Outcomes in patients with and without disability admitted to hospital with COVID-19: a retrospective cohort study.

BACKGROUND: Disability-related considerations have largely been absent from the COVID-19 response, despite evidence that people with disabilities are at elevated risk for acquiring COVID-19. We evaluated clinical outcomes in patients who were admitted to hospital with COVID-19 with a disability compared with patients without a disability. METHODS: We conducted a retrospective cohort study that included adults with COVID-19 who were admitted to hospital and discharged between Jan. 1, 2020, and Nov. 30, 2020, at 7 hospitals in Ontario, Canada. We compared in-hospital death, admission to the intensive care unit (ICU), hospital length of stay and unplanned 30-day readmission among patients with and without a physical disability, hearing or vision impairment, traumatic brain injury, or intellectual or developmental disability, overall and stratified by age (≤ 64 and ≥ 65 yr) using multivariable regression, controlling for sex, residence in a long-term care facility and comorbidity. RESULTS: Among 1279 admissions to hospital for COVID-19, 22.3% had a disability. We found that patients with a disability were more likely to die than those without a disability (28.1% v. 17.6%), had longer hospital stays (median 13.9 v. 7.8 d) and more readmissions (17.6% v. 7.9%), but had lower ICU admission rates (22.5% v. 28.3%). After adjustment, there were no statistically significant differences between those with and without disabilities for in-hospital death or admission to ICU. After adjustment, patients with a disability had longer hospital stays (rate ratio 1.36, 95% confidence interval [CI] 1.19-1.56) and greater risk of readmission (relative risk 1.77, 95% CI 1.14-2.75). In age-stratified analyses, we observed longer hospital stays among patients with a disability than in those without, in both younger and older subgroups; readmission risk was driven by younger patients with a disability. INTERPRETATION: Patients with a disability who were admitted to hospital with COVID-19 had longer stays and elevated readmission risk than those without disabilities. Disability-related needs should be addressed to support these patients in hospital and after discharge

An ethical framework for cardiac report cards: a qualitative study

BACKGROUND: The recent proliferation of health care report cards, especially in cardiac care, has occurred in the absence of an ethical framework to guide in their development and implementation. An ethical framework is a consistent and comprehensive theoretical foundation in ethics, and is formed by integrating ethical theories, relevant literature, and other critical information (such as the views of stakeholders). An ethical framework in the context of cardiac care provides guidance for developing cardiac report cards (CRCs) that are relevant and legitimate to all stakeholders. The purpose of this study is to develop an ethical framework for CRCs. METHODS: Delphi technique – 13 panelists: 2 administrators, 2 cardiac nurses, 5 cardiac patients, 2 cardiologists, 1 member of the media, and 1 outcomes researcher. Panelists' views regarding the ethics of CRCs were analyzed and organized into themes. RESULTS: We have organized panelists' views into ten principles that emerged from the data: 1) improving quality of care, 2) informed understanding, 3) public accountability, 4) transparency, 5) equity, 6) access to information 7) quality of information, 8) multi-stakeholder collaboration, 9) legitimacy, and 10) evaluation and continuous quality improvement. CONCLUSION: We have developed a framework to guide the development and dissemination of CRCs. This ethical framework can provide necessary guidance for those generating CRCs and may help them avoid a number of difficult issues associated with existing ones

“It’s the difference between life and death”: The views of professional medical interpreters on their role in the delivery of safe care to patients with limited English proficiency

<div><p>Background</p><p>Patients with limited English proficiency (LEP) experience poorer quality care and more adverse events in hospital. Consequently, there is interest in understanding the role of professional medical interpreters in efforts to improve patient safety.</p><p>Objective</p><p>To describe the views of professional medical interpreters on their role in the delivery of safe patient care.</p><p>Design</p><p>Qualitative analysis of in-depth semi-structured interviews.</p><p>Participants</p><p>15 professional medical interpreters affiliated with the Healthcare Interpretation Network in Toronto, Canada.</p><p>Approach</p><p>Participants’ views on their role in patient safety were analyzed and organized into themes.</p><p>Key results</p><p>Professional medical interpreters described being uniquely situated to identify and prevent adverse events involving patients with LEP by: 1) facilitating communication and enhancing patients’ comprehension, 2) giving voice to patients, and 3) speaking up about safety concerns. Participants described a tension between ‘speaking up’ and interpreters’ ethical imperative to remain impartial. Interpreters also highlighted several challenges, including 4) medical hierarchy and healthcare providers’ limited knowledge of the role of interpreters. These challenges introduced safety issues if providers asked interpreters to act outside of their scope of practice.</p><p>Conclusions</p><p>Our study found that professional medical interpreters view their work as integral to the delivery of safe care to patients with LEP. In order to effectively engage in patient safety efforts together, interpreters and providers require a mutual understanding of their roles. Team hierarchy and limited provider knowledge of the role of interpreters can introduce safety concerns. In addition, interpreters describe a tension between “speaking up” about patient safety and the need for interpreters to remain impartial when facilitating communication. Healthcare institutions, providers, and interpreters must engage in discussion on how to best to “speak up” and integrate interpreters into safety efforts. Importantly, the benefits of partnering with interpreters can only be realized when providers consistently use their services.</p></div

