Overcoming challenges encountered by Spanish-speaking trauma patients

Many trauma patients face a myriad of challenges when recovering from a traumatic injury, problems that can be compounded when their English proficiency is limited. An outreach program to Spanish-speaking trauma patients can help improve access to follow-up care and community resources, according to a study published in the Journal of the American College of Surgeons.

The study evaluated the Non-English Speaking Trauma Survivors (NESTS) pathway initiated in January 2022 at Massachusetts General Hospital and Brigham and Women's Hospital in Boston, both of which are Level I trauma centers. Over the course of 23 months, the research team identified 114 patients with limited English proficiency, 80 (70%) of whom agreed to participate after a NESTS community health worker contacted them and explained the available services.

The extent and nature of the patients' needs surprised the researchers, according to lead study author Alexis G. Antunez, MD, MS, a general surgery resident at Brigham and Women's Hospital.

"When we engaged with this population, we found that their needs in recovering after trauma and burn injuries were much more fundamental than we had initially hypothesized," she said. "The greatest needs that came out of our intake survey were that people were hoping to have assistance with food, housing, transportation, and utilities."

The NESTS pathway addressed those needs in a meaningful way, Dr. Antunez said. Key study findings include:

• Among the participating patients, 85% were approached in person during their initial hospitalization. The remainder were contacted by phone after discharge.
• A high percentage 75% had mental health, social service, or other types of needs identified, 80% of whom were connected to resources.
• More than half (57.5%) of patients reported food insecurity as a vulnerability, followed by transportation (41.3%), and utilities (37.5%).

An analysis of the Functional Outcomes and Recovery after Trauma Emergencies database, which draws data from three trauma centers in Boston, including Boston Medical Center, helped identify potential needs. The researchers also interviewed patients, community organizations, physicians, hospital administrators, and insurers to determine the target population's unmet needs.

"One of the needs that came out of the analysis is that Spanish-speaking patients with low English proficiency tended to have less access to mental health care after they suffered a traumatic injury," Dr. Antunez said.

Ana Hoffman, a certified community health worker who has worked in an outpatient psychiatry clinic and whose first language is Spanish, met in person with the Spanish-speaking trauma patients in both institutions and handled follow-up calls from discharged patients. Additionally, she helped track down prescriptions and assisted in filling out applications for social services. "Every patient is different, and they have different needs," Ms. Hoffman, a study co-author, said.

NESTS is continuing at both institutions and it can be replicated, provided funding is available, Dr. Antunez said. "It's incredibly scalable. The only expense of this pathway is funding the community health worker," she said.

While the study did not include a cost-benefit analysis of NESTS, Ms. Hoffman has seen its impact. "Many of the patients now just text me when they can't get their medication, and the first thing that they used to do is go to the emergency room," she said.

Study co-authors with Dr. Antunez and Ms. Hoffman are Juan P. Herrera-Escobar, MD, MPH; Saba Ilkhani, MD, MPH; Katie M. Foley, MSc; Carolyn Zier, BA; Lorna Campbell, LICSW; Nathaniel Pinkes, MPH; Madeline D. Valverde, BA; Gezzer Ortega, MD, MPH; Emma Reidy, MPH; Amanda J. Reich, Ph.D., MPH; Ali Salim, MD, FACS; Nomi Levy-Carrick, MD, MPhil; and Geoffrey A. Anderson, MD, FACS, MPH.