Kirsten E. Austad, MD, MPH, assistant professor of family medicine, has received a K23 award from the National Institutes of Health’s National Institute on Minority Health and Health Disparities. The five-year, $810,133 award will be used to adapt an evidence-based intervention to improve care at the time of hospital discharge for patients with limited English proficiency (LEP).
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 with LEP—a growing demographic in the United States—are the most likely to be negatively impacted by these gaps in quality and safety given the communication barriers created by language discordant care and their additional social vulnerabilities.
“Patients with LEP are more likely to have poor comprehension of discharge instructions, face barriers to obtaining medications, report new or worsening symptoms once home, and suffer post-discharge adverse events. Such inequities lead to poor outcomes, which drive health disparities,” explains Austad, who also is a hospitalist at Boston Medical Center (BMC) and medical director for the hospital’s HealthNet Inpatient Family Medicine service.
While multiple care transition interventions have been shown to improve these outcomes, they have excluded patients with LEP. ReEngineered Discharge (RED) is a multi-component discharge intervention that has been shown to reduce repeat visits by 32% and improve patient experience. The goal of this grant is to adapt RED for patients with LEP, informed by new data on patient preferences and a multidisciplinary adaptation process utilizing key stakeholders, and then test it in a pilot trial.
“To improve health equity in outcomes relating to hospital discharge, care transition programs such as RED must be adapted to meet the needs of those with LEP, addressing language barriers, cultural factors, and social determinants of health salient at the time of discharge,” she added.
Austad completed a fellowship in global women’s health where she focused on improving delivery of reproductive health care in rural indigenous Maya communities of Guatemala. She is currently interim co-associate director in the Evans Center for Implementation & Improvement Sciences at Boston University.
Her research seeks to use implementation science to promote health equity and improve patient experience in safety-net settings. She is interested in intervention adaptation to reduce health disparities and facilitate linguistic and cultural concordance.