Hunt Clinical Competence Global World€¦ · New Cultural Trends. 1. Racial and Ethnic Disparities...

Do you know me?My name is Jin. My name is Jean. My name is Gene. My name is Jeanne.

Presented by:David B. Hunt, JDLorraine Griffin-JohnsonCentraCare

Clinical Competence in a Globally Mobile World – An Evidence-Based Approach

AGENDA1. Changing demographics – implications for health care.2. Disparities reduction efforts have failed – what’s next?3. Provider Cultural and Linguistic Competence

Assessment.4. Case Study: CentraCare Health System, Minnesota5. What have we learned? National data base results. 6. Next steps: Rating providers’ clinical competence in

treating minority patients.

• Evidence-based healthcare consulting and training services on health equity and cross-cultural healthcare

• Selected by AHA/IFD in 2015 as national consultant to their #123forEquity Campaign

• Selected by BCBSA as national vendor on cultural competence• First e-learning program on cultural competence (2004)• First e-learning program on The Law of Language Access (2010)• Conducted national webinars on the law of language access in

healthcare for the ABA and the AHA (2012)• National/international presentations on The New Science of

Unconscious Bias. Keynotes for AMA in 2015.• Nation’s first e-learning program on Global Medicine (2014)

About Us: Critical Measures, LLC.

What Distinguishes Critical Measures?

- Extensive healthcare experience with prestigious national hospital systems and health plans.

- Expertise in workforce diversity and equitable care- Evidence-based, interdisciplinary approach combining:

- Clinical expertise in internal medicine, tropical and travel medicine, infectious and parasitic diseases

- Legal expertise in health law, civil rights law and the law of language access (Title VI, ADA)

- Expertise in diversity, inclusion and intercultural communication/conflict resolution.

Changing Demographics –Implications for Healthcare

Three Demographic Megatrends

1. Race2. Immigration3. New Cultural Trends

1. Racial and Ethnic Disparities in Patient Outcomes

2. Providing Language Access to LEP Patients/Families

A. Medical – Quality/Safety IssueB. Legal – Civil Rights Issue (Title VI,

ADA)

3. Medical Disparities Resulting from Globally Mobile Populations

What is Cross-Cultural Healthcare?

Racial and Ethnic Disparities

• Historical backdrop of prejudice and racial discrimination in health care. Tuskegee

• People of Color receive lower-quality health care than whites, even when insurance status, income, age and severity of conditions are comparable.”

• Major disparities continue to be found in many key diagnostic areas: cardiovascular disease, cancer, stroke, kidney dialysis, HIV/AIDS, asthma, diabetes, mental health, maternal and child health.

• Bottom line: our fastest growing patient populations are receiving the worst care in American hospitals.

Language Access for LEP, Deaf and Hard of Hearing Patients

• Business Case• Medical Quality and Safety Case• Legal and Civil Rights Case

– Federal and State Laws– National Origin/Disability

Discrimination– Informed Consent– Medical Malpractice

• Bottom line: failing to provide effective language access services is not just bad communication it is bad medicine

Globally Mobile Populations Create New Paradigm for Medicine

• One billion international travelers today. Expected to double in 10 years.

• Airplanes as game changer.• Many diseases of foreign origin

have the same symptoms as diseases of domestic origin.

• 60% of U.S. physicians have never had any formal training on cross-cultural medicine.

• Bottom line: Providers unprepared to practice global medicine.

Diseases of Foreign Origin in the U.S.

Reducing Disparities –New and Better Approaches

AHA’s #123forEquity Pledge to Act

Where Are We Today? Disparities Have Not Improved

• A 2015 Agency for Healthcare Research and Quality (AHRQ) report notes that over 60 percent of disparities in quality of care have stayed the same or worsened for blacks, Asians and low-income populations.

• Racial health disparities cost the U.S. health system more than $57 billion a year, according to researchers from Johns Hopkins University and the University of Maryland.

Why Haven’t Disparities Reduction Efforts Worked?

