Continuity as Care: Improving Diagnostic Flow in New York's Multilingual Clinics
DOI:
https://doi.org/10.58445/rars.3441Keywords:
Diagnostic continuity, Diagnostic delay, Multilingual clinical care, Interpreter services, New York community clinics, Urban public health, Information flow, Clinical workflow efficiency, Continuity of care, Patient follow-up, Health equity in NY, Electronic health records (EHR), Workflow fragmentation, Preventive-care access, Linguistic barriers, NYC Health Hospitals Community-based healthcare, Diagnostic Continuity Index (DCI), Systems-based precision, Brentwood clinical observationsAbstract
Background: Diagnostic delays in multilingual community clinics represent a critical but underexamined barrier to health equity. In New York's high-volume healthcare settings, communication interruptions—through language barriers, fragmented workflows, and interdepartmental handoffs—create measurable gaps in the diagnostic continuum. This study examines how informational precision functions as a structural determinant of clinical outcomes.
Methods: Thirty-two field observations were conducted at Brentwood outpatient and physical-therapy centers in Suffolk County, NY, serving a predominantly Hispanic population. Using mixed-methods analysis, variables including interpreter use, cross-departmental communication steps, diagnostic delay (days), and patient comprehension were quantified and analyzed through Pearson correlation coefficients. Qualitative field notes were coded for workflow patterns and communication breakdowns.
Results: Mean diagnostic delay was 2.3 days, with 38% of cases requiring multiple follow-up attempts before patient notification. Interpreter-assisted encounters showed a 20% increase in patient comprehension and a moderately strong negative correlation with missed follow-ups (r ≈ -0.6), despite being 15% longer in duration. Twelve percent of cases required repeated testing due to misrouted documentation. The Diagnostic Continuity Index (DCI), defined as DCI = 1 - (T_d/T_i), yielded a baseline score of 0.62 for current workflows, with simulated improvements projecting an increase to 0.83 through bilingual automated alerts and streamlined communication pathways.
Conclusions: Diagnostic continuity operates as a measurable clinical variable shaped by communication infrastructure. The DCI provides a scalable metric for quantifying and improving workflow precision in multilingual settings. Modest informational reforms—automated bilingual notifications, trained continuity analysts, and quarterly DCI audits—can substantially reduce preventable delays and advance health equity across New York's community clinic network.
References
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Copyright (c) 2025 Emely Alvarez
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