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Tools to improve discharge equity: Protocol for the pilot TIDE trial.

Kirsten Austad1,2, Cecilia Thai3, Alegna Zavatti4

  • 1Department of Family Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.

Contemporary Clinical Trials Communications
|January 15, 2025
PubMed
Summary

The Tools to Improve Discharge Equity (TIDE) intervention provides discharge instructions in patients' preferred languages. This pilot study aims to improve understanding and reduce hospital readmissions for non-English language preference patients.

Keywords:
Hospital dischargeImplementation scienceLimited English proficiencyNon-English language preferenceTransitions of care

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Area of Science:

  • Health equity
  • Patient safety
  • Implementation science

Background:

  • Most US hospitals do not provide discharge instructions in patients' preferred non-English languages.
  • This gap increases risks of medical errors and hospital readmission for patients with non-English language preference (NELP).
  • Innovative solutions are needed to improve discharge equity for NELP patients.

Purpose of the Study:

  • To pilot the Tools to Improve Discharge Equity (TIDE) intervention.
  • To assess the effectiveness and implementation of language-concordant discharge tools for patients with NELP.
  • To inform future strategies for improving hospital discharge safety and equity.

Main Methods:

  • A type I hybrid implementation-effectiveness pilot randomized trial.
  • The TIDE intervention includes translated medication calendars, pictograms, and audio recordings of discharge instructions.
  • Recruitment of 50 patients from top four non-English language groups (Spanish, Haitian Creole, Cape Verdean Creole, Vietnamese) and their care teams.

Main Results:

  • Patient recall of primary diagnosis and understanding of discharge instructions measured by a 24-point score.
  • Evaluation of patient experience, intervention acceptability, feasibility, appropriateness, and clinical effectiveness (including hospital readmission).
  • Mixed methods evaluation to identify determinants of intervention uptake.

Conclusions:

  • The TIDE intervention is the first designed to address discharge needs for patients with NELP.
  • Study results will guide future multi-level implementation strategies to enhance hospital discharge safety and equity.