1. Failure to adequately collect patient race, ethnicity and language (REL) data.

2. Failure to tie patient REL data to patient outcomes. (Less than 50% of American hospitals currently do…)

3. Focus on hospitals versus providers practice behaviors.

4. Failure to address variations in provider practice styles.

5. Variations particularly dramatic in treatment of minority patients.

Why Focus on Variations in Provider Practice Styles?

1. Unwanted variation in health care delivery: variation that can’t be explained by illness, medical evidence or patient preference.

2. Variations particularly dramatic in treatment of minority patients.

3. Extensiveness of variations suggest that medicine is not practiced as a science.

Picker – Treated with Courtesy, By Race, CLIENT “A”Question/Statement White Of Color Signif?Courtesy of admissions staff rated 2.0% 5.9% Yesfair or poor.Courtesy of people who took blood 2.8% 8.8% Yessamples rated fair or poorCourtesy of people who brought food 5.0% 8.8% Yesrated fair or poor.Courtesy of people bringing to and from 1.2% 6.2% Yesroom rated fair or poor.Courtesy of people taking x-rays rated 1.4% 7.6% Yesfair or poor.Courtesy of people who cleaned room 3.3% 8.6% Yesrated fair or poor

Kaiser Creates Patient Satisfaction Report Cards for Providers

1. Financial compensation tied (in part) to patient satisfaction scores.

2. Patient satisfaction broken out by key patient demographics.

3. Question: which patients are leastsatisfied with my care?

4. Encourages virtuous cycle of change.

Segment Items

Score

Difference ScoreYour Overall

Fac/Dept

2007YE

2008YE

2009YE

3-Yr Avg

3-Yr Avg

(Your - Fac/Dept)

Familiar Visit 75.1 89.1 89.9 85.5 85.1 0.4

Stranger Visit 69.0 65.0 75.0 69.1 64.4 4.7

Under 18 75.0

18 - 34 46.4 62.5 68.2 58.9 65.0 -6.1 ( - )

35 - 44 74.1 76.8 92.6 80.5 73.1 7.4 ( + )

45 - 64 79.7 77.7 86.9 81.5 80.4 1.1

65+ 75.0 73.9 84.3 78.9 82.2 -3.3

African Amer. 66.7 80.0 77.5

Chinese 81.1 70.0 85.1 79.8 75.6 4.2

Filipino 78.9 90.0 72.2 83.9 78.3 5.6 ( + )

Hispanic/Latino 77.3 66.7 78.9 73.5 77.1 -3.6

Japanese 84.2 76.7

Other 11.5 75.0 82.8 56.0 75.8 -19.8 ( - - )

Other Asian 73.5 90.4 82.2 83.2 72.3 10.9 ( + + )

White 70.3 69.4 90.3 77.8 82.0 -4.2

Female 73.0 70.1 90.5 78.5 76.9 1.6

Male 70.5 82.4 70.1 74.7 81.0 -6.3 ( - )

Provider Cultural and Linguistic Competence Assessment

Provider Cultural & Linguistic Competence Assessment

1. Created with assistance from top physician and provider experts in cross-cultural medical care.

2. Emphasis is not on cultural competence but on clinical competence in a globally mobile world.

3. Focuses not on providers attitudes towards disparities but rather on practice behaviors.

4. Asks and answers two key questions:. A. Which minority patient populations are providers

most/least prepared to treat? B. Do providers’ practice behaviors match clinical best practices and current legal/regulatory requirements?

Provider Cultural & Linguistic Competence Assessment

5. Examines providers’ practice behaviors with respect to eight non-traditional patient populations:A. Limited English ProficientB. Deaf and Hard of HearingC. ImmigrantsD. RefugeesE. International TravelersF. Military VeteransG. LGBTQH. Racial and Ethnic Minorities

6. What do these patients have in common? Travel, language and culture.

A Patient-Centered Approach Accounts for Patient Diversity

1. In the past, physicians were taught to make diagnoses based on a “review or systems” model (7 cardinal systems).

2. While this approach worked well in the past, globalization and patient diversity make it less reliable today.

3. Ask: what [clinical] difference does patient difference make?

4. “It is much more important to know what sort of a patient has a disease than what sort of disease a patient has.” William Osler, M.D.

