For traumatic injury survivors, figuring out treatment plans after being released from the hospital can be challenging — even more so for patients with limited English proficiency. Language barriers, combined with cultural and systemic barriers, mean Spanish-speaking trauma survivors are less likely to get the care they need.
To better understand the problem, researchers at Massachusetts General Hospital and Brigham and Women’s Hospital — both Level I trauma centers — launched the Non-English Speaking Trauma Survivors, or NESTS, Pathway.
They found that the extent and nature of the patients’ needs surpassed what they originally thought. Two co-authors of the study, Dr. Alexis Antunez and Dr. Geoff Anderson, joined GBH’s All Things Considered host Arun Rath to share more of their findings. What follows is a lightly edited transcript.
Arun Rath: First off, before we talk about the extent of those challenges that you found in this study, give us a bit more background on NESTS. I imagine establishing it in the first place [means] there must have been a sense of need to start off with.
Dr. Geoff Anderson: Yeah, you’re absolutely right about that. What we noticed is — we’ve been collecting information about our trauma patients for some time now; we were interested in their long-term outcomes.
We’ve been interviewing all of the patients who get discharged from our trauma service about a year after their hospitalization to find out how they’ve been doing on a whole host of realms — of domains — of health. So not just their physical health, but also their mental health, their social health, financial health.
We’ve learned a lot from talking to patients over the course of the last two years. ... What we noticed were some real disparities in the long-term outcomes for our patients with limited English proficiency.
We noticed this especially with regard to their long-term mental health. They were sometimes three times less likely to get mental health care follow-up, despite being [at] an equal or even greater risk for long-term poor outcomes from a mental health perspective.
Rath: Tell us about how NESTS tries to address those inequities.
Dr. Alexis Antunez: Sure. So the first step of any patient’s journey in the NESTS Pathway is coming into the hospital really unexpectedly and, unfortunately, with traumatic injuries or burn injuries. We have a dedicated researcher who screens the lists of trauma and burn patients at our two participating MassGeneral/Brigham hospitals every day.
She’s able to communicate the patient’s information to our community health worker, Ana Hoffman, who is really the heart and soul of this program. She is trained in social work, community health work and psychiatry, and she is bilingual and also a certified medical interpreter. She’s a really special person that makes [the NESTS] pathway work.
What she does is she goes in-person to the bedside of these patients on their first or second day in the hospital after having an unexpected accident, and administers, from a research perspective, our first survey in the [NESTS] pathway, but from another perspective really takes an inventory of the needs that these patients have.
She then follows up longitudinally over time, especially after discharge, to help meet the needs identified through this instrument. One of the major and surprising findings for us from doing the study and cataloging this work from our first cohort of patients is that those needs are so much more fundamental than we thought they were going to be.
Rath: Talk about that. What surprised you about the findings?
Antunez: We found that patients — although they have more needs in terms of navigating health care or mental health — as we expected, their biggest areas of need were financial and material support for housing, utilities and food.
When we are at the bedside caring for these patients and also looking at this problem from a research perspective, to see that and really understand that someone who can’t buy groceries or is worried about paying rent is going to have an exponentially more difficult time navigating an illness and illness recovery after a traumatic injury.
Rath: Pretty profound material concerns. [The study] also mentioned mental health needs. Were there surprises there, in terms of the findings?
Antunez: That’s a difficult one because I think even in non-Spanish-speaking populations, there is a reticence to admit needs, and there’s a stigma around that. It’s definitely a goal of future work for us to better capture that need, but I think we came up against some underreporting.
Encouragingly, though, with Ana’s help, we saw that patients had a two- or three-fold increase in their referrals to mental health resources, even though they — we suspect — underreported this need. Just having someone who can help them make those phone calls and set up those appointments led them to match other patients’ use of mental health resources after discharge.
Anderson: Yeah, I think that was one of the really exciting findings that came out of this project so far — that through the use of a community health worker in [the NESTS] pathway, we were able to essentially close that gap in mental health referrals between our English-speaking and our non-English-speaking patients, which was really exciting for us.
Rath: Moving forward from these results, how will this affect NESTS work going forward? Is it as simple as just, you need to do more of that — more Spanish-speaking community health workers?
Anderson: I think that we’ve shown that having a community health worker on board at trauma centers in this country is a really valuable asset, and part of the outcome of this is [that] we hope to encourage a much broader use of community health workers in Level I trauma centers to help with patient navigation.
I think that the other thing that comes out of this ... is that this has been so successful for our non-English-speaking patients. What we want to look at next is: What about all of our other patients who are socially vulnerable, who have difficulties with the other kinds of social determinants of health?
Our next phase of this is to roll this out for patients who have low socioeconomic status, low social support, victims of violence, in addition to our patients with limited English proficiency. We want to take this forward to see if patient navigation can help other vulnerable populations as well.
