Transcript - Migration Policy Institute

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Marsha Regenstein, PhD, Director
April 25, 2007
Speaking Together
 National program to improve quality of care for patients with
limited English proficiency (LEP)
 Helps hospitals improve interpreter services by testing
strategies and spreading best practices
 Comprised of a learning collaborative of 10-hospitals located
nationwide
 Funded by Robert Wood Johnson Foundation
Why Do We Need Language Services?
 Patients increasingly diverse and multicultural
• One in six Americans speaks a language other than English at home;
20 million people speak or understand little English
 Patients with limited English get less and poor-quality care
• Communication plays a major role in proper diagnosis, treatment,
follow-up care and ongoing disease management–all contributors to
quality of overall health care
Flores G. Language Barriers to Health Care in the U.S. NEJM 355(3):229-231, July 20, 2006.
Percent of Residents in Selected Cities who Speak a
Language Other than English at Home
50
41.9
40
28.1
30
20
17.9
31.2
32.2
Cambridge
Phoenix
16.8
9.3
10
0
US
Lincoln
DC
Worcester
Source: US Census Bureau, State Quick Facts. Data are from 2000 Census.
Manhattan
Studies Show…
 Patients with language barriers:
• Have a higher risk of non-adherence to medications
• Less likely to have regular source of medical care
• More likely to leave hospital against advice and miss follow-up
appointments
 Patients who need—but don’t get—interpreters often don’t
fully understand their diagnosis and treatment
We Also Know That…


Family and friends too often used as interpreters
•
Misinterpret or omit doctors’ questions
•
Omit potentially embarrassing patient complaints
Qualified medical interpreters make a difference
•
Increase the use of preventive services
•
Reduce medical errors
•
Reduce hospitalization rates
•
Doctors understand cultural influences on health
Doing No Harm?
 Joint Commission underscores the problem
• Half of LEP patients experiencing adverse events suffered physical
harm—compared to one-third of English speakers
• LEP rate of permanent or severe harm or death more than twice that
of English speaking patients
The Challenge for Hospitals


Hospitals required to provide interpreters to LEP patients at
no charge
•
Minimal federal guidance
•
No uniform standards for assessing the effectiveness of language
services.
Hospitals have limited information on best practices
•
How do we know if current services are meeting patient needs?
•
What institutions are doing it well and how can we learn from them?
Barriers to Using Language Services
 Cost: Per encounter costs range from about $20-50
 Inaccessibility:
•
•
•
•
•
Services may or may not be available
If available, need to schedule or arrange in advance OR
Need to wait for interpreter/service to arrange
Telephone interpretation can be clunky and inconvenient
Frequent problems with equipment
 Intrusive, especially with poorly-trained staff
 Poor quality interpreting
Providers Need to Create Demand
 Time pressures are real, even independent of costs
• Docs/nurses are resistant
• Reliance on family and friends (and the ubiquitous janitor!)
But -- Without trained interpreters or assessed bilingual
providers, evidence shows that it’s a disaster
waiting to happen…
 Link to patient safety and risk management often is
rationale for increased resources in hospitals
Speaking Together Project Goals

Identify and test models for providing language
services by working with participating hospitals

Measure the effectiveness of language services at
these participating hospitals; create performance
benchmarks for improvement

Share success stories within and across hospitals and
health systems
Participating Hospitals:
 Set improvement targets
• Focus on improving:


An inpatient service
Two clinical outcomes (diabetes, heart disease, or depression)
and any general outcome with clinical significance
 Use rapid cycle change to improve services
 Collect uniform data to assess results
 Share best practices and lessons learned
Hospital Performance Goals
IOM Domain
Goal
Safe
Avoid injuries to patients from language services
Effective
Provide language services based on scientific studies on who will
benefit
Patient-Centered
Provide language assistance that is respectful of and responsive to
individual patient preferences, needs, culture and values
Timely
Reduce waits and sometimes harmful delays for both those who
receive and those who give care
Efficient
Avoid waste of equipment, supplies, ideas, energy
Equitable
Provide language assistance that does not vary in quality because of
language preference, gender, ethnicity, geographic location, and
socioeconomic status
Measuring Performance

Speaking Together developed specific measures being
used in collaborative
•
Process:






Based on IOM Dimensions of Quality
Literature Review and Expert Interviews
Draft measures
Expert panel focus group
Evaluation experts and other reviewers
Field tests
Core Measures


What % of patients screened for preferred language?
What % receive assistance from trained interpreters at
assessment and discharge?
What % wait longer than 15 minutes for interpreters?
What % of interpreters wait longer than 10 minutes for
interpreters?
How much time interpreters spend interpreting?



•
Also: length of encounters, % of interpreters trained, % of bilingual
providers assessed for language fluency, time interpreters spend
providing other patient services …
Project Outcomes
 Underscore link between quality of care and effectiveness
of interpreter services
 Examine productivity and cost of interpreter services
 Document demand for language services
 Identify tested models for delivering high-quality interpreter
services
 Enhance relationships between language services and
other hospital components
Questions?
Marsha Regenstein, PhD
Director, Speaking Together:
National Language Services Network
[email protected]
(202) 530-2310