| Description |
Hispanics living in Utah experience health disparities related to economic, sociocultural, environmental, and geographic disadvantages. Language barriers contribute to these disparities, resulting in disproportionate risks for illness, chronic disease, and poor maternal/infant outcomes. Professional medical interpretation and language-concordant written resources are evidence-based practices that address language barriers, promote patient satisfaction, and positively impact health outcomes. Local Problem Spanish-speaking patients at Valley Women's Health, American Fork Division, experience language barriers, leading to unequal care compared to English-speaking patients. Inconsistent use of professional medical interpretation and inadequate provision of Spanish forms and handouts are noted as barriers. Staff and providers express dissatisfaction with language services, citing concerns such as video interpretation service functionality, limited time for extended visits on clinic schedules, and inadequate language-appropriate written resources. Culturally and Linguistically Appropriate Services (CLAS) are evidence-based standards that address these concerns while ensuring compliance with government and legal requirements. This Doctor of Nursing Practice scholarly project aimed to address a health inequity experienced by Spanish- speaking patients by improving clinic policies and practices related to language-appropriate services at a women's health clinic. Methods The Model for Improvement guided this quality improvement (QI) initiative by providing a framework for team development and function, establishing objectives and measures, and monitoring intervention effectiveness through Plan-Do-Study-Act cycles. Data collection methods included chart reviews, pre-and post-implementation surveys, and weekly rounding. Qualitative and quantitative methods were used for data analysis and reporting the interventions' effectiveness, feasibility, and usability. Interventions Multiple interventions were developed to achieve the project's aims of increasing the use of professional language interpretation and Spanish written resources. Clinic policies were revised to correspond with government regulations, legal requirements, and CLAS standards. A clinic language services workflow was developed and disseminated with a training video that was produced for the project. All commonly used English forms and handouts were professionally translated into Spanish and a centralized computer file folder for Spanish resources was established. Interventions to promote documentation of interpretation in the electronic health record included adding flags to label charts for patients requiring interpretation and adding fields addressing interpretation use to commonly used note templates. Results Pre- and post-implementation data analysis revealed that bilingual provider visits increased by 45%, while professional language interpretation usage rose by 36%. The quantity of Spanish- language written resources increased by 244%. Weekly visits by Spanish-speaking patients increased from 7.3 to 7.9, representing an 8% increase. The staff and provider surveys reflected high levels of satisfaction with the project. In the post-implementation survey, 93.6% of respondents credited the project's interventions with improving services to Spanish-speaking patients. Conclusions This QI project addressed a health inequity in a vulnerable population, showcasing the feasibility and usability of a practical implementation strategy for delivering evidence-based, language- appropriate services to Spanish-speaking patients. Revised clinical policies and streamlined workflows bolstered staff and provider satisfaction, leading to enhanced utilization of professional language interpretation, bilingual providers, and Spanish forms and handouts. The project findings will be shared with other clinic sites within this women's health organization across Utah. |
