Published by: Boris Kalanj on 10/20/2011 9:37:06 AM
This entry is the fourth in a series for National Healthcare Quality Week (Oct. 16-22).
This month’s issue of Health Affairs provides us with a new progress report on the state of equity in America’s health care. The issue comes a full 10 years following the seminal Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century, which affirmed quality as a mainstream concern in health care with equity as one of its integral parts.
Equitable care was defined as care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, or socioeconomic status. In the decade since the report, much research has been done on healthcare disparities and while some studies have documented modest progress, numerous others have found persistent disparities in such important areas as healthcare access, utilization, quality, outcomes, and patients’ experience with care.
Nowhere are the issues of equity more resonant than in the world of public hospitals. In California, the 19 members of the California Association of Public Hospitals and Health Systems (CAPH) represent only 6% of all hospitals statewide, yet they provide nearly 50% of the hospital care to the state’s uninsured. They also serve a population that is over 70% non-White and over 50% limited-English proficient (LEP). Given this incredible patient diversity, many public hospitals have taken the challenge of providing equitable, patient-centered and culturally competent care head-on.
Here are a couple of examples: First, California’s public hospitals recognized very early that enabling effective communication across language barriers is one of the key strategies for alleviating disparities. Back in 2003, when I managed a nascent interpreting program in a hospital in the Upper Midwest, I made a visit to Alameda County Medical Center, which at that time had an effective program of sharing staff interpreters with San Francisco General Hospital through an innovative videoconferencing technology. These were the early days of public hospital leadership on providing meaningful access to health care for LEP patients. Many private companies nation-wide have since picked up on this idea and video remote interpreting (VRI) is now a major mode of providing healthcare interpreter services.
However, public hospitals have retained their lead. These days, as a staff member at the California Health Care Safety Net Institute (SNI), I am proud that some six years ago my organization helped incubate what is now the Health Care Interpreter Network (HCIN), a sophisticated and user-friendly video/voice network where highly qualified interpreters are efficiently shared across 12 California public hospitals and several others. The network, which was written up by Elizabeth Jacobs and colleagues in the current issue of Health Affairs, provides more than 70,000 qualified health care interpretations per month, a three-fold growth from its beginnings 5 years ago.
In my second example, SNI is currently launching an initiative with California public hospital systems to work together to improve the patient experience. Recognizing that many gaps exist in our knowledge about patient experience, particularly for diverse patient populations, the SNI and CAPH members began with a quest for better data. All California public hospital systems have recently committed to implementing the CG-CAHPS survey, which was developed by AHRQ to measure and report patients’ perspectives of care in ambulatory settings. This is a pioneering project in the safety net and is being followed with significant interest by the national CAHPS development team.
The hospitals have reached consensus on a standardized and coordinated approach to CG-CAHPS implementation, which will enable them to compare their data and work together to improve performance. The survey will be administered in multiple languages and the results will be consistently stratified by race, ethnicity and primary language. Ultimately, having better data will help the public hospitals more effectively reveal, understand and mitigate any potential disparities in patient experience. This initiative was integrated with the Delivery System Reform Incentive Program created under California’s Section 1115 Medicaid Waiver as a unique pay-for-performance program under which public hospitals are working to meet ambitious milestones to improve quality, experience and outcomes of care.
Such attention to diversity is ubiquitous in most public hospitals. Many other examples could be drawn to illustrate how in this era of health care reform, the safety net seems poised to stay at the forefront of the nation’s quest for effective and equitable health care of our ever more heterogeneous population.
Mr. Boris Kalanj
Senior Program Associate, Quality and Healthcare Equity
CAPH - California Association of Public Hospitals and Health Systems