National Healthcare Disparities Report - LDI Health Economist

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Patient Centeredness Chapter 5 Similarly, the HHS Office for Civil Rights, in partnership with 18 medical schools in the National Consortium for Multicultural Education, funded by the National Institutes of Health, provides a course on cultural competency in medicine that focuses on Title VI compliance, “Stopping Discrimination Before It Starts: The Impact of Civil Rights Laws on Health Care Disparities.” iv This course discusses, in part, the HHS Office for Civil Rights’ Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons. This guidance explains that recipients of Federal financial assistance must take reasonable steps to provide LEP people with a meaningful opportunity to participate in HHS-funded programs. Failure to do so may violate the prohibition under Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d et seq., against national origin discrimination (HHS, 2008). In addition, the HHS Office for Civil Rights is responsible for the enforcement of Section 1557 of the Affordable Care Act, 42 U.S.C. 18116, which provides that an individual shall not be excluded from participation in, be denied the benefits of, or be subjected to discrimination on the grounds prohibited under Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d et seq. (race, color, national origin), Title IX of the Education Amendments of 1972, 20 U.S.C. 1681 et seq. (sex), the Age Discrimination Act of 1975, 42 U.S.C. 6101 et seq. (age), or Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 794 (disability), under any health program or activity, any part of which is receiving Federal financial assistance, or under any program or activity that is administered by an executive agency or any entity established under Title I of the Affordable Care Act or its amendments. Importance Morbidity and Mortality n Patient-centered approaches to care have been shown to improve patients’ health status. These approaches rely on building a provider-patient relationship, improving communication, fostering a positive atmosphere, and encouraging patients to actively participate in provider-patient interactions (Stewart, et al., 2000; Anderson, 2002). n A patient-centered approach has been shown to lessen patients’ symptom burden (Little, et al., 2001). n Patient-centered care encourages patients to comply with treatment regimens (Beck, et al., 2002). n Patient-centered care can reduce the chance of misdiagnosis due to poor communication (DiMatteo, 1998). Cost n Patient centeredness has been shown to reduce underuse and overuse of medical care (Berry, et al., 2003). n Patient centeredness can reduce the strain on system resources and save money by reducing the number of diagnostic tests and referrals (Little, et al. 2001). n Although some studies have shown that being patient centered reduces medical costs and use of health service resources, others have shown that patient centeredness increases providers’ costs, especially in the short run (Bechel, et al., 2000). iv This course (available in the Association of American Medical Colleges’ MedEdPORTAL, https://www.mededportal.org/publication/7740) has been presented at five national medical schools. For the 2011-2012 academic year, “Stopping Discrimination Before It Starts” has been incorporated into the fourth year curriculum at Emory University School of Medicine and the University of Colorado School of Medicine. 164 National Healthcare Quality Report, 2011
Patient Centeredness Measures The National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR) track several measures of patients’ experience of care. The reports also address the priority of ensuring that each person and family are engaged as partners in their care, found in the National Strategy for Quality Improvement in Health Care. v The rationale is that “[h]ealth care should give each individual patient and family an active role in their care. Care should adapt readily to individual and family circumstances, as well as to differing cultures, languages, disabilities, health literacy levels, and social backgrounds.” Examples of person-centered care could be ensuring that patients’ feedback on their preferences, desired outcomes, and experiences of care is integrated into care delivery and enabling patients to effectively manage their care. The NHDR has tracked a growing number of patient centeredness measures. Organized around the National Strategy for Quality Improvement in Health Care (National Quality Strategy), the 2011 NHDR presents the following measures that relate to the goal to provide patient-centered care: Chapter 5 n Adults and children who reported poor communication at the doctor’s office (composite). n Adults who reported poor communication with nurses and doctors at the hospital. n Provider’s involvement of the patient in making treatment decisions. This year, the NHDR includes an expanded section that deals with language and includes some contextual data on primary language spoken at hospitals in California and New Jersey. In addition, this chapter includes two supporting measures: whether language assistance was provided by the usual source of care and need for a translator. The last supporting measure deals with whether a provider sometimes or never asked for the patient’s help in making treatment decisions. This measure relates to the National Quality Strategy goal of patient engagement. Findings Patients’ Experience of Care—Adults Optimal health care requires good communication between patients and providers, yet barriers to providerpatient communication are common. To provide all patients with the best possible care, providers need to understand patients’ diverse health care needs and preferences and communicate clearly with patients about their care. v Available at www.healthcare.gov/center/reports/nationalqualitystrategy032011.pdf. National Healthcare Quality Report, 2011 165
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U.S. Department of Health and Human
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