Is "appearing chronically ill" a sign of poor health? A study of diagnostic accuracy.

OBJECTIVE: To determine the sensitivity and specificity of a physician's assessment that a patient "appears chronically ill" for the detection of poor health status. METHODS: The health status of 126 adult outpatients was determined using the 12-Item Short Form Health Survey (SF-12). Physician participants (n = 111 residents and faculty) viewed photographs of each patient participant and assessed whether or not the patient appeared chronically ill. For the entire group of physicians, the median sensitivity and specificity of "appearing chronically ill" for the detection of poor health status (defined as SF-12 physical health score below age group norms by at least 1 SD) were calculated. The study took place from February 2009 to January 2011. RESULTS: Forty-two participants (33%) had an SF-12 physical health score ≥1 SD below age group norms, and 22 (18%) had a score ≥2 SD below age group norms. When poor health status was defined as an SF-12 physical score ≥1 SD below age group norms, the median sensitivity was 38.1% (IQR 28.6-47.6%), specificity 78.6% (IQR 69.0-84.0%), positive likelihood ratio 1.64 (IQR 1.42-2.15), and negative likelihood ratio 0.82 (IQR 0.74-0.87). For an SF-12 physical score ≥2 SD below age group norms, the median sensitivity was 45.5% (IQR 36.4-54.5%), specificity 76.9% (IQR 66.3-83.7%), positive likelihood ratio 1.77 (IQR 1.49-2.25), and negative likelihood ratio 0.75 (IQR 0.66-0.86). CONCLUSIONS: Our study suggests that a physician's assessment that a patient "appears chronically ill" has poor sensitivity and modest specificity for the detection of poor health status in adult outpatients. The associated likelihood ratios indicate that this assessment may have limited diagnostic value

Migrant agricultural workers’ deaths in Ontario from January 2020 to June 2021: a qualitative descriptive study

Abstract Background Nine migrant agricultural workers died in Ontario, Canada, between January 2020 and June 2021. Methods To better understand the factors that contributed to the deaths of these migrant agricultural workers, we used a modified qualitative descriptive approach. A research team of clinical and academic experts reviewed coroner files of the nine deceased workers and undertook an accompanying media scan. A minimum of two reviewers read each file using a standardized data extraction tool. Results We identified four domains of risk, each of which encompassed various factors that likely exacerbated the risk of poor health outcomes: (1) recruitment and travel risks; (2) missed steps and substandard conditions of healthcare monitoring, quarantine, and isolation; (3) barriers to accessing healthcare; and (4) missing information and broader issues of concern. Conclusion Migrant agricultural workers have been disproportionately harmed by the COVID-19 pandemic. Greater attention to the unique needs of this population is required to avoid further preventable deaths

Sensitivity and Specificity of “Appearing Chronically Ill” for the Detection of Poor Health Status, Resident Physicians Compared to Faculty Physicians.

*<p>When faculty and resident physicians were compared, median sensitivity, specificity, and positive and negative likelihood ratios did not differ significantly at p<0.05.</p

Sensitivity and Specificity of “Appearing Chronically Ill” for the Detection of Poor Health Status, Patients Greater than 50 Years of Age compared to Patients Less Than 50 Years of Age.

*<p>When poor health status was defined as ≥2 SD below age-group norms, the specificity of “appearing chronically ill” was significantly greater for patients aged ≥50 years compared to those <50 years of age with p = 0.003.</p

Sensitivity, Specificity, Positive and Negative Likelihood Ratios of “Appearing Chronically Ill” for the Detection of Poor Health Status (n = 111 physicians).

1<p>IQR denotes inter-quartile range.</p