An HHS Collaboration to Improve Quality of Care for Diverse Patients Guadalupe Pacheco, MSW Office of Minority Health, OS,OPHS HHS November 6, 2007

2 A National Health Concern u Health care providers in the U.S. are seeing an increase in the number of patients with different cultural backgrounds u Increasing diversity of patients challenge the provision of health care services Communication barriers between providers and patients can cause misunderstanding of diagnoses and treatment Cultural and linguistic differences can reduce patient compliance and satisfaction

3 Institute of Medicine 2002 Report: Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care u Potential sources of disparities Patients: minority patients are more likely to refuse recommended services, delay seeking care, and not follow physician orders Health care system: places time constraints on physicians and restricts time to overcome language and cultural barriers Providers: more likely to rely on shortcuts due to time constraints Patients: minorities have more difficulty trusting their health care providers

4 Statistics of Errors in Health Care* u Between 44,000 and 98,000 Americans die each year in hospitals as a result of medical errors u 7,000 deaths due to medication errors in 1993 u National costs for preventable adverse events are between $17 billion and $29 billion; health care costs account for over one-half of that total cost Cultural and linguistic competence may eliminate common errors, such as misunderstanding prescriptions, not following doctor’s orders, and failing to make follow-up appointments. * From To Err is Human: Building a Safer Health System. IOM, 2000.

5 What is A Physician’s Practical Guide to Culturally Competent Care? u Designed to equip providers with awareness, knowledge, and skills required to treat diverse patients u Accredited for up to 9 continuing education hours for: Physicians Physician Assistants Nurse Practitioners Nurses Pharmacists u Funded by the Office of Minority Health, Department of Health and Human Services u Offered online at no cost u Launched in December 2004

6 Development Process of the Curriculum

7 Curriculum Design and Features Participants can: u Watch streaming video case studies u Answer pre- and posttests that provide immediate feedback u Take surveys u Receive instant online grading and CME/CEU certification at no cost u Order the complementary DVD supplement u View other providers’ comments

8 CMS Quality Improvement Organizations u Contracted by CMS to conduct case review to ensure care provided to Medicare beneficiaries meets nationally recognized standards of health care u Work with consumers, physicians, hospitals, and other caregivers to make health care: Safe Effective Patient-Centered Timely Efficient Equitable

9 QIO Statement of Work u Based on Part B of Title XI of the Social Security Act u Requirements for QIO Program include: Improve quality of care for beneficiaries Protect the integrity of the Medicare Trust Fund by ensuring Medicare pays for services that are reasonable and medically necessary Protect beneficiaries by addressing individual complaints and provider-issued notices u Currently involved in the 8 th Statement of Work (until 2008) Includes Tasks 1, 3, and 4

10 Task 1d2 : Improvement of Quality of Care u Designed to improve quality of care with respect to preventing and treating clinical disorders u States QIOs will promote cultural competency and improved quality of primary care to underserved populations u Uses CCCMs as program of choice to conduct cultural competency improvement Practice level: one practitioner or clinic administrator 80% of practices must complete Theme 3: Organizational Supports Practitioner level: 80% of selected practitioners must complete Theme 2: Language Access Services Completion is defined as receiving score of 70% or better on theme posttest

11 OMH and QIO Partnership u The QIO Facilitator’s Guide Funded by Centers for Medicare and Medicaid Services and the Underserved Quality Improvement Organization Support Center Enables facilitators to deliver A Physician’s Practical Guide to Culturally Competent Care to a group of health care providers Includes PowerPoint slides to accompany material taught in session Used by QIOs throughout the country during facilitated sessions u Technical support OMH contractors offer technical assistance during QIO facilitated sessions via phone and

12 QIO User Statistics* 4,415 of 12,327 users are QIO affiliated * As of September 26, 2007

13 Participants Age

14 Participants Ethnicity

15 QIO Top Degrees and Specialties SpecialtyPercentage Family Medicine47% Internal Medicine19% Pediatrics4% Obstetrics/Gynecology3% Degree TypePercentage Medical Degree (MD)43% Registered Nurse (RN)12% Nurse Practitioner (NP)7% Bachelors6% Doctor of Osteopathy (DO)5%

16 QIO Registrants State by State

17 Participants Posttest Averages Module Posttest

18 QIO Survey Feedback u “The Facilitator’s Guide was extremely helpful. It is one of the most comprehensive, step-by-step guides for facilitating a curriculum that I’ve ever seen.” u “Participant interaction flows pretty naturally from the content, especially the video vignettes.” u “The video vignettes are great. Participants frequently cite them as the best part of the course, and they definitely promote the most discussion.” u “Participants enjoyed having a hard copy of the certificate to take with them.”

19 Additional OMH Programs u Culturally Competent Nursing Modules Released in March 2007 Free online course accredited for nurses and social workers u Health Care Language Services Implementation Guide Released in June 2007 Online tool to assist health care organizations in implementing language access services to serve patients with limited English proficiency u Disaster Response Cultural Competency Curriculum Currently in development Will target EMS personnel, disaster mental health workers, and disaster organization personnel

20 For More Information, Contact: Guadalupe Pacheco, MSW Project Officer Office of Minority Health, HHS Ann Kenny, MPH, BSN, RN Project Director SRA International