Take Assessment By Phone/Computer

Welcome to the Assessment

Copy of Your Report Arrives By E-mail

View Your Report

Review Your Feedback

1. Identifies patient populations that providers feel best and least prepared to treat. Offers a strategic roadmap for individual improvement

2. Compares provider practice behaviors against clinical best practices and compliance with existing legal and regulatory requirements.

3. Provides 100 page individualized feedback report with practical, actionable steps that providers can take now to improve care to minority populations.

4. Protects providers from unwanted legal risks by identifying areas of potential legal exposure and offering tips, tactics to comply with the law.

5. Offers a wealth of hot-linked internet resources to medical journal articles, websites, free training resources and other best practice materials. Just one click away for busy providers.

Benefits to Providers

1. Quickly identifies: what problems exist, where those problems exist and what types of providers exhibit those problems.

2. Allows organizations to track, monitor and measure progress on complex diversity-related patient care issues by establishing a baseline and comparing present against past results.

3. Allows hospital systems to:A. Compare themselves to other leading hospital systemsB. Compare hospitals against other hospitals within your systemC. Compare providers by medical sub-specialty

4. Allows hospital systems to determine whether providers are following national best practices and meeting existing legal/regulatory requirements.

5. Target financial resources and training interventions to where they are most needed.

Benefits to Hospital Systems

Case Study:CentraCare Health System

1. Minnesota Demographics:

Race: 80% White, 20% of Color (U.S. 61% White 39% of Color)Immigrants: 8.2% of state foreign born versus 13.4% in U.S.Ranks first nationally in secondary migration.Largest Somali population in U.S., 2nd largest Hmong pop.Refugees: Ranks 1st in U.S. in % of immigrants who are refugeesLanguage: 11.3% of state speaks a language other than English (versus 21% nationally)

2. Central Minnesota and St. Cloud Demographics: Dramatic increase in Somali Muslim population in historically White, Catholic community.

CentraCare Health System - Location

Demographic Comparisons: St. Cloud, Minnesota & U.S.

Population St. Cloud Minnesota U.S.People of Color 19.7% 20.1% 39.3%Foreign Born 9.4% 7.8% 13.2%Foreign Language 12.4% 11.1% 21.1%Spoken At Home (Age 5+)

Notes: Source: U.S. Census Quick Facts. Racial statistics from 2017. Foreign born statistics from 2012-2016. Language statistics from 2012-20116. Statistics for St. Cloud are for the City of St. Cloud.

Overview: CentraCare Health System

Diversity and Inclusion Structure

Diversity and Inclusion

Diversity and Inclusion Structure

CentraCare Employee Resource Groups

Veterans

Millennials

Double Nickel

Single Parent

LGBTQ

Women’s LEAD

AmeriLatin

African American

In 2011, CentraCare retained Critical Measures to conduct a series of diversity and cultural competence assessments to include:

• A Diversity Workforce Assessment of diversity issues in CentraCare’s workforce.

• A Language Access Audit of CentraCare’s systems, policies and practices for providing language access services to Limited English Proficient and Deaf and Hard of Hearing patients.

• A Provider Cultural and Linguistic Competence Assessment of CentraCare providers ability to provide cross-cultural medical care in accord with national best practices.

In 2018, CentraCare agreed to repeat these assessments.

2011 Diversity Assessments

What’s Different About the 2018 Project?1. Ability to compare results against 2011 baseline.2. Ability to compare CentraCare system against other national

hospital systems.3. Providers financially incentivized to complete assessment.4. Individualized provider feedback reports comparing responses

to national best practices4. Comparative provider feedback data comparing each provider’s

responses against all CentraCare providers, all CentraCare providers in same medical subspecialty, national providers in CM database and national providers in same med. subspecialty

5. Providers use results to identify areas where further development & training is necessary in partnership with peer coaches. Training options tied to practice deficiencies.

How Did You Gain Provider Cooperation and Participation?

