Susanna O'Kula: Patient Recruitment at the Bronx VA BACK

Published by Gwen Cullen

The list didn’t look promising. On this sweltering Friday afternoon, only three or four patients on the floors were eligible for the study, compared to the ten or twelve we can speak to on Mondays after the weekend’s intake. The last week had been slow—only two patients enrolled—and we weren’t exactly sure why. Perhaps it was the season (fewer admissions in the summer) or perhaps it was the (unfounded) belief of many veterans that they could lose their VA benefits if they admitted to using non-VA providers. The social worker, research assistant, and I nevertheless arrived on one of the upper floors and found the first patient’s room. When the social worker emerged from Mr. C’s room to say that yes, we could approach him, I was glad we could add another patient to the study, but when she said he really didn’t speak much English, I was ecstatic—he was exactly the sort of patient I wanted to reach.

The study assesses the impact that a computerized regional health information organization (RHIO) has on veterans’ medical reconciliation and care transitions outcomes. Once enrolled, patients assigned to the intervention group are visited by a pharmacist who compares current and previous medications using VA and RHIO records to prevent redundancies and errors (as opposed to the control group, whose medical reconciliation only utilizes their VA records). A month later I call patients to ask a series of follow-up questions about adverse symptoms, like dizziness, headaches, GI difficulties, and incontinence, related to their medications.

I’ve added items to the study’s baseline questionnaire that inquire about language preference, the language mostly spoken at home, and the language(s) veterans speak with both VA and non-VA providers because I’m interested in any correlation between lack of English fluency and poor care transitions outcomes, such as adverse drug events, negative responses to the Care Transitions Measure, or even readmissions. Though many patients identify as Hispanic, they often tell me their primary language is English or that even if they speak Spanish at home, English is the language in which they’re most comfortable communicating. Not so today! When I asked Mr. C which language he preferred for our conversation, “español” was his emphatic choice. It became clear, in fact, that I would need to translate the rest of the baseline questions (besides those relating to language) into Spanish, otherwise he wouldn’t be able to respond.

During my half hour with him, I learned that Mr. C’s VA provider doesn’t speak Spanish during visits and that he would actually prefer a Spanish-speaking provider. Gauging by his slight eyebrow raise in response to my question, I’m not sure anyone had ever asked him his preference before. He uses a visiting nurse service when at home and appreciates that his nurse speaks Spanish with him “todo el tiempo” (all the time). Mr. C’s consent was followed by Mr. G’s, a veteran in his nineties who is fluent in English, knew lots of French while in Europe during World War II, and speaks not a word of Spanish. I don’t know to which group either man will be assigned, and I don’t know the significance of English or Spanish fluency on their particular care transitions outcomes (at least not yet!), but I was glad we’d found them both. We finished the week on a high note—two patients in an afternoon on a day when we’d thought we would find none.

Though the study will continue long after my MSTAR summer is officially over, I look forward to further involvement with the project during the rest of my medical school training. I’m excited to see how we as future clinicians can adapt healthcare technologies to an ever-changing U.S. veteran population.

Susanna O'Kula
Mount Sinai School of Medicine

"Diary of an MSTAR Student" follows scholars in the 2012 Medical Student Training in Aging Research (MSTAR) Program, highlighting their summer experiences. As they continue their path of research, training and clinical practice, read their daily thoughts at www.afar.org/mstarblog. New diary entries are posted every day, so check back soon.