scholarly journals Su salud a la mano (your health at hand): patient perceptions about a bilingual patient portal in the Los Angeles safety net

2019 ◽  
Vol 26 (12) ◽  
pp. 1525-1535 ◽  
Author(s):  
Alejandra Casillas ◽  
Giselle Perez-Aguilar ◽  
Anshu Abhat ◽  
Griselda Gutierrez ◽  
Tanya T Olmos-Ochoa ◽  
...  
Keyword(s):  
Los Angeles ◽  
Technology Acceptance ◽  
Health Systems ◽  
Safety Net ◽  
Patient Portal ◽  
Annual Household Income ◽  
Patient Centered ◽  
Spanish Speaking ◽  
English Speaking ◽  
Education Support

Abstract Objectives Driven by beneficial patient-centered outcomes associated with patient portal use and the Affordable Care Act, portal implementation has expanded into safety nets—health systems that offer access to care to a large share of uninsured, Medicaid, and other vulnerable populations. However, little attention has been paid to the factors that affect portal accessibility by the vulnerable patients served by these health systems—including those who are limited English proficient (LEP). Materials and Methods The Los Angeles County Department of Health Services (LAC DHS), the second-largest safety net system in the nation, launched its first patient portal, and one of the few bilingual English-Spanish interfaces in existence, in March of 2015. To explore portal awareness and perceptions, we conducted focus groups with LAC DHS patients, in English and Spanish (LEP). The Technology Acceptance Model was used to guide thematic analysis of focus group data. Results Of the 46 participants, 37 were patients and 9 were caretakers; 23 were English-speaking and 23 Spanish-speaking LEP. All patients had diabetes or hypertension. Over half had an annual household income <$10 000, yet 78% of English-speaking and 65% of Spanish-speaking LEP participants reported at-home Internet access. Participants’ discussion centered around 3 major thematic narratives: (1) participants’ awareness or attitudes about the LAC DHS portal; (2) role of culture, language, or community with regard to portal accessibility and utility; and (3) perceived needs for successful portal implementation. Conclusions Safety net participants identified concrete benefits to the portal and emphasized the need for portal engagement that offered accessible education, support, and resources in clinical and community settings. The portal offers an additional opportunity to engage the patient and family with trusted and validated health information, and should be further developed in this capacity. This study provides a better understanding of preferred improvements of patient portal engagement that guide broader health technology efforts to address electronic health disparities.

scholarly journals Communication and Shared Decision Making in the Breast Cancer Treatment Consultation: A Comparative Analysis of English- and Spanish-Speaking Patients

2019 ◽  
Vol 4 (2) ◽  
pp. 238146831988165
Author(s):  
Marilyn M. Schapira ◽  
Arshia Faghri ◽  
Elizabeth A. Jacobs ◽  
Kathlyn E. Fletcher ◽  
Pamela S. Ganschow ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Breast Cancer Treatment ◽  
Shared Decision ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Spanish Speaking ◽  
Wilcoxon Rank Sum Test ◽  
English Speaking

Background. Communication in the breast cancer treatment consultation is complex. Language barriers may increase the challenge of achieving patient-centered communication and effective shared decision making. Design. We conducted a prospective cohort study among Spanish- and English-speaking women with stage 0 to 3 breast cancer in two urban medical centers in the Midwestern United States. Patient centeredness of care and decisional conflict were compared between Spanish- and English-speaking participants using the Interpersonal Processes of Care (IPC) and Decision Conflict Scale (DCS), respectively. Clinician behaviors of shared decision making were assessed from consultation audio-recordings using the 12-item Observing Patient Involvement in Decision Making (OPTION) scale. Multivariate regression analyses were conducted to control for differences in baseline characteristics and clinician specialty. Results. Fifteen Spanish-speaking and 35 English-speaking patients were enrolled in the study. IPC scores (median, interquartile range [IQR]) were higher (less patient centered) in Spanish- versus English-speaking participants in the domains of lack of clarity (2.5, 1-3 v. 1.5, 1-2), P = 0.028; perceived discrimination (1.1, 1-1 v. 1.0, 1-1), P = 0.047; and disrespectful office staff (1.25, 1-2 v. 1.0, 1-1), P < 0.0005 (Wilcoxon rank-sum test). OPTION scores (median, IQR) were lower in Spanish- versus English-speaking participants (21.9, 17.7-27.1 v. 31.3, 26.6-39.6), P = 0.001 (Wilcoxon rank-sum test). In multivariate analysis, statistically significant differences persisted in the IPC lack of clarity and disrespectful office staff between Spanish- and English-speaking groups. Conclusions. Our findings highlight challenges in cancer communication for Spanish-speaking patients, particularly with respect to perceived patient centeredness of communication. Further cross-cultural studies are needed to ensure effective communication and shared decision making in the cancer consultation.

