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Adapting an Evidence-Based Intervention to Improve the Hospital Discharge Process for Patients with Limited English Proficiency

Award Number: K23MD019068
ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP
PERIOD OF PERFORMANCE START DATE: 09/23/2023
PERIOD OF PERFORMANCE END DATE: 03/31/2028

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Adapting an Evidence-Based Intervention to Improve the Hospital Discharge Process for Patients with Limited English Proficiency - PROJECT SUMMMARY Hospital discharge is a high-risk time due to the frequency of miscommunication, medication errors, and discontinuity of providers which lead to dangerous and costly hospital readmissions. Patients who face communication obstacles, including those with other language preference (OLP)—a growing demographic in the United States—are the most likely to be negatively impacted by these gaps in quality and safety. Patients with OLP are more likely to have poor comprehension of discharge instructions, face challenges to obtaining medications, report new or worsening symptoms once home, and suffer post-discharge adverse events. Further supports to improve communication could improve health outcomes. While multiple care transition interventions have been shown to improve these outcomes, they have excluded patients with OLP. ReEngineered Discharge (RED) is a multi-component discharge intervention that was shown to reduce reutilization by 32% and improve patient experience. To improve outcomes relating to hospital discharge, care transition programs such as RED must be adapted to meet the needs of those with OLP, addressing communication, access limitations, and consideration of personal preferences relevant at the time of discharge. Intervention adaptation is a proven strategy to improve health outcomes by ensuring intervention fit, and thus effectiveness. The goal of this application is to adapt RED for patients with OLP, informed by new data on patient preferences and a multidisciplinary adaptation process utilizing key stakeholders, and test it in a pilot trial. In Aim 1, I will conduct a discrete choice experiment (DCE), a modified survey methodology to quantify preferences through implicit trade-offs in choices, to understand how those with OLP value different discharge supports. In Aim 2, I will apply the ADAPT methodology, an evidence-based approach that harnesses wisdom from a team of stakeholders, to determine the specific adaptations to RED. In Aim 3, I will test the adapted intervention (RED-OLP) in a low resource hospital through a pilot randomized controlled trial with the goal to assess key implementation outcomes (fidelity, acceptability, and feasibility) as well as the feasibility collecting data on clinical outcomes. The proposed research will provide me with experience in the following domains, which address specific deficits in my training in implementation science to date: quantitative approaches to understanding stakeholder preference, intervention adaptation, and conduct of clinical trials. This research builds on my prior work and my clinical expertise as a hospitalist. My training aims—along with my multi-disciplinary mentor/advisor team with experience in outcomes research, implementation science, and patient-provider communication—will facilitate my transition to research independence and position me to test the RED-OLP model in a multi-site hybrid type II effectiveness-implementation trial.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $162,202 )
2026	2026	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL	BOSTON	MA	02118	SUFFOLK	USA	Minority Health and Health Disparities Research	002	4	7/14/2026	NON-COMPETING CONTINUATION	$0
2026	2026	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL	BOSTON	MA	02118	SUFFOLK	USA	Minority Health and Health Disparities Research	001	4	6/19/2026	NON-COMPETING CONTINUATION	$162,202
2026	2025	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL	BOSTON	MA	02118	SUFFOLK	USA	Minority Health and Health Disparities Research	000	3	11/18/2025	NON-COMPETING CONTINUATION	$0
														Subtotal = $162,202

Issue Date FY: 2025 ( Subtotal = $162,187 )
2025	2025	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL	BOSTON	MA	02118	SUFFOLK	USA	Minority Health and Health Disparities Research	002	3	4/20/2025	NON-COMPETING CONTINUATION	$162,187
2025	2025	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL	BOSTON	MA	02118	SUFFOLK	USA	Minority Health and Health Disparities Research	003	3	9/6/2025	NON-COMPETING CONTINUATION	$0
2025	2024	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL	BOSTON	MA	02118	SUFFOLK	USA	Minority Health and Health Disparities Research	001	2	4/20/2025	NON-COMPETING CONTINUATION	$0
2025	2024	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL	BOSTON	MA	02118	SUFFOLK	USA	Minority Health and Health Disparities Research	000	2	3/17/2025	NON-COMPETING CONTINUATION	$0
														Subtotal = $162,187

Issue Date FY: 2024 ( Subtotal = $161,950 )
2024	2024	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL	BOSTON	MA	02118	SUFFOLK	USA	Minority Health and Health Disparities Research	001	2	7/8/2024	NON-COMPETING CONTINUATION	$161,950
2024	2023	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL	BOSTON	MA	02118	SUFFOLK	USA	Minority Health and Health Disparities Research	000	1	6/28/2024	NEW	$0
														Subtotal = $161,950

Issue Date FY: 2023 ( Subtotal = $161,856 )
2023	2023	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL	BOSTON	MA	02118	SUFFOLK	USA	Minority Health and Health Disparities Research	000	1	9/23/2023	NEW	$161,856
2023	2023	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL	BOSTON	MA	02118	SUFFOLK	USA	Minority Health and Health Disparities Research	001	1	9/25/2023	NEW	$0
														Subtotal = $161,856

Grand Total All Awards = $648,195

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Adapting an Evidence-Based Intervention to Improve the Hospital Discharge Process for Patients with Limited English Proficiency

Award Number: K23MD019068

ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP

PERIOD OF PERFORMANCE START DATE: 09/23/2023

PERIOD OF PERFORMANCE END DATE: 03/31/2028

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