Jennifer Leng

Patient Satisfaction with Different Interpreting Methods: A Randomized Controlled Trial

BackgroundGrowth of the foreign-born population in the U.S. has led to increasing numbers of limited-English-proficient (LEP) patients. Innovative medical interpreting strategies, including remote simultaneous medical interpreting (RSMI), have arisen to address the language barrier. This study evaluates the impact of interpreting method on patient satisfaction.Methods1,276 English-, Spanish-, Mandarin-, and Cantonese-speaking patients attending the primary care clinic and emergency department of a large New York City municipal hospital were screened for enrollment in a randomized controlled trial. Language-discordant patients were randomized to RSMI or usual and customary (U&C) interpreting. Patients with language-concordant providers received usual care. Demographic and patient satisfaction questionnaires were administered to all participants.Results541 patients were language-concordant with their providers and not randomized; 371 were randomized to RSMI, 167 of whom were exposed to RSMI; and 364 were randomized to U&C, 198 of whom were exposed to U&C. Patients randomized to RSMI were more likely than those with U&C to think doctors treated them with respect (RSMI 71%, U&C 64%, pu2009<u20090.05), but they did not differ in other measures of physician communication/care. In a linear regression analysis, exposure to RSMI was significantly associated with an increase in overall satisfaction with physician communication/care (β 0.10, 95% CI 0.02–0.18, scale 0–1.0). Patients randomized to RSMI were more likely to think the interpreting method protected their privacy (RSMI 51%, U&C 38%, pu2009<u20090.05). Patients randomized to either arm of interpretation reported less comprehension and satisfaction than patients in language-concordant encounters.ConclusionsWhile not a substitute for language-concordant providers, RSMI can improve patient satisfaction and privacy among LEP patients. Implementing RSMI should be considered an important component of a multipronged approach to addressing language barriers in health care.

Cancer Portal Project: A Multidisciplinary Approach to Cancer Care Among Hispanic Patients

PURPOSEnThis study investigates the impact of a multilingual, multidisciplinary team targeting social and economic determinants of cancer treatment adherence among at-risk Hispanic immigrants.nnnMETHODSnPatients were recruited at 10 hospital-based cancer clinics in New York City between December 2008 and November 2009. This is a nested cohort study of Hispanic patients and their sociodemographic characteristics, areas of needed assistance, and reported impact of meeting service needs on keeping appointments. At the core of the intervention is the trained, bilingual Portal Access Facilitator, who assesses needs and synchronizes an individualized set of transdisciplinary services for each patient.nnnRESULTSnA total of 328 Hispanic patients participated in the study. Of these, 89% preferred to speak Spanish in the health care setting, and 17% had no health insurance. The most common cancer diagnosis among participants was breast cancer (35%) followed by GI (17%) and gynecologic (16%) cancers. Patients most commonly requested financial support (59%), food support (37%), transportation assistance (21%), social work services (14%), psychosocial support (6%), help with health insurance issues (5%), and legal services (5%). In a follow-up assessment of high-need patients in urgent need of financial support, 86% reported that portal services helped them attend cancer care and treatment appointments, and 72% reported that portal services decreased worry about their care.nnnCONCLUSIONnMost patients reported that financial, social, and logistical support would help them attend their appointments for cancer care and treatment. Further multidisciplinary interventions should be implemented and evaluated to address social and economic determinants in cancer care for this population.