scholarly journals Portals of Change: How Patient Portals Will Ultimately Work for Safety Net Populations (Preprint)

2019 ◽  
Author(s):  
Alejandra Casillas ◽  
Anshu Abhat ◽  
Anish Mahajan ◽  
Gerardo Moreno ◽  
Arleen F Brown ◽  
...  
Keyword(s):  
Los Angeles ◽  
Health Care Disparities ◽  
Health Technology ◽  
Safety Net ◽  
The United States ◽  
Patient Portals ◽  
Department Of Health ◽  
Vulnerable Patients ◽  
English Speaking ◽  
Technology Tool

UNSTRUCTURED Despite the implementation of internet patient portals into the safety net after the introduction of the Affordable Care Act in the United States, little attention has been paid to the process of engaging vulnerable patients into these portals. The portal is a health technology tool that was developed with a mainstream, English-speaking audience in mind. Thus, there are valid concerns that such technologies will actually exacerbate health care disparities, conferring further advantages to the already advantaged. In this paper, we describe a framework for portal engagement (awareness, registration, and use) among safety net patients. We incorporate the experiences in the Los Angeles County Department of Health Services to illustrate important contextual factors for portal outreach in our safety net. Finally, we discuss considerations for moving forward with health technology in the safety net as the next version of patient portals are being developed.

scholarly journals Diversity, Equity and Inclusion in an Age-Friendly Health System

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 942-943
Author(s):  
Elizabeth Eckstrom ◽  
Emily Morgan ◽  
Bryanna de Lima ◽  
Anna Pleet
Keyword(s):  
Health Systems ◽  
Demographic Data ◽  
Cognitive Screening ◽  
Patient Centered ◽  
Centered Care ◽  
Core Elements ◽  
English Speaking ◽  
Internal Medicine Clinic ◽  
Equity And Inclusion ◽  
What Matters

Abstract The Age-Friendly Health Systems (AFHS) initiative uses a 4Ms framework to encourage patient-centered care for older adults. Many health systems have implemented the core elements of AFHS – What Matters, Mentation (Cognition and Depression), Medications, and Mobility – with the goal to uniformly apply these elements to all patients 65 years and older. However, equity in AFHS delivery has not yet been examined. Five diversity, equity, and inclusion (DEI) factors, including gender, race, ethnicity, preferred language and MyChart activation, were cross-sectionally analyzed against the 4Ms framework for patients seen (in person or virtual visit) in an academic internal medicine clinic between April 2020 and April 2021 (N= 3370) using two-way contingency tables. Preferred language, gender, and MyChart activation yielded significant pairings with the 4M metrics. For the AFHS What Matters metric, females were 1.10 times more likely than males and English-speaking patients were 1.67 times more likely than non-English speaking patients to receive advance care planning (p &lt;0.01). Females and patients with MyChart activation were about 2.0 times more likely to have a high-risk medication on their medication list compared to males and patients without MyChart activation (p &lt;0.01). MyChart activation was also significantly associated with cognitive screening. Patients with MyChart activation were 1.09 times more likely than patients without MyChart activation to get cognitive screening (p &lt;0.001). This study, the first to incorporate demographic data, into AFHS quality measures, suggest a need to develop best practices for equitable Age-Friendly care at the clinical team and the institutional policy level.

scholarly journals Community Partnering for Behavioral Health Equity: Public Agency and Community Leaders’ Views of its Promise and Challenge

