Qualitative evaluation of mental health services for clients with limited English proficiency

BACKGROUND: To meet federal requirements under Title VI of the Civil Rights Act, the state of California instituted policies requiring that comprehensive mental health services in native languages be made available to limited English proficiency (LEP) populations when concentrations exceed “threshold” levels. METHODS: This paper builds on promising results from quantitative evaluations by reporting on qualitative interviews with Latino and Vietnamese LEP clients in mental health services (N = 20) to examine the awareness, impact, and implications of these threshold language policies. RESULTS: Results suggest that, while individuals are often not aware of the policies themselves, the language-related services they receive that are prompted by the policies are critical to treatment initiation and retention. Results also convey the complexities of using interpreters for sensitive psychological topics, and suggest that, for LEP individuals seeking mental health treatment, providers who speak their native languages are generally preferred. CONCLUSIONS: Access to language-appropriate services seems to be an important part of why LEP populations seek mental health treatment. However, there are multiple variables that factor into the usage and usefulness of such services

Estimating the Effects of Immigration Status on Mental Health Care Utilizations in the United States

Immigration status is a likely deterrent of mental health care utilization in the United States. Using the Medical Expenditure Panel Survey and National Health Interview survey from 2002 to 2006, multivariable logistic regressions were used to estimate the effects of immigration status on mental health care utilization among patients with depression or anxiety disorders. Multivariate regressions showed that immigrants were significantly less likely to take any prescription drugs, but not significantly less likely to have any physician visits compared to US-born citizens. Results also showed that improving immigrants’ health care access and health insurance coverage could potentially reduce disparities between US-born citizens and immigrants by 14–29% and 9–28% respectively. Policy makers should focus on expanding the availability of regular sources of health care and immigrant health coverage to reduce disparities on mental health care utilization. Targeted interventions should also focus on addressing immigrants’ language barriers, and providing culturally appropriate services

A single overnight stay after robotic partial nephrectomy does not increase complications.

OBJECTIVE: To evaluate the feasibility of post-operative day 1 (POD1) discharge following robotic partial nephrectomy (RPN) and to determine whether a protocol targeting a shorter length of stay (LOS) is associated with any difference in the rate of post-operative complications. METHODS: We reviewed a prospectively maintained, multi-institutional database of patients who underwent RPN from September 2013 to September 2016. Three of the six participating surgeons used a protocol that targeted discharge on POD1, while three surgeons did not. Patient characteristics and post-operative complication rates between the two groups were compared. RESULTS: A total of 665 patients were included, 455 of whom were treated by surgeons utilizing a POD1 discharge protocol while 210 were not. The mean LOS for those in the POD1 protocol group was 1.13 days versus 2.02 in the non-protocol group. Between groups, there were no differences in age (p=.098), body mass index (p=.164), tumor size (p=.502), or R.E.N.A.L. Nephrometry score (p=.974), but POD1 discharge protocol patients had higher age-adjusted Charlson comorbidity score (4 vs 2, p=.033), were less likely to have a hilar tumor (15.9% vs 23.1%, p=.03), and had a larger percent decrease in discharge estimated glomerular filtration rate (-15.9% vs -7.1%, p CONCLUSION: Discharge on POD1 after RPN is feasible, reproducible by different surgeons, and not associated with an increased risk of post-operative complications

Real‐World Evaluation of an Automated Algorithm to Detect Patients With Potentially Undiagnosed Hypertension Among Patients With Routine Care in Hawaiʻi

Background This real‐world evaluation considers an algorithm designed to detect patients with potentially undiagnosed hypertension, receiving routine care, in a large health system in Hawaiʻi. It quantifies patients identified as potentially undiagnosed with hypertension; summarizes the individual, clinical, and health system factors associated with undiagnosed hypertension; and examines if the COVID‐19 pandemic affected detection. Methods and Results We analyzed the electronic health records of patients treated across 6 clinics from 2018 to 2021. We calculated total patients with potentially undiagnosed hypertension and compared patients flagged for undiagnosed hypertension to those with diagnosed hypertension and to the full patient panel across individual characteristics, clinical and health system factors (eg, clinic of care), and timing. Modified Poisson regression was used to calculate crude and adjusted risk ratios. Among the eligible patients (N=13 364), 52.6% had been diagnosed with hypertension, 2.7% were flagged as potentially undiagnosed, and 44.6% had no evidence of hypertension. Factors associated with a higher risk of potentially undiagnosed hypertension included individual characteristics (ages 40–84 compared with 18–39 years), clinical (lack of diabetes diagnosis) and health system factors (clinic site and being a Medicaid versus a Medicare beneficiary), and timing (readings obtained after the COVID‐19 Stay‐At‐Home Order in Hawaiʻi). Conclusions This evaluation provided evidence that a clinical algorithm implemented within a large health system's electronic health records could detect patients in need of follow‐up to determine hypertension status, and it identified key individual characteristics, clinical and health system factors, and timing considerations that may contribute to undiagnosed hypertension among patients receiving routine care