Traditional Chinese Medicine Use among Chinese Immigrant Cancer Patients

Traditional Chinese Medicine (TCM) includes both herbal remedies and non-herbal practices. Chinese cancer patients are particularly at high risk for herb–drug interactions. Providers, both primary care physicians and oncologists, frequently do not ask patients about TCM use, which has potentially dangerous consequences. This study describes an assessment of TCM use while undergoing conventional cancer treatment, among a cohort of Chinese immigrant cancer patients in New York City. The Immigrant Health and Cancer Disparities Service at Memorial Sloan–Kettering Cancer Center assists underserved cancer patients through a patient navigation program, the Cancer Portal Project. Six questions related to TCM are included in the existing Portal Needs Assessment Intake. Mandarin- or Cantonese-speaking Portal patients enrolled between January 2010 and May 2012 were surveyed. One hundred nine Chinese-speaking patients were enrolled in the Portal Project during the study period. Forty-six completed the TCM questions. Ninety-six percent preferred to speak Mandarin, Cantonese, or Fujianese in the healthcare setting. Thirty-nine percent (nu2009=u200918) of the 46 participants reported using TCM since being diagnosed with cancer. Nearly all (nu2009=u200916) who used TCM reported using herbal medicines. Ten TCM users did not describe sharing their use with Western doctors. Eight (44xa0%) of TCM users reported concurrently using TCM and conventional cancer treatment. Larger scale studies should further explore the concurrent use of TCM and conventional cancer treatment in this unique population. Future research should also address patient–provider communication related to the concurrent use of TCM and cancer treatment. This is also an important area of education for both patients and providers.

Detection of depression with different interpreting methods among Chinese and Latino primary care patients: a randomized controlled trial.

Language barriers may contribute to the under-detection of depression in Latinos and Asians. A total of 782 English, Spanish, and Chinese-speaking primary care patients were enrolled in a randomized controlled trial. Language discordant patients were randomized to Remote Simultaneous Medical Interpreting (RSMI) or usual and customary (U&C) interpreting. The Beck Depression Inventory-Fast Screen (BDI-FS) was administered. Patients were tracked for 1 year. A total of 462 patients completed the BDI-FS. Thirty-three percent had a positive (≥4) screen. Twenty-seven percent of BDI-FS positive patients were diagnosed with depression. Among BDI-FS positive patients, Chinese-speakers were less likely to be diagnosed compared with English speakers (31% vs. 10%, Pxa0<xa00.05). There was a trend towards greater diagnosis with RSMI (27% detection with RSMI vs. 20% U&C, Pxa0=xa00.41). The diagnosis of depression among BDI-FS positive patients in our population was low, particularly among Chinese-speakers. RSMI could be an important part of a multi-faceted approach to improving the detection of depression.

Do Our Patients Have Enough to Eat?: Food Insecurity among Urban Low-income Cancer Patients

This study assessed the prevalence and predictors of food insecurity among a cohort of underserved oncology patients at New York City cancer clinics. A demographic survey and the U.S. Household Food Security Survey Module were administered. A multivariate General Linear Model Analysis of Covariance was used to evaluate predictors of food insecurity. Four hundred and four (404) completed the surveys. Nearly one-fifth (18%) had very low, 38% low, 17% marginal, and 27% high food security. The Analysis of Covariance was statistically significant (F[7, 370] = 19.08; p < .0001; R-Square = 0.26). Younger age, Spanish language, poor health care access, and having less money for food since beginning cancer treatment were significantly associated with greater food insecurity. This cohort of underserved cancer patients had rates of food insecurity nearly five times those of the state average. More research is needed to understand better the causes and impact of food insecurity among cancer and chronic disease patients.

Targeting Social and Economic Correlates of Cancer Treatment Appointment Keeping among Immigrant Chinese Patients

Chinese immigrants have high rates of a variety of cancers and face numerous social and economic barriers to cancer treatment appointment keeping. This study is a nested cohort of 82 Chinese patients participating in the Immigrant Cancer Portal Project. Twenty-two percent reported having missed appointments for oncology follow-up, radiation therapy, and/or chemotherapy. Patients most commonly reported needing assistance with financial support to enable appointment keeping. Efforts to further address social and economic correlates in cancer care should be developed for this population.

