Caregiver Satisfaction with Medical Providers' Communication: Comparison Between Spanish-Speaking Caregivers with Limited English Proficiency (LEP) and Caregivers Who Are English-Proficient (EP).

OBJECTIVES: Barriers to communication have been observed with patients and families who prefer a language other than English for medical conversations, referred to as individuals with limited English proficiency (LEP). We used the pediatric Family Satisfaction with ICU 24R (FS-ICU) survey to assess communication satisfaction for English-proficient (EP) and Spanish-speaking LEP caregivers. We added additional questions related to attendance at morning rounds, frequency of provider updates, interpreter use, and general satisfaction with communication. METHODS: This was a single-center, prospective, observational cohort study in the pediatric intensive care unit (PICU) and cardiothoracic intensive care unit (CICU) of a tertiary, academic, free-standing children's hospital. Caregivers of children < 18 years old admitted for at least 48 h to the PICU or CICU between June and September 2022 were eligible for enrollment. MEASUREMENTS AND MAIN RESULTS: 24 LEP and 74 EP caregivers completed the survey questions. The LEP group had lower household income and education levels and higher incidence of public insurance. FS-ICU scores for both LEP and EP caregivers suggested high satisfaction, without significant difference between the groups. However, qualitative analysis revealed dissatisfaction for LEP caregivers related to information, inclusion, and language barriers. EP caregivers had more positive references to information and emotional connection but indicated dissatisfaction around consistency and responsiveness. 18% of LEP caregivers reported regularly attending rounds, versus 67% of the EP group (p value < .001). 39% of LEP versus 52% of EP caregivers reported multiple daily updates, although the difference was not statistically significant. 29% of LEP respondents reported nonfluent MD/NPs using an interpreter never, rarely, or some of the time. CONCLUSIONS: There was no difference in satisfaction scores between LEP and EP caregivers. LEP caregivers had lower socioeconomic status based on public insurance and reported income and education level. Qualitative data allowed more nuanced understanding of communication satisfaction, which correlated with LEP caregivers' reported lower attendance at morning rounds, inconsistent interpreter use, and a trend toward less frequent provider updates.

Evaluating concurrent validity of criminal justice and clinical assessments among women on probation.

BACKGROUND: Women in the criminal justice (CJ) system experience complex and comorbid medical, psychiatric, and substance use disorders, which often contribute to CJ involvement. To identify intersections between CJ and health needs, we calculated Spearman r correlations between concurrent CJ and clinical assessments from women on probation in Connecticut who were enrolled in a clinical trial. We examined longitudinal trends in CJ risk scores over 9 years of observation (2005-2014), modeling time to probation recidivism with shared gamma frailty models and comparing contiguous time points by Wilcoxon matched-pairs signed rank tests. RESULTS: Women (N = 31) were predominantly white (67.7%) with at least some high school education (58.1%) and mostly unemployed (77.4%) and unstably housed (83.9%). Most met clinical criteria for severe substance use and/or psychiatric disorders. Concurrent measures of substance use, mental health, social support, partnerships, and risk by the Level of Service Inventory-Revised (LSI-R) and clinical assessments were not significantly correlated. The LSI-R personal/emotional sub-score, however, positively correlated with the Addiction Severity Index psychiatric composite score (r = 0.40, 95% CI 0.03-0.68, p = 0.03). After adjusting for age, race and number of previous events, having some high school education versus none marginally decreased the hazard for probation recidivism and having > 5 inpatient psychiatric admissions versus none increased the hazard of probation recidivism 7-fold (HR 7.49, 95% CI 1.33-42.12, p = 0.022). Women with 0-1 recurrent probation terms (n = 16) had a significantly lower mean LSI-R score than those with 2-4 recurrent probation terms (35.9 [SD 6.4] versus 39.2 [SD 3.0], p = 0.019), but repeated LSI-R scores did not change over time, nor vary significantly beyond the group mean. CONCLUSIONS: In this small, quantitative study of women on probation, widely used CJ assessment tools poorly reflected women's comorbid medical, psychiatric, and substance use needs and varied minimally over time. Findings illustrate the limitations of contemporary CJ assessment tools for women with complex needs. The field requires more comprehensive assessments of women's social and health needs to develop individualized targeted case plans that simultaneously improve health and CJ outcomes.

Systolic blood pressure does not reliably identify vasoactive status in chronic heart failure.

BACKGROUND: In chronic heart failure (CHF), titration of vasodilating medications is often guided by monitoring of systolic blood pressure (BP). However, systolic BP may not indicate the patient's true vasoactive status-best approximated by systemic vascular resistance-because cardiac output is also a contributing factor. Impedance cardiography (ICG) is a validated noninvasive method of measuring cardiac output and systemic vascular resistance. METHODS: To evaluate the relationship between systolic BP and systemic vascular resistance index (SVRI) in patients with CHF, we retrospectively evaluated the systolic BP and SVRI from 71 consecutive patients during 615 CHF clinic visits. Measurement of systolic BP was through the oscillometric method and SVRI through ICG (BioZ ICG Monitor, CardioDynamics, San Diego, CA). Absolute values and relative changes in systolic BP and SVRI were compared and characterized by systolic BP grouping. RESULTS: The 71 patients were an average of 69.3 +/- 12.2 years, New York Heart Association functional class 2.52 +/- 0.6, 46.5% men, and 47.8% ischemic etiology. Frequency by systolic BP grouping was: <100 mm Hg in 67 subjects (10.9%), 100 to 119 mm Hg in 245 subjects (39.8%), and >/=120 mm Hg in 303 subjects (49.3%). The correlation (R(2) value) of systolic BP to SVRI was 0.21 (N = 615), and change in systolic BP to change in SVRI from previous visit was 0.27 (N = 547). In 138 visits in which systolic BP did not change by 5 mm Hg or more, SVRI changed by 20% or more in 41 (29.7%). In the 67 visits in which systolic BP was below 100, only 6 (9.0%) had low SVRI and 57 (85.1%) had normal SVRI. In the 245 visits with systolic BP 100 to 119, 58 (23.7%) had high SVRI. CONCLUSIONS: Measurement of systolic BP alone does not reliably indicate the degree of vasoconstriction or vasodilation that exists in patients with CHF. Measurement of SVRI by ICG may help guide determination of need and tolerance for vasodilating medications in CHF.