1. Met with provider leaders one-on-one to explain project, answer questions and address concerns.

2. Agreement that project would be educational not punitive.3. Agreement that provider’s individual responses would remain

entire confidential. CentraCare receives system-level data only. No provider identification.

4. Organizational top medical leaders vocal, active in promoting project and signed all communication letters.

5. Convened Clinical Partners Committee to guide, oversee project.

6. Held discussion forums with providers to explain project, answer questions and address concerns.

Clinical Partners Committee

1. Oversee development of Provider Assessment tool.2. Oversee development of individualized feedback to providers.3. Critically analyze provider survey results on multiple levels

(system, hospital, medical sub-specialty) 4. Offer guidance on communicating these results to the entire

CentraCare system5. Provide input on follow-up, provider training/education efforts

and peer coaching.6. Act as champions/advocates for this effort in conversations with

provider peers. Example: September 11 Clinical Partners Forum

1. Diversity Workforce Assessment.A. Status: Completed January 2019.B. Response Rate: 42%. 5,200 total employee responses. (2,000

more than in 2011.)2. Language Access Audit – in progress.3. Provider Cultural and Linguistic Competence Assessment.

A. Status: Completed March 2019.B. Response Rate: 71% overall (654 of 926 providers)C. Physician Response Rate: 85% (421 of 498). More than

doubled the number of physicians who took the assessment in 2011 (181)

Assessment Project: Progress To Date

What Have We Learned?National Database Results

1. Critical Measures has been conducting provider cultural and linguistic competence assessments for large, multi-hospital systems for over 8 years.

2. As a result, we have accumulated a national database with over 2,000 medical providers (MD’s, APP’s, RN’s, PA’s etc.).

3. The assessments can be used to : A. Compare hospital systems to other hospital systemsB. Compare hospitals against each other within hospital systemsC. Compare medical providers against each other by medical sub-

specialties both locally and nationally 4. In particular, the assessment allows hospital systems to measure

improvements in the care and treatment of diverse patient populations by setting a baseline and monitoring future improvements against that baseline.

Critical Measures National Provider Database

MD’s See Racial/Ethnic Disparities As A U.S., State Problem, Less Of A Problem at Their Hospital

All MD RespondentsQuestion: In your view, how significant is the problem of racial and ethnic disparities in healthcare in [the United States, Your State or Your Local Hospital System]?

Very Moderately Rel. Unimp./Position Important Important Unimportant TotalUnited States 43% (669) 42% (668) 15% (233) 1,570Your State 41% (635) 42% (652) 17% (261) 1,548Your Hospital 31% (488) 42% (645) 27% (412) 1,545

Source: Critical Measures National Database

U.S. MD’s Feel Least Prepared to Treat Refugees, Deaf And LEP Patients.

All MD RespondentsQuestion: How prepared do you believe that you are to provide care to patients [from the following groups]?

Very Well/Well Less Than Group Prepared Well Prepared TotalLimited English Profic. 48% 772 52% 831 1,603Deaf/Hard of Hearing 43% 687 57% 921 1,608New/Recent Immigrants 52% 828 48% 763 1,591New/Recent Refugees 44% 713 56% 893 1,606GLBT Patients 88% 1,410 12% 196 1,606Non-Western Health Beliefs 58% 930 42% 675 1,605International Travelers 75% 808 25% 266 1,074

Hospital Systems Vary Widely in M.D.Preparedness to Treat LEP Patients.

Question: How prepared do you believe that you are to provide care to patients who speak languages other than English?

Physician Respondents Only

Very Well or Less Than Hospital System Well Prepared Well Prepared TotalSystem A (WI) 48% ( 29) 52% ( 31) 60System B (MD) 39% (134) 61% (212) 346System C (MN) 52% ( 94) 48% ( 85) 179System D (NC) 42% (127) 58% (178) 305System E (FL) 58% (205) 42% (150) 355System F (SC) 51% (183) 49% (175) 358Total 48% 772 52% 831 1,603

Source: Critical Measures Provider Database

Primary Care MD’s Less Prepared to Treat LEP Patients Than Other MD’s.