2018 ◽  
Vol 28 (Supp) ◽  
pp. 397-406 ◽  
Author(s):  
Elizabeth Bromley ◽  
Chantal Figueroa ◽  
Enrico G. Castillo ◽  
Farbod Kadkhoda ◽  
Bowen Chung ◽  
...  
Keyword(s):  
Los Angeles ◽  
Behavioral Health ◽  
Health Systems ◽  
Safety Net ◽  
Relationship Building ◽  
Health Improvement ◽  
System Transformation ◽  
Structured Interviews ◽  
Community Based ◽  
Public Agency

Objective: To understand potential for multi-sector partnerships among com­munity-based organizations and publicly funded health systems to implement health improvement strategies that advance health equity.Setting: In 2014, the Los Angeles County (LAC) Board of Supervisors approved the Health Neighborhood Initiative (HNI) that aims to: 1) improve coordination of health services for behavioral health clients across safety-net providers within neighborhoods; and 2) address social determinants of health through community-driven, public agency sponsored partnerships with community-based organizations.Design: Key stakeholder interviewing dur­ing HNI planning and early implementation to elicit perceptions of multi-sector partner­ships and innovations required for partner­ships to achieve system transformation and health equity.Participants: Twenty-five semi-structured interviews with 49 leaders from LAC health systems, community-based organizations; and payers.Main Outcomes Means: Grounded the­matic analysis of interview data.Results: Leaders perceived partnerships within and beyond health systems as transformative in their potential to: improve access, value, and efficiency; align priori­ties of safety-net systems and communities; and harness the power of communities to impact health. Leaders identified trust as critical to success in partnerships but named lack of time for relationship-building, limitations in service capacity, and ques­tions about sustainability as barriers to trust-building. Leaders described the need for procedural innovations within health systems that would support equitable part­nerships including innovations that would increase transparency and normalize infor­mation exchange, share agenda-setting and decision-making power with partners, and institutionalize partnering through training and accountability.Conclusions: Leaders described improv­ing procedural justice in public agencies’ relationships with communities as key to effective partnering for health eq­uity.Ethn Dis.2018;28(Suppl 2):397-406; doi:10.18865/ed.28.S2.397.

scholarly journals Patient and provider perspectives on the potential value and use of a bilingual online patient portal in a Spanish-speaking safety-net population

2017 ◽  
Vol 24 (6) ◽  
pp. 1160-1164 ◽  
Author(s):  
Alejandro Ochoa ◽  
Ken Kitayama ◽  
Sebastian Uijtdehaage ◽  
Michelle Vermillion ◽  
Michael Eaton ◽  
...  
Keyword(s):  
Health System ◽  
Response Rate ◽  
Safety Net ◽  
Patient Portal ◽  
Spanish Speaking ◽  
Potential Value ◽  
Provider Perspectives ◽  
Survey Results ◽  
High Level ◽  
Patient And Provider Perspectives

Abstract Objective To assess patient and provider perspectives on the potential value and use of a bilingual patient portal in a large safety-net health system serving predominantly Spanish-speaking patients. Materials and Methods We captured patient and provider perspectives through the administration of surveys to assess Internet access, barriers, and facilitators to patient portal adoption, along with portal preferences. We report on these survey results using descriptive and comparative statistics. Results Four hundred patients (82% response rate) and 59 providers (80% response rate) participated in the study. Although 73% of providers believed that the patient portal would increase patient satisfaction, just 39% planned to recommend portal use to patients, citing concerns related to time and reimbursement. In contrast, 72% of patients believed the patient portal would strengthen the patient-provider relationship and 77% believed it would improve the quality of care. Latino patients in particular believed the patient portal would strengthen the patient-provider relationship. Seventy-five percent of patients reported interest in a mobile version of the portal. Discussion Patients from a safety-net health system, most of whom were Spanish-speaking, reported a high level of interest in the patient portal. Providers at the same health system expressed reluctance about the portal due to concerns related to time and reimbursement. Conclusion Bilingual patient portal implementation has considerable potential to promote health care engagement within Spanish-speaking safety-net populations; however, lack of provider engagement in the process could undermine the effort.

