Improving Quality, Addressing Disparities, and Achieving Equity

Language Barriers and Health Care

Joseph R. Betancourt, M.D., M.P.H.

Director, The Disparities Solutions CenterSenior 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 OutcomesHow do we link communication to outcomes?

Communication

Patient Satisfaction

Adherence

Health Outcomes

Minorities Face Greater Difficulty in Communicating with Physicians

19%16%

23%

33%

27%

0%

20%

40%

Total White AfricanAmerican

Hispanic AsianAmerican

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.

Percent of adults with one or more communication problems*

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 Treatmentwww.nap.edu

Recommendations

• Increase awareness of existence of disparities

• Address systems of care– Support race/ethnicity data collection, quality improvement, evidence-

based 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 provider-patient 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