Download Establishing the Link Between Cultural Competency and

Improving Quality, Addressing
Disparities, and Achieving Equity
Language Barriers and Health Care
Joseph R. Betancourt, M.D., M.P.H.
Director, The Disparities Solutions Center
Senior Scientist, Institute for Health Policy
Director for Multicultural Education, Massachusetts General Hospital
Assistant Professor of Medicine, Harvard Medical School
Outline
• Racial/Ethnic Disparities in Health Care
• Quality, Equity, and Language Barriers
• Looking Forward
Linking Communication
to Outcomes
How do we link communication to outcomes?
Communication
Patient Satisfaction
Adherence
Health Outcomes
Minorities Face Greater Difficulty in
Communicating with Physicians
Percent of adults with one or more communication problems*
40%
33%
27%
23%
20%
19%
16%
0%
Total
White
African
American
Hispanic
Asian
American
Base: Adults with health care visit in past two years.
* Problems include understanding doctor, feeling doctor listened, had questions but did not ask.
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Disparities in Health Care 2002
Racial/Ethnic disparities
consistently found across a
wide range of health care
settings, disease areas, and
clinical services, even when
various confounders (SES,
insurance) are controlled for.
IOM’s Unequal Treatment
www.nap.edu
Recommendations
• Increase awareness of existence of disparities
• Address systems of care
– Support race/ethnicity data collection, quality improvement, evidencebased guidelines, multidisciplinary teams, community outreach
– Improve workforce diversity
– Facilitate interpretation services
• Provider education
– Health Disparities, Cultural Competence, Clinical Decisionmaking
• Patient education (navigation, activation)
• Research
– Promising strategies, Barriers to eliminating disparities
Quality Health Care
• Health care should be
– Safe
– Effective
– Patient-centered
– Timely
– Efficient
– Equitable
IOM’s Crossing the Quality Chasm:
Links to Language Barriers
Safe- free from medical errors; includes avoiding misdx;
preventing unnecessary risk; achieving informed consent
– LEP patients more likely to have medical errors with greater clinical
consequences than their counterparts
Effective- use evidence-based guidelines for all patients
populations; includes consideration of pt preferences & values
– Spanish-speaking patients discharged from ER less likely to understand
diagnosis, medications, instructions, and plans for follow-up care
Patient Centered- deliver care that is respectful and responsive
to individual patient health beliefs, needs and values
– Spanish-speaking patients more likely to report problems their care, and
less satisfied with the patient-provider relationship.
IOM’s Crossing the Quality Chasm:
Links to Language Barriers
Timely- avoids delays due to systemic barriers or providerpatient misunderstanding
– LEP patients have longer wait times in the ED
Efficient- avoids unnecessary costs due to poor
communication and missed health promotion opportunities
– LEP patients have greater LOS for same clinical condition as their
counterparts; more likely to use ED for care, and more likely to miss
appointments; MD’s more likely to costly tests w/LEP patients
Equitable- outcomes do not vary based on personal
characteristics (i.e. gender, race/ethnicity, SES)
– Significant racial/ethnic disparities persist for LEP patients
Looking Forward
• Addressing language barriers won’t just help us
address disparities, but improve quality
• Interpreter services aren’t a luxury, but a necessity
• Medical interpretation is a science with solid
standards that need to be disseminated widely