1. 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

2. Outline Racial/Ethnic Disparities in Health Care Quality, Equity, and Language Barriers Looking Forward

3. Linking Communication to Outcomes How do we link communication to outcomes? Communication Patient Satisfaction Adherence Health Outcomes

4. Minorities Face Greater Difficulty in Communicating with Physicians 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*

5. 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.

6. 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, 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

7. Quality Health Care Health care should be –Safe –Effective –Patient-centered –Timely –Efficient –Equitable

8. 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.

9. 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

10. 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