The investigators will test the impact of a package of linguistically appropriate discharge teaching tools against current standard of care for patients with Limited English proficiency (LEP) in an unblinded randomized controlled trial. The tools include an expanded medication calendar in English and the patients' preferred language, pictographics to illustrate return precautions (what signs/symptoms require further evaluation), an audio recording of the nurse reviewing the After Visit Summary (composed by providers) to allow for review by patients and caretakers after discharge. The investigators will evaluate the effectiveness of the package of discharge teaching tools on patients' understanding/recall, key implementation outcomes, and secondary clinical outcomes via a structured interview 1-2 weeks after discharge and chart review 30 days after discharge. The objectives of this research study are: 1. test the effectiveness of a linguistically appropriate toolkit for improving patient understanding of discharge instruction content 2. Assess the feasibility and fidelity of the intervention in anticipation of a multi-site implementation trial 3. assess the feasibility and appropriateness of the linguistically appropriate toolkit to nurses and in-person interpreters 4. to assess the acceptability of the intervention to patients and their satisfaction with it 5. to collect data on implementation context in anticipation for a multi-site trial 6. to collect preliminary data on the toolkit's impact on clinical outcomes including medication adherence and hospital re-utilization.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
104
Linguistically appropriate discharge teaching aids: a medication calendar, pictographics added to the after visit summary (AVS), and an audio recording of the discharge teaching.
Boston Medical Center
Boston, Massachusetts, United States
Patient understanding of discharge instructions
Assessed by a composite score of six key domains of discharge instructions (primary diagnosis, self-care instructions, return precautions, medication changes, medication indications, follow-up) as determined by two physician adjudicators (1=poor, 4 = near perfect). Higher scores demonstrate better understanding.
Time frame: 1-2 weeks post discharge
Patient understanding of primary diagnosis of hospitalization
Determined by two physician adjudicators (1=poor, 4 = near perfect). Higher scores demonstrate better understanding.
Time frame: 1-2 weeks post discharge
Implementation effectiveness
Effectiveness will be assessed by observations of and comments from patients, nurses and visitors from qualitative interviews related to the adoption, acceptability, appropriateness, and feasibility of the discharge process
Time frame: 18 months
Hospital re-utilization
Assessed by a combined outcome of admission or emergency department (ED) visit within 30 days of index discharge
Time frame: 30 days
Number of participants with completion of primary care follow-up
Assessed from participants' medical records
Time frame: 30 days
Participant participation in discharge teaching
Participants are observed by a research team member during discharge teaching and will document the number of questions asked.
Time frame: 1-2 weeks
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