the core competencies and in any constellation of geriatric ambulatory care sites that are already available to the faculty.

Country of origin and racio-ethnicity: are there differences in perceived organizational cultural competency and job satisfaction among nursing assistants in long-term care?

Background: Long-term care facilities nationwide are finding it difficult to train and retain sufficient numbers of nursing assistants, resulting in a dire staffing situation. Researchers, managers, and practitioners alike have been trying to determine the correlates of job satisfaction to address this increasingly untenable situation. One factor that has received little empirical attention in the long-term care literature is cultural competence. Cultural competence is defined as a set of skills, attitudes, behaviors, and policies that enable organizations and staff to work effectively in cross-cultural situations. Purpose: To examine organizational cultural competence as perceived by nursing assistants and determine if this was related to differences in job satisfaction across countries of origin and racio-ethnic groups. Methods: Primary data collected from a cross-section of 135 nursing assistants at four New England nursing homes. Demographics, perceptions of organizational cultural competence, and ratings of job satisfaction were collected. A multivariate, generalized linear model was used to assess predictors of job satisfaction. A secondary analysis was then conducted to identify the most important components of organizational cultural competency. Results: Perception of organizational cultural competence (p = .0005) and autonomy (p = .001) were the strongest predictors of job satisfaction among nursing assistants; as these increase, job satisfaction also increases. Neither country of origin nor racio-ethnicity was associated with job satisfaction, but racio-ethnicity was associated with perceived organizational cultural competence (p = .05). A comfortable work environment for employees of different races/cultures emerged as the strongest organizational cultural competency factor (p = .04). Recommendations: Developing and maintaining organizational cultural competency and employee autonomy are important managerial strategies for increasing job satisfaction and improving staff retention. Toward this end, creating a comfortable work environment for employees of different races/cultures is an integral part of the process. Managerial recommendations are discussed.

Minimizing Geriatric Rehospitalizations A Successful Model

Rehospitalizations may indicate care quality problems. The authors conducted a retrospective cohort study of adults aged 65 years and older, comparing 30-day rehospitalization rates. Rates were compared for comprehensive geriatrics practice patients and for patients receiving usual general medical care. The unadjusted 30-day rehospitalization rate was 18% overall, 21% for geriatrics patients cared for on the geriatrics inpatient service, 22% for geriatrics practice patients on general medical services (GMSs), and 17% for older patients on GMS. Compared with older adults discharged from a GMS, geriatrics patients on the geriatrics service had an adjusted odds ratio for readmission of 1.00 (95% confidence interval = 0.88-1.13). Despite greater frailty, patients cared for in an interdisciplinary geriatrics practice were no more likely to be rehospitalized than adults receiving “usual care,” when adjusted for age and disease burden. Incomplete adjustment may account for this finding, which did not confirm the hypothesis that comprehensive geriatrics care would yield fewer rehospitalizations.