scholarly journals Long-Term Financial Burden of Breast Cancer: Experiences of a Diverse Cohort of Survivors Identified Through Population-Based Registries

2014 ◽  
Vol 32 (12) ◽  
pp. 1269-1276 ◽  
Author(s):  
Reshma Jagsi ◽  
John A.E. Pottow ◽  
Kent A. Griffith ◽  
Cathy Bradley ◽  
Ann S. Hamilton ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Los Angeles ◽  
Financial Distress ◽  
Breast Cancer Survivors ◽  
Financial Burden ◽  
Population Based ◽  
Spanish Speaking ◽  
Financial Decline ◽  
English Speaking

Purpose To evaluate the financial experiences of a racially and ethnically diverse cohort of long-term breast cancer survivors (17% African American, 40% Latina) identified through population-based registries. Methods Longitudinal study of women diagnosed with nonmetastatic breast cancer in 2005 to 2007 and reported to the SEER registries of metropolitan Los Angeles and Detroit. We surveyed 3,133 women approximately 9 months after diagnosis and 4 years later. Multivariable models evaluated correlates of self-reported decline in financial status attributed to breast cancer and of experiencing at least one type of privation (economically motivated treatment nonadherence and broader hardships related to medical expenses). Results Among 1,502 patients responding to both surveys, median out-of-pocket expenses were ≤ $2,000; 17% of respondents reported spending > $5,000; 12% reported having medical debt 4 years postdiagnosis. Debt varied significantly by race: 9% of whites, 15% of blacks, 17% of English-speaking Latinas, and 10% of Spanish-speaking Latinas reported debt (P = .03). Overall, 25% of women experienced financial decline at least partly attributed to breast cancer; Spanish-speaking Latinas had significantly increased odds of this decline relative to whites (odds ratio [OR], 2.76; P = .006). At least one privation was experienced by 18% of the sample; blacks (OR, 2.6; P < .001) and English-speaking Latinas (OR, 2.2; P = .02) were significantly more likely to have experienced privation than whites. Conclusion Racial and ethnic minority patients appear most vulnerable to privations and financial decline attributable to breast cancer, even after adjustment for income, education, and employment. These findings should motivate efforts to control costs and ensure communication between patients and providers regarding financial distress, particularly for vulnerable subgroups.

scholarly journals Portals of Change: How Patient Portals Will Ultimately Work for Safety Net Populations

10.2196/16835 ◽  
2020 ◽  
Vol 22 (10) ◽  
pp. e16835
Author(s):  
Alejandra Casillas ◽  
Anshu Abhat ◽  
Anish Mahajan ◽  
Gerardo Moreno ◽  
Arleen F Brown ◽  
...  
Keyword(s):  
Los Angeles ◽  
Health Care Disparities ◽  
Health Technology ◽  
Safety Net ◽  
The United States ◽  
Patient Portals ◽  
Department Of Health ◽  
Vulnerable Patients ◽  
English Speaking ◽  
Technology Tool

Despite the implementation of internet patient portals into the safety net after the introduction of the Affordable Care Act in the United States, little attention has been paid to the process of engaging vulnerable patients into these portals. The portal is a health technology tool that was developed with a mainstream, English-speaking audience in mind. Thus, there are valid concerns that such technologies will actually exacerbate health care disparities, conferring further advantages to the already advantaged. In this paper, we describe a framework for portal engagement (awareness, registration, and use) among safety net patients. We incorporate the experiences in the Los Angeles County Department of Health Services to illustrate important contextual factors for portal outreach in our safety net. Finally, we discuss considerations for moving forward with health technology in the safety net as the next version of patient portals are being developed.

scholarly journals Meaningful use in the safety net: a rapid ethnography of patient portal implementation at five community health centers in California

2017 ◽  
Vol 24 (5) ◽  
pp. 903-912 ◽  
Author(s):  
Sara L Ackerman ◽  
Urmimala Sarkar ◽  
Lina Tieu ◽  
Margaret A Handley ◽  
Dean Schillinger ◽  
...  
Keyword(s):  
Health Care ◽  
Health Systems ◽  
Low Income ◽  
Community Health Centers ◽  
Health Care Systems ◽  
Meaningful Use ◽  
Safety Net ◽  
Patient Portal ◽  
Patient Portals ◽  
Staff Support