Question: How prepared do you believe that you are to provide care to patients who speak languages other than English?

Primary Care MD Respondents Only

Very Well or Less Than Position Well Prepared Well Prepared TotalAll Physicians 48% 772 52% 831 1,603Family Medicine MDs 34% ( 54) 66% (107) 161OB-GYN MDs 41% ( 36) 59% ( 51) 87Pediatric MDs 52% ( 90) 48% ( 82) 172Internal Medicine MDs 39% ( 43) 61% ( 67) 110Primary Care MD’s 42% 223 58% 307 530


Hospitals Vary In Their Use of Trained/Qualified Medical Interpreters When Treating LEP Patients

Question: When providing care to LEP patients, how often do you use trained/qualified medical interpreters?

All Physician (MD) Respondents

Hospital System Always/Usually Sometimes Never TotalSystem A (WI) 55% ( 31) 30% ( 17) 15% ( 9) 57System B (MD) 61% (195) 25% ( 81) 14% (46) 322System C (MN) 78% (133) 16% ( 27) 6% (10) 170System D (NC) 69% (202) 22% ( 66) 9% (28) 296System E (FL) 45% (136) 40% (122) 15% (47) 305System F (SC) 88% (275) 9% ( 28) 3% (11) 314Total All MD’s 66% 972 23% 341 11% 151 1,464

Hospitals Vary Widely In Their Use of Adult Family Members and Friends as Interpreters

Question: When providing care to LEP patients, how often do you use patients’ adult friends or family members as interpreters?


Hospital System Always/Usually Sometimes Never TotalSystem A (WI) 20% ( 11) 61% ( 35) 19% (11) 57System B (MD) 31% ( 98) 56% (180) 13% (42) 320System C (MN) 23% ( 39) 67% (114) 10% (17) 170System D (NC) 31% ( 91) 60% (177) 9% ( 26) 294System E (FL) 40% (107) 53% (139) 7% (19) 265System F (SC) 10% ( 32) 56% (175) 34% (105) 312Total All MD’s 27% 378 58% 820 15% 220 1,418

Hospitals Vary Widely In Their Use of Minor Children as Medical Interpreters

Question: When providing care to LEP patients, how often do you use patients’ minor children (<18 years old) as interpreters?


Hospital System Always/Usually Sometimes Never TotalSystem A (WI) 3% ( 2) 30% ( 17) 67% (38) 57System B (MD) 10% ( 32) 38% (120) 52% (168) 320System C (MN) 10% ( 17) 42% ( 71) 48% (82) 170System D (NC) 11% ( 32) 51% (149) 38% (112) 293System E (FL) 12% ( 39) 44% (132) 44% (132) 303System F (SC) 5% ( 15) 22% ( 70) 73% (225) 310Total All MD’s 10% 137 38% 559 52% 757 1,453

Most Physicians Are Not Familiar With Legal Requirements for Working With Interpreters.

Question: How familiar are you with legal requirements for working with interpreters?


Very Fam. Rel. Unfamiliar Hospital System or Familiar or Unfamiliar TotalSystem A (WI) 71% ( 41) 29% ( 17) 58System B (MD) 41% (140) 59% (199) 339System C (MN) 38% ( 67) 62% (108) 175System D (NC) 37% (112) 63% (188) 300System E (FL) 41% (136) 59% (198) 334System F (SC) 69% (247) 31% (110) 357Total ALL Hospital MD’s 48% 743 52% 820 1,563


Most MD’s Always Use Interpreters To Obtain Informed Consents From LEP. But 37% Do Not.

Question: How frequently do you use an interpreter to obtain an LEP patient’s informed consent to a procedure?

All Physician Respondents

Hospital System Always Less Than Always* TotalSystem A (WI) 71% ( 41) 29% ( 17) 58System B (MD) 48% (156) 52% (168) 324System C (MN) 73% (127) 27% ( 46) 173System D (NC) 65% (187) 35% (102) 289System E (FL) 55% (170) 45% (138) 308System F (SC) 76% (241) 24% ( 75) 316Total – All MD’s 63% 922 37% 546 1,468* Less than always = respondents who selected usually, sometimes or never.Source: Critical Measures Provider Database

45% of MD’s Do Not Always Document The Use of An Interpreter In The Patient’s Medical Record.

