1. Click to edit Master text styles Second level Third level Fourth level Fifth level Click to edit Master title style Marsha Regenstein, PhD, Director April 25, 2007

2. 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

3.  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 Why Do We Need Language Services?

4. Flores G. Language Barriers to Health Care in the U.S. NEJM 355(3):229-231, July 20, 2006.

5. Source: US Census Bureau, State Quick Facts. Data are from 2000 Census.

6.  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 Studies Show…

7. 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

8. 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

9. 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?

10. 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

11. 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

12. 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

14. 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

15. Hospital Performance Goals IOM DomainGoal 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

16. 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

17. 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 …

18. 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

19. Questions? Marsha Regenstein, PhD Director, Speaking Together: National Language Services Network marshar@gwu.edu (202) 530-2310 marshar@gwu.edu