Denise D. Quigley’s research while affiliated with RAND Corporation and other places

Background. Healthcare provided by bilingual providers or with assistance from qualified interpreters is intended to improve patient-provider communication. Despite federal laws requiring healthcare facilities to provide access to appropriate interpretation language assistance services for patients not proficient in English, many Spanish-preferring patients receive primary care from providers not fluent in Spanish or who regularly use formal interpreters. Methods. Partnering with two urban SafetyNet providers in Southern California, we conducted focus groups in Spanish with Spanish-preferring patients who received care from providers who: 1) were Spanish-qualified, 2) used formal interpreters, and 3) used informal interpreters or other communication strategies. We coded transcripts to identify themes and compared patient experiences across provider types. Subjects. 62 adult Spanish-preferring primary care patients. Results. Spanish-preferring patients reported preference for continuity with their English-speaking providers despite language barriers because of established rapport. Patients receiving care from Spanish-qualified providers reported greater trust, more comprehensive care (i.e., covered more issues with minimal detail), yet with many interactions rushed. Formal interpreters facilitated better understanding and professional communication, however, impersonalized patient-provider interactions. Informal interpreters or ad-hoc strategies led to mixed experiences, often dependent on patient or provider ability to accurately convey medical information. Conclusion. Spanish-preferring patient experiences highlighted the necessity for healthcare systems to support robust language and interpretation services that enhance direct communication, ensure interpreter quality, and maintain long-term patient-provider relationships. Improvements in policy and practice are needed to optimize healthcare communication for Spanish-preferring patients, since patient-provider communication is critical for high-quality health outcomes and experiences in multilingual settings.

Background and objectives: Narrative comments from the Child Hospital Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey from a single open-ended question are specific enough to make improvements (ie, actionable). A multiitem set might yield more insights. We compare comments from the single-item Child Hospital CAHPS and the 6-item beta version Narrative Item Set (NIS). Methods: The Child HCAHPS NIS was piloted 2021 to 2022 at an urban children's hospital that fielded the Child HCAHPS survey since 2017. We analyzed 382 NIS comments (n = 77 parents and guardians) and compared them to single-item comments. Results: NIS respondents wrote nearly 6 times the word count compared with respondents presented with a single item, with 75% of NIS respondents providing narrative to 5 or 6 NIS items. Single-item comments were more positive (57% vs 39% NIS), yet most (61%) NIS comments included at least 1 negative remark (vs 43% single-item). Eighty-two percent of NIS comments included content on the Child HCAHPS survey (vs 51% single-item). The most common Child HCAHPS topics in NIS narratives were about being kept informed of child's care and whether doctors treated respondents with courtesy and respect. More NIS comments were deemed actionable (69% vs 39% single-item), with 1 NIS item - what a parent wished had gone differently- eliciting the most-actionable narrative. Conclusions: The multi-item NIS elicited high percentages of comments with sufficient detail to make improvements. A large NIS demonstration is needed to assess how quality leaders and frontline staff use NIS comments to improve inpatient pediatric care.

OBJECTIVE To examine the content and actionability of written comments from parents and guardians on the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) survey. METHODS We coded 548 narrative text comments linked to demographic information from the Child HCAHPS survey from July 2017 to December 2020 about inpatient pediatric care at an urban children’s hospital-within-a-hospital at an academic medical center. We developed initial codes based on research findings and the content of the Child HCAHPS survey, and also added codes that emerged from the comments. We performed directed and conventional content analysis. RESULTS Most comments were positive and provided by the child’s mother. About half referred to content on the Child HCAHPS survey, primarily on being treated with courtesy and respect or explaining care at discharge. Comments about other topics most frequently provided a narrative rating of the provider or described whether providers were caring and friendly. Thirty-nine percent of comments were deemed sufficiently specific to make improvements (ie, actionable) in inpatient pediatric care; negative comments or comments about care for sicker patients were more often actionable. CONCLUSIONS Child HCAHPS comments provided rich detail and a large portion were deemed actionable. Comments also provided insights into topics both on the survey itself and on many other inpatient pediatric issues raised by parents and guardians. More research is needed on the value of Child HCAHPS comments, the association between Child HCAHPS open-ended and closed-ended responses, and how quality leaders and frontline staff use comments to improve inpatient pediatric care.