February 2006

Addressing health care-related language barriers is a growing concern affecting providers of all sizes, nationwide. While hospital systems and large organizations are the focus of attention, private practice physicians often struggle to serve increasing numbers of limited English proficient patients who come knocking on their doors. As physicians look for practical solutions, medical associations are responding. Here is the latest on how several professional societies are helping physicians help their limited English proficient patients:

AMA online program series focuses on languages barriers in medical practice.

The American Medical Association’s (AMA) released its second program in a monthly series entitled, Educating Physicians on Controversies in Health (EpoCH), this time addressing language barriers. The new video, entitled “Optimal Strategies for Addressing Language Barriers between Physicians and Patients,” covers some of the issues that arise when physicians and patients are unable to communicate in the same language. Click here to see the video.

EpoCH programs aim to stimulate interest in improving population health, an area of increasing relevance within clinical practice. All EpoCH episodes are archived for ongoing access through the AMA web site. Future topics will include “Racially Tailored Medicines: Is There a Science Behind the Marketing?” and “Uninformed Consent: What Can Happen When a Patient Does Not Understand the Information You Have provided?”

Universal symbols recognized by American Academy of Family Physicians as a possible solution to language barriers

American Academy of Family Physicians (AAFP) recently recommended to its members that they adopt Hablamos Juntos universal symbols as a possible solution to language barriers. The AAFP discusses in one of its publications how some symbols are applicable to family medicine practices and recommended that physicians download the symbols from the Hablamos Juntos website and use them in their offices. Click here to access the article.

Call for Presentation Submissions for the Fifth Annual National Health Communication Conference Health Literacy is top priority for the American College of Physicians (ACP) Foundation. Joining with the Institute of Medicine, ACP has convened in recent years top experts in the fields of health literacy and health communication, and other stakeholders, including the education and business communities, the insurance sector, and government and nonprofit organizations. In conjunction with its nationwide campaign "Health Communication Initiative,” the Foundation is requesting submissions for presentations for its Fifth Annual National Health Communication Conference. Topics for this year’s conference will include professional health education, public education, health services research, the business case, insurance reform, vulnerable populations, and chronic disease management.

The Foundation is involved in research to help advance the development of patient-oriented programs that focus specifically on solutions for populations affected by low health literacy. For more information on the Foundation and its current research, visit the Foundation’s website by clicking here. For more information on submission procedures or general information on the conference, you can contact the Program Manager Jonathan Uhl at juhl@acponline.org or click here.

The quality of American health care continues to improve at a modest pace, with health care disparities narrowing overall for many minority Americans. But for Hispanics, disparities have widened in both quality of care and access to care measures, according to reports by the Agency for Healthcare Research and Quality (AHRQ).

The findings are contained in the 2005 National Healthcare Quality Report and its companion document, the 2005 National Healthcare Disparities Report. These reports, issued annually, measure quality and disparities in four key areas of health care:

• Effectiveness,
• Patient safety,
• Timeliness,
• Patient centeredness.

The Healthcare Research and Quality Act of 1999 directed the Agency to develop the two annual reports. A primary objective of the Disparities report is to analyze the prevailing disparities in health care delivery as they relate to racial factors and socioeconomic factors in priority populations. This report clearly demonstrates that racial, ethnic, and socioeconomic disparities are national problems that affect health care at all points in the process, at all sites of care, and for all medical conditions. Research has demonstrated that culture and language can profoundly affect the health and quality of care received by Latinos. Failure to consider these issues in clinical encounters can lead to a variety of adverse consequences, including decreased satisfaction with care and medical errors.

In a recent news article, Carolyn Clancy, AHRQ’s director, cited language barriers as one potential contributor to health care disparities. Link to the article by clicking here. This could, in part, demonstrate why the report also showed that the quality of patient-provider communication has declined among Hispanic adults even as it improved among white adults. Clancy also noted that Hispanics receive poorer quality of care than whites in 53% of the measures, and only 41% of the quality disparities were narrowing for Hispanics. Disparities are also growing for most measures of access to care for Hispanic patients. The AHRQ report consists of 179 measures derived from over 29 data sets culminating from four to five years of research.

While the recent Disparities report clearly shows that disparities exist and highlight specific areas, the question remains why such disparities are widest for Hispanics compared with other races? According to Dr. Ernest Moy, the lead staff member for AHRQ's 2005 National Healthcare Disparities Report, it is a combination of many factors. “For many of the racial groups that exist in America, they have some kinds of problems, but not all of them,” he said. “Hispanics are more likely to lack health insurance. Many of them have language problems. Many of them have cultural problems and many of them are immigrants. When you have this combination of factors – maybe that’s the issue that’s driving the widening disparities.”

For further commentary by Dr. Clancy and Dr. Moy, you can view a transcript of the press conference by clicking here.

Recognizing that an inability to communicate clearly with medical providers can result in serious misunderstandings about diagnosis and treatment, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) recently made a revision to the Information Management standard IM.6.20 that now requires hospitals to collect information on the language and communication needs of patients. This new standard underwent field review and was approved by the Hospital Professional and Technical Advisory Committee.

This new addition to IM.6.20 was in response to research that showed that differences in language and culture can have major impacts on the quality and safety of care and that disparities in health services and outcomes are associated with race, ethnicity and language.

JCAHO is a not-for-profit, national accrediting organization that sets health care standards. The commission’s mission is to “continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations.”

Hablamos Juntos (Spanish for “We Speak Together”) is a national program of the Robert Wood Johnson Foundation to eliminate language barriers that can lead to medical errors and compromise the quality of care. Building on the work of ten demonstration sites around the country Hablamos Juntos is committed to developing practical solutions health care organizations can use to improve the care delivered to limited English proficient patients.

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