Monash Health Case Study The social risks of poor oral health among refugees This project, undertaken in partnership with Monash Health Dental Services, aims to assess the social risks contributing to poor oral health among refugees, and determine correlations between social risks and caries prevalence. A social risk assessment tool was developed; informed by existing literature, and stakeholder and community consultations. More than 200 refugee clients participated in this study. Findings identified several biographic and social risk factors significantly associated with dental caries among refugee clients, including: ‘age groups (21-29 and 30-39 years)’, ‘additional health issue’, and ‘health literacy: need to visit the dentist only when in pain’. Addressing the underlying risks is integral to reducing the prevalence of caries among refugees, and these findings provide a solid evidence base to inform health promotion interventions at individual and community levels. This study was presented at the FDI World Dental Congress, Madrid, Spain, in August 2017. Additional projects Additional research projects include: ‘LTB Primary Care Model – Pilot Evaluation’; ‘Perinatal mental health in women of refugee background’; ‘Afghan Family Planning Project’; and ‘OPTIMISE’. Throughout 2016-2017, <strong>MH</strong>RHW participated in five national and international conferences, and three peer-reviewed publications, and new research findings will continue to be disseminated via these channels throughout 2018-2019. Research and Innovation: Supporting Culturally and Linguistically Diverse Communities Since 2015, a collaboration between Monash Health Community, Monash Health Language Services, Monash Health’s Allied Health Research Unit and Monash University has worked to explore mechanisms to better understand and also improve the care and experience of patients from culturally and linguistically diverse communities. Two initial projects were completed: Matched pairs analysis of hospital admitted patients with limited English proficiency (Quantitative); and, descriptive analysis of 100 episodes of care Quantitative research (retrospective case controlled study utilizing matched pairs analysis) has identified that patients with limited English proficiency, defined as those who received an interpreter during a multi-day inpatient admission, will stay on average two days longer in hospital when compared to English speaking patients matched for age, diagnosis and expected length of stay. This initial research, when complemented by a detailed descriptive analysis of 100 episodes of care of patients with limited English proficiency, also identified that access to an interpreter within 24 hours of hospital presentation has the potential to normalise the identified length of stay discrepancy. Supported by a third project: Length of stay disparity in hospital admitted patients with limited English proficiency: a qualitative exploration. This qualitative project was designed to complement initial quantitative analysis. It explored the experience and perceptions of Monash Health staff, interpreters, and culturally and linguistically diverse patients and their families, including patients that were Dari, Greek, Vietnamese and Mandarin speaking. Distinct themes emerged regarding clinician experiences of language discordant encounter. These included: (1) Negotiating care when unable to get an accurate assessment; (2) Empirical knowledge fills the gaps; (3) Using family members instead of professional interpreters: a vexed solution; (4) Disparities in care provision; and (5) Communication drought: broken by a flood. Similarly, key experiential themes emerged from patient and interpreter focus groups (publication pending). Next steps: Collectively, these three projects form our baseline understanding of the experience and hospital care of patients with limited English proficiency, their families and our employees. Additional partnerships, innovation initiatives and funding opportunities are currently being explored by the collaboration, who aim to test and implement mechanisms to normalise any length of stay discrepancy and most importantly, transform the care experience of people with limited English proficiency and people providing their care. 32
Research Report 2017 Three collaborative projects have laid the groundwork to improve the experience and hospital care of patients with limited English proficiency 33
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