Question: How frequently do you document the use of an interpreter in the patient’s medical record?


Hospital System Always Less Than Always* TotalSystem A (WI) 65% ( 37) 35% ( 20) 57System B (MD) 53% (170) 47% (153) 323System C (MN) 47% ( 80) 53% ( 91) 171System D (NC) 49% (143) 51% (151) 294System E (FL) 42% (130) 58% (177) 307System F (SC) 78% (245) 22% ( 71) 316Total – All MD’s 55% 805 45% 663 1,468* Less than always = respondents who selected usually, sometimes or never.Source: Critical Measures Provider Database

Only 26% of MD’s Always Use the Teach-Back Method to Check for LEP Patient’s Understanding.

Question: When providing care to LEP patients, how frequently do you ask patients’ to repeat your instructions to check on their level of understanding?


Hospital System Always Less Than Always* TotalSystem A (WI) 39% ( 22) 61% ( 35) 57System B (MD) 30% ( 96) 70% (229) 325System C (MN) 21% ( 37) 79% (135) 172System D (NC) 20% ( 59) 80% (235) 294System E (FL) 29% ( 88) 71% (220) 308System F (SC) 28% ( 84) 73% (232) 316Total – All MD’s 26% 386 74% 1,086 1,472

* Less than always = respondents who selected usually, sometimes or never.Source: Critical Measures Provider Database

86% of Physicians Sampled Provide Care to Immigrants and Refugees.

Question: Do you provide care to patients who are immigrants and/or refugees?

ALL Physician RespondersPosition YES___ NO____ TotalSystem A (WI) 86% ( 50) 14% ( 8) 58System B (MD) 81% (273) 19% ( 64) 337System C (MN) 92% (159) 8% ( 14) 173System D (NC) 89% (261) 11% ( 33) 294System E (FL) 92% (307) 8% ( 27) 334System F (SC) 79% (278) 21% ( 75) 353Total 86% 1,328 14% 221 1,549


Yet 48% of MD’s Are Less Than Well Prepared to Treat Immigrant Patients.

Question: How prepared do you believe that you are to provide care to patients who are new or recent immigrants?

Physician Respondents Only

Very Well or Less Than Position Well Prepared Well Prepared TotalSystem A (WI) 57% ( 34) 43% ( 26) 60System B (MD) 40% (139) 60% (195) 334System C (MN) 47% ( 84) 53% ( 95) 179System D (NC) 44% (134) 56% (171) 305System E (FL) 73% (259) 27% ( 95) 354System F (SC) 50% (178) 50% (181) 359Total 52% 828 48% 763 1,591


Primary Care MD’s Believe Themselves Less Prepared to Treat Immigrants Than Other MD’s.

Question: How prepared do you believe that you are to provide care to patients who are new or recent immigrants?

Primary Care MD Respondents Only

Very Well or Less Than Position Well Prepared Well Prepared TotalAll Physicians 52% 828 48% 763 1,591Family Medicine MDs 40% ( 68) 60% (104) 172OB-GYN MDs 39% ( 35) 61% ( 54) 89Pediatric MDs 49% ( 85) 51% ( 87) 172Internal Medicine MDs 45% ( 49) 55% ( 61) 110All Primary Physicians 44% 237 56% 306 543


Most MDs Are Unfamiliar With Two of the Five Leading Diseases Among Immigrants.

Question: How familiar would you say that you are with the following diseases ….?

All MD Respondents/All Clients

Very Fam. Rel. Unfamiliar Disease or Familiar or Unfamiliar TotalStrongyloides 30% (402) 70% (925) 1,327Schistosomaisis 42% (555) 58% (765) 1,320Malaria 73% (969) 27% (350) 1,319Hepatitis B. 93% (1,234) 7% ( 94) 1,328Tuberculosis 93% (1,236) 7% ( 89) 1,325

Primary Care MD’s Are More Likely Than MD’s Generally To Ask About Patients’ Sexual Partners.