Abstract Objective:US health care institutions are implementing secure websites (patient portals) to achieve federal Meaningful Use (MU) certification. We sought to understand efforts to implement portals in “safety net” health care systems that provide services for low-income populations. Materials and Methods:Our rapid ethnography involved visits at 4 California safety net health systems and in-depth interviews at a fifth. Visits included interviews with clinicians and executives (n = 12), informal focus groups with front-line staff (n = 35), observations of patient portal sign-up procedures and clinic work, review of marketing materials and portal use data, and a brief survey (n = 45). Results:Our findings demonstrate that the health systems devoted considerable effort to enlisting staff support for portal adoption and integrating portal-related work into clinic routines. Although all health systems had achieved, or were close to achieving, MU benchmarks, patients faced numerous barriers to portal use and our participants were uncertain how to achieve and sustain “meaningful use” as defined by and for their patients. Discussion:Health systems’ efforts to achieve MU certification united clinic staff under a shared ethos of improved quality of care. However, MU’s assumptions about patients’ demand for electronic access to health information and ability to make use of it directed clinics’ attention to enrollment and message routing rather than to the relevance and usability of a tool that is minimally adaptable to the safety net context. Conclusion:We found a mismatch between MU-based metrics of patient engagement and the priorities and needs of safety net patient populations.

scholarly journals Predictors of SARS-CoV-2 Infection in Youth at a Large, Urban Healthcare Center in California, March–September 2020

2021 ◽  
Vol 9 ◽  
Author(s):  
Caitlin N. Newhouse ◽  
Tawny Saleh ◽  
Trevon Fuller ◽  
Tara Kerin ◽  
Mary C. Cambou ◽  
...  
Keyword(s):  
Viral Load ◽  
Los Angeles ◽  
Poverty Line ◽  
Safety Net ◽  
Academic Institution ◽  
Symptom Presentation ◽  
Median Viral Load ◽  
Older Youth ◽  
English Speaking ◽  
Positive Results

Objective: To understand which social, epidemiologic, and clinical risk factors are associated with SARS-CoV-2 infection in youth accessing care in a large, urban academic institution.Methods: We conducted a prospective cohort study with case–control analyses in youth who received testing for SARS-CoV-2 at our academic institution in Los Angeles during the first wave of the COVID-19 pandemic (March–September 2020).Results: A total of 27,976 SARS-CoV-2 assays among 11,922 youth aged 0–24 years were performed, including 475 youth with positive SARS-CoV-2 results. Positivity rate was higher among older, African American, and Hispanic/Latinx youth. Cases were more likely to be from non-English-speaking households and have safety-net insurance. Zip codes with higher proportion of Hispanic/Latinx and residents living under the poverty line were associated with increased SARS-CoV-2 cases. Youth were more likely to have positive results if tested for exposure (OR 21.5, 95% CI 14.6–32.1) or recent travel (OR 1.5, 95% CI 1.0–2.3). Students were less likely to have positive results than essential worker youth (OR 0.5, 95% CI 0.3–0.8). Patterns of symptom presentation varied significantly by age group; number of symptoms correlated significantly with age in SARS-CoV-2 cases (r = 0.030, p &lt; 0.001). SARS-CoV-2 viral load did not vary by symptom severity, but asymptomatic youth had lower median viral load than those with symptoms (21.5 vs. 26.7, p = 0.009).Conclusions: Socioeconomic factors are important drivers of SARS-CoV-2 infection in youth. Presence of symptoms, exposure, and travel can be used to drive testing in older youth. Policies for school reopening and infection prevention should be tailored differently for elementary schools and universities.

Book Reading Styles Among English-Speaking and Spanish-Speaking Latino Caregivers

2008 ◽  
Author(s):  
Patricia H. Manz ◽  
Ageliki Nicolopoulou ◽  
Catherine B. Bracaliello ◽  
Allison N. Ash
Keyword(s):  
Book Reading ◽  
Spanish Speaking ◽  
Reading Styles ◽  
English Speaking ◽  
Latino Caregivers
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