Culturally Tailored Health Camps and Cardiovascular Risk among South Asian Immigrants

Introduction. South Asians have a high prevalence and early age of onset of diabetes, metabolic syndrome, and cardiovascular disease (CVD). We assess the potential of a culturally responsive intervention, health camps, to identify and inform U.S. South Asian community members at risk for CVD. Methods. We held four culturally and linguistically tailored health camps between October 2009 and November 2010 to educate participants about and screen for CVD risk factors, including diabetes, hypertension, and hypercholesterolemia. Data analysis was conducted in December 2010. Results. Nearly 300 (289) South Asians registered at the health camps: 20% reported a previous diagnosis of diabetes, 34% elevated blood pressure, and 22% hypercholesterolemia. Most (240) participants had their blood glucose measured; 13% had values >200 mg/dl. Most (265) had their blood pressure measured; 32% had elevated values. Over half (57%) of LDLs were <100 mg/dl. Discussion. Health camps are a potentially important component in addressing increased CVD risk in this vulnerable population.

Mexican urban occupational health in the US: a population at risk.

Mexicans are the largest immigrant group in the US. Little is known about their urban occupational health status. We assess occupational illness, injury, and safety training among New York City Mexican immigrants. This study is a consecutive sample of the Mexican immigrant population utilizing Mexican Consulate services in New York City over two weeks in March 2009. Bilingual research assistants approached persons waiting in line at the Consulate and administered an occupational health questionnaire. 185 people agreed to participate. Most work in restaurants (37%), cleaning (18%), construction (12%), babysitting/nanny (7%), retail (9%), and factories (5%). 22% had received safety training. 18% reported work-related pain or illness. 18% suffered from a job-related injury since immigrating. Most injuries were in construction, factories, and restaurants. 29% had not reported their injury. This study provides evidence that the urban Mexican immigrant population is at high risk for work-related illness and injury, is not receiving adequate safety training, and is under-reporting occupational injury. Culturally and linguistically responsive community outreach programs are needed to provide occupational health and safety information and resources for urban Mexican workers.

Step On It! Impact of a Workplace New York City Taxi Driver Health Intervention to Increase Necessary Health Care Access

OBJECTIVESnWe describe the impact of the Step On It! intervention to link taxi drivers, particularly South Asians, to health insurance enrollment and navigate them into care when necessary.nnnMETHODSnStep On It! was a worksite initiative held for 5 consecutive days from September 28 to October 2, 2011, at John F. Kennedy International Airport in New York City. Data collected included sociodemographics, employment, health care access and use, height, weight, blood pressure, and random plasma glucose. Participants were given their results, counseled by a medical professional, and invited to participate in free workshops provided by partner organizations.nnnRESULTSnOf the 466 drivers participated, 52% were uninsured, and 49% did not have a primary care provider. Of 384 drivers who had blood pressure, glucose, or both measured, 242 (63%) required urgent or regular follow-up. Of the 77 (32%) requiring urgent follow-up, 50 (65%) sought medical care at least once, of whom 13 (26%) received a new diagnosis. Of the 165 (68%) requiring regular follow-up, 68 (41%) sought medical care at least once, of whom 5 (7%) received a new diagnosis.nnnCONCLUSIONSnThis study provides encouraging results about the potential impact of an easy-to-deliver, easily scalable workplace intervention with a large, vulnerable population.

Language Discordance and Influenza Vaccination

Growth of the foreign-born population in the United States in recent years has led to increasing numbers of limited-English-proficient (LEP) patients (US Census Bureau, 2003). Language discordance between patients and their medical providers is a major factor impeding effective provision of health care (Flores, 2005; Hampers, Cha, Gutglass, Binns, & Krug, 1999; KirkmanLiff & Mondragon, 1991; Kline, Acosta, Austin, & Johnson, 1980; Ku & Flores, 2005; Manson, 1988; Marks et al., 1987; Woloshin, Schwartz, Katz, & Welch, 1997; Yeo, 2004). Influenza infections are a major cause of mortality in the United States. In the 1990’s there were approximately 36,000 influenza-associated deaths annually (Thompson et al., 2003). Influenza vaccination is the primary method of controlling the disease, and is an important preventive health service. The New York City Department of Health and Mental Hygiene recommends priority vaccination of highest risk individuals including all people aged ≥65,