Question: How frequently do you ask patients about whether they have sex with men, women or both?

All Primary Care MD Respondents

Position Always Less Than Always* TotalTotal – All MD’s 11% 158 89% 1,221 1,379Family Medicine MD’s 23% ( 31) 77% (103) 134OB-GYN MD’s 34% ( 28) 66% ( 54) 82Pediatric MD’s 11% ( 17) 89% (133) 150Internal Medicine MD’s 26% ( 24) 74% ( 69) 93Total Primary Care MD’s 22% 100 78% 359 459


Primary Care MD’s Are More Likely Than MD’s Generally To Ask About Patients’ Sexual History.

Question: How frequently do you ask patients about whether they have sex with men, women or both?

All Primary Care MD Respondents

Position Always Less Than Always* TotalTotal – All MD’s 11% 145 89% 1,231 1,376Family Medicine MD’s 17% ( 22) 83% (110) 132OB-GYN MD’s 43% ( 35) 57% ( 47) 82Pediatric MD’s 14% ( 21) 86% (129) 150Internal Medicine MD’s 23% ( 21) 77% ( 72) 93Total Primary Care MD’s 22% 99 78% 358 457


60% of Physicians Have Never Had Any Formal Training on Cross-Cultural Medicine.

Question: Have you ever received any formal training on cross-cultural medicine?

All Physician (MD) RespondentsYes Yes No/Don’t

Hospital System <5 yrs > 5 yrs Know TotalSystem A (WI) 14% 26% 60% 58 System B (MD) 15% 24% 61% 333 System C (MN) 24% 16% 54% 161 System D (NC) 14% 17% 69% 296 System E (FL) 23% 18% 59% 332System F (SC) 27% 19% 54% 352Total 20% 20% 60% 1,532

Source: Critical Measures Provider Database, 2017

69% of All MD’s Surveyed Want Additional Training On Cross-Cultural Care.

Question: How important is it to you to receive training and information on cross-cultural care?

All Physician (MD) RespondentsVery Important Relatively Unimp.

Hospital System Or Important Or Unimportant TotalSystem A (WI) 57% ( 33) 43% ( 25) 58System B (MD) 66% (220) 34% (114) 334System C (MN) 71% (123) 29% ( 50) 173System D (NC) 67% (197) 33% ( 96) 293System E (FL) 75% (246) 25% ( 84) 330 System F (SC) 70% (247) 30% (105) 352Total – All MD’s 69% 1,066 31% 474 1,540

Source: Critical Measures Database, 2017

Next Steps: Rating Provider Competence in Treating

Minority Patient Populations

Next Steps: Rating Providers’ Clinical Competence in Minority Patient Care

1. Critical Measures is working with leading national medical experts to rate providers’ clinical competence in treating each of the minority patient populations contained in our assessment.

2. Separate rating systems will be developed for each patient population based on provider use of clinical best practices specific to that population.

3. Thus far, we have developed rating systems that evaluate providers performance in treating LEP and Deaf/hoh patients.

4. Over time, we hope to develop a comprehensive rating system that aggregates patient sub-domain scores into a single comprehensive score.

1. Overall Ratings – 25.5% of 1,199 physicians were rated as “excellent” (90+), 36.7% were rated as “good” (80-89), 26.1% were rated as “fair” (70-79) and 11.7% were rated as “poor” (<70).

Score ALL MD’s

Excellent (90+) 25.5%Good (80-90) 36.7%Fair (70-80) 26.1%Poor (<70-70) 11.7%

As a result, under this methodology, 62% of 1,199 physicians were rated as either “excellent” or “good” while 38% were rated as “fair” or “poor”.

