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2.  Professional Language Interpretation and Inpatient Length of Stay and Readmission Rates 
Journal of General Internal Medicine  2012;27(10):1294-1299.
Background
The population of persons seeking medical care is linguistically diverse in the United States. Language barriers can adversely affect a patient’s ability to explain their symptoms. Among hospitalized patients, these barriers may lead to higher readmission rates and longer hospitalizations. Trained interpreters help overcome communication barriers; however, interpreter usage among patients is suboptimal.
Objective
To investigate differences among patients with limited English proficiency (LEP) in their length of stay (LOS) and 30-day readmission rate associated with their receiving professional interpretation at admission or discharge.
Design
We analyzed the rates of interpretation at admission and discharge of all LEP patients admitted to a tertiary care hospital over a three-year period. We calculated length of stay in days and as log of LOS. We also examined 30-day readmission. Using multivariable regression models, we explored differences among patients who received interpretation at admission, discharge, or both, controlling for patient characteristics, including age, illness severity, language, and gender.
Participants
All LEP patients admitted between May 1, 2004 and April 30, 2007.
Main Measures
Length of hospital stay as related to use of professional interpreters; readmission to the hospital within 30 days.
Key Results
Of the 3071 patients included in the study, 39 % received language interpretation on both admission and discharge date. Patients who did not receive professional interpretation at admission or both admission/discharge had an increase in their LOS of between 0.75 and 1.47 days, compared to patients who had an interpreter on both day of admission and discharge (P < 0.02). Patients receiving interpretation at admission and/or discharge were less likely than patients receiving no interpretation to be readmitted with 30 days.
Conclusions
The length of a hospital stay for LEP patients was significantly longer when professional interpreters were not used at admission or both admission/discharge.
Electronic supplementary material
The online version of this article (doi:10.1007/s11606-012-2041-5) contains supplementary material, which is available to authorized users.
doi:10.1007/s11606-012-2041-5
PMCID: PMC3445680  PMID: 22528618
low English proficient (LEP); interpreters; length of stay (LOS)
3.  Lessons Learned From a Collaborative to Improve Care for Patients With Diabetes in 17 Community Health Centers, Massachusetts, 2006 
Preventing Chronic Disease  2010;7(4):A83.
Introduction
In 2006, the Massachusetts League of Community Health Centers convened a collaborative to systematically improve health care delivery for patients with diabetes in 17 community health centers. Our goal was to identify facilitators of and barriers to success reported by teams that participated in this collaborative.
Methods
The collaborative's activities lasted 13 months. At their conclusion, we interviewed participating team members. We asked about their teams' successes, challenges, and take-home messages for future collaborative efforts. We organized their responses into common themes by using the Chronic Care Model as a framework.
Results
Themes that emerged as facilitators of success included shifting clinic focus to more actively involve patients and to promote their self-management; improving the understanding and implementation of professional guidelines; and expanding staff roles to accommodate these goals. Patient registries were perceived as beneficial but lacking adequate technical support. Other barriers were staffing and time constraints.
Conclusions
Cooperative efforts to improve health care delivery for people with diabetes may benefit from educating the health care team about guidelines, establishing a stronger role for the patient as part of the health care team, and providing adequate technical instruction and support for the use of clinical databases.
PMCID: PMC2901581  PMID: 20550841
4.  Impact of New Therapeutics for Hepatitis C Virus Infection in Incarcerated Populations 
Topics in antiviral medicine  2013;21(1):27-35.
Inmate populations bear a disproportionate share of the burden of hepatitis C virus (HCV) infection. With more than 90% of prisoners released back to their communities within a few years of sentencing, incarceration can be viewed as an opportunity to provide HCV screening and therapeutic interventions to benefit the individual, reduce the costs of HCV management to the health care system from a societal perspective, and improve overall public health. Although optimal medical management of HCV within prison settings would increase the current cost of correctional health care, it could decrease transmission within the community, reduce overall disease burden, and lower the future societal health care costs associated with end-stage liver disease. Nonetheless, most prison systems treat only a small fraction of infected inmates. Current and emerging therapeutic agents will cure HCV infection in the vast majority of patients. Mathematical modeling also shows that expanded HCV screening and treatment are cost-effective from the societal perspective. In this article, we will describe appropriate treatment regimens, propose strategies to lessen the burden of these costly HCV therapies on correctional health care systems, and address the challenges of expanded HCV screening in correctional settings.
PMCID: PMC3875217  PMID: 23596276

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