From Evidence to Action – A Recent Client Case Study
Critical Measures worked with a Midwestern multi-hospital system from 2011 to 2013 to conduct a CLAS-based organizational assessment, Language Access Audit and a Provider Cultural and Linguistic Competence Assessment. This client is based in a community that has seen a substantial influx of Somali, Hmong and Hispanic immigrants over the last decade.
Our CLAS-based organizational assessment and Language Access Audit identified many quality and safety issues with the client’s provision of language access services to Limited English Proficient (LEP) and Deaf and Hard of Hearing patients. We worked with the client to remedy many of these issues.
Then, we conducted our electronic Provider Cultural and Linguistic Competence Assessment. Over 500 doctors, nurses and advanced practice providers took the assessment. The results for the client’s doctors showed:
- 97% treated LEP patients. (Similar to the U.S. average.)
- Nearly half of client’s providers felt “less than well prepared” to care for these patients.
- Client’s primary care M.D.s, by their own self-evaluation, were the least well prepared to provide care to LEP patients despite the fact that they had the most frequent contact with them.
- 30% did not routinely use qualified interpreters to obtain the informed consent of LEP patients. Further, approximately 50% did not routinely record the use of an interpreter in the patient’s medical record.
- 92% treat immigrants and refugees. But over 60% of the client’s providers felt less than well prepared to do so effectively. Again, primary care M.D.s felt least well prepared to interact with these patients.
- 56% to 70% did not routinely ask about patients’ country of origin or recent travel history despite the fact that the answers to these questions could have substantially affected the patients’ ultimate diagnosis.
- 52% were unfamiliar with Schistosomaisis and an additional 65% were unfamiliar with Strongyloides – two of the five most common diseases found in immigrants and refugees to the U.S.
To address these issues, the client began training over 750 of its physicians and nurses through our Language Access and the Law e-learning program. Over 300 providers took and completed the program in the fall of 2013. Here is a sample of their initial results:
- 94% of users strongly agreed/agreed that the program met their expectations.
- 91% strongly agreed/agreed that the information presented would help them to improve patient care.
- 87% would recommend the program to colleagues.
- Prior to completing the program, 69% felt very confident/confident in their ability to treat LEP patients. After completing the program, 95% felt very confident/confident in their ability to treat LEP patients (+26%). (Note: when we first asked this question in 2011, 50% felt very confident/confident and 50% felt less than confident/not at all confident in their ability to treat LEP patients. Total gain: +45%.)
- Prior to taking the course, 63% believed the issue of language access for LEP patients was very important or important. After completing the program, 94% of users believed the issue was very important or important (+31%).
- From pre-test to post-course evaluation, the number of users who stated that it was their routine practice to use family members, friends or minor children to interpret for LEP patients was reduced by more than 50%.
- Prior to completing the course, 40% said that it was their routine practice to ask patients’ to repeat back their treatment instructions in their own words to check for understanding. After completing the course, 89% of users said that they would implement this practice (+49%).
- Average pre-test score: 57.8. Average post-test score: 80.9. Net gain: 23 points or 30% improvement.
With ongoing assistance from Critical Measures, this multi-hospital system continues to focus on improving the quality and safety of care for culturally and linguistically diverse patients. As a result of our work together, their physicians and staff have significantly improved system-wide health equity and reduced legal risks associated with the provision of language access services.
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