Application of Scoring MethodologyTo National Data Base

Score All MD’s E.D. Hospitalist Surgeon Other

Excellent/Good 62.2% 44.5% 70.9% 54.9% 72.1%(80-100)Fair/Poor 37.8% 55.5% 29.1% 45.1% 27.9%(<70-79)

N = 1,199 72 55 186 463

< Well Prepared 53% 38.9% 34.5% 54.8% 50.1%

Results Show Marked Differences ByType of Provider

Score All MD’s Family OB/GYN Pediatric Internist Medicine

Excellent/Good 62.2% 49.2% 61.4% 65.6% 49.4%(80-100)Fair/Good 37.8% 50.7% 38.6% 34.3% 50.6%(<70-79)N = 1,199 134 70 134 85

< Well Prepared 53% 70.7% 63.2% 51.5% 57.6%

Results Show Substantial Differences Among Primary Care Physicians

Next Steps: Targeted Training Interventions

Language Access and the Law: Outcomes

• 92% of provider users strongly agreed or agreed that “the information presented in the program will help me to improve patient care.” (6% expressed no opinion. 2% disagreed.)

• 87% of all MD users strongly agreed/agreed that they would recommend the Language Access and the Law e-learning activity to colleagues. (12% no opinion, 2% disagreed.)

Initial Results Show That MDs Use Interpreters More, Family Less

• Significantly, physician users stated that they increased their use of trained medical interpreters (including telephonic interpreters) by 37% after completing the program compared to their self-reported use rates prior to taking the program.

• Further, physician users self-reported use of family members and adult friends as interpreters decreased by 55% from pre to post activity completion.

• Before taking the course, 49% of participants considered the topic of language access for LEP patients to be “very important.” After taking the course, 82% of participants considered the topic of language access for LEP patients to be “very important”. (+33%)

• The average pre-test score was 55. The average post-test score was 81 – an improvement of 26 points or 32%.

Viewpoints - Objectives

1. Improve identification and treatment of diseases of foreign origin2. Overcome communication challenges with diverse patients: LEP, deaf and

hard of hearing, immigrant and refugee and GLBT patients3. Improve patient trust, clinical outcomes and patient satisfaction4. Avoid unwanted litigation and legal exposure by taking preventive measures5. Improve clinical objectivity by overcoming unconscious biases and

assumptions6. Learn skills to improve care to all patients in a globally mobile world7. Meets CME state requirements for patient safety, risk management, cultural

competence, and medical ethics

Viewpoints: User Outcomes

Viewpoints User Outcome Data2014-2016

Strongly Agree No Strongly Disagree

Criterion or Agree Opinion or DisagreeI would recommend this activity 80% 18% 2%

to my colleagues.

Overall, activity met my 80% 16% 4%expectations

Information presented will help 78% 20% 2%me to improve patient care.

Average pre-test score: 37 Average post-test score: 91Difference pre to post: +57

Source: Critical Measures, 86 total users (57 MD’s = 66%)

Viewpoints: User Outcomes

MD Users’ Self-Reported Confidence In TheirAbility to Effectively Care For Diverse Patients

Before and After Taking Viewpoints Course(% Confident or Very Confident)

Patient Type Before After DifferenceGlobally Mobile Patients 66% 87% +21%Immigrants & Refugees 52% 84% +32%Deaf and HOH Patients 39% 80% +41%LEP Patients 70% 88% +18%GLBT Patients 80% 89% + 9%

Source: Critical Measures, February 2014 – June 2016, Total MD Users: 57.

Viewpoints: User OutcomesMD Users’ Self-Reported Use of Clinical

Best Practices When Caring For Diverse PatientsBefore and After Taking Viewpoints Course

(> 70% Using Practice)

Best Practice Before After Difference

Consider (non-U.S.-centric) 16% 44% +28%

travel-related diagnoses.

Ask patients about their country 18% 44% +26%

of origin and recent travel history.

Conduct a comprehensive sexual 14% 48% +34%

risk assessment on your patients.

Use qualified medical interpreters 24% 50% +26%

or ASL interpreters.

Use teach-back method to check 12% 44% +32%

for patient understanding.

Source: Critical Measures, February 2014 – June 2016, Total MD Users: 57.

Hunt Clinical Competence Global World€¦ · New Cultural Trends. 1. Racial and Ethnic Disparities...

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