Critical access hospital CLAS perspectives from the C-suite
Upcoming SlideShare
Loading in...5
×
 

Critical access hospital CLAS perspectives from the C-suite

on

  • 168 views

Purpose ...

Purpose
This descriptive, survey-based study extends earlier research by exploring how Critical Access Hospitals (CAHs) across the nation provide Culturally and Linguistically Appropriate Services (CLAS) for their patients.

Methods
Personal emails announcing a national electronic survey of CAHs in 45 states were sent to 968 of the 1,329 CAHs in the United States (73%). The survey was completed by 137 of the 1,329 CAHs (14.15% participation rate, 10.3% of all CAHs).

Findings
CAHs with larger non-White or non-English speaking patient populations had a greater variety and more frequent use of language services than CAHs that served less diverse populations. CAHs that collected cultural and linguistic information from patients were significantly more likely to have mechanisms in place to ensure this information followed the patient throughout the continuum of care. CAHs that collected cultural and linguistic information from patients offered significantly more mechanisms to address their patients’ cultural and linguistic needs. CAHs with larger non-White or non-English speaking populations were significantly more likely to employ FTEs related to CLAS than CAHs that served less diverse populations. CAHs with larger non-White or non-English speaking populations were not significantly more likely to provide CLAS training than CAHs that served less diverse populations.

Conclusions
Collection of patient demographic information may relate to use of that information in the patient’s healthcare encounter. Location in a diverse population may not be an indicator of the CAHs provision of CLAS services.

Statistics

Views

Total Views
168
Views on SlideShare
168
Embed Views
0

Actions

Likes
0
Downloads
3
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • The electronic survey link sent via National Rural Health Association’s e-newsletter in late December 2012 and again in mid-January 2013 did not yield any responses. Next, a list of all 1,329 critical access hospitals (CAHs) in the US was obtained from CMS. Their CEOs, CNOs or other executives’ names and email addresses were obtained from facility websites. Personal emails were sent to leaders of 1,116 CAHs (a letter template is shown in Appendix D). Some emails (13%) were returned as undeliverable. Between January 31, 2013 and March 13, 2013, an individual email was sent to 968 facilities with valid email addresses received one individual email with a follow-up reminder email approximately 10 days later, sent as a blind carbon copy (BCC) in batches of 10-50 addresses. There were 213 CAHs for which no email address was available and these facilities were not contacted. A follow up analysis indicated that contacted facilities and facilities that could not be contacted had an identical average number of beds (22.4 beds vs. 22.4 beds, respectively). Of the 968 facilities with deliverable emails, 270 (27.89%) opened the survey and 183 (18.90%) responded to the first question. Complete survey responses were obtained from 137 (14.15%) of the contacted CAHs and were analyzed to answer research questions.
  • The electronic survey link sent via National Rural Health Association’s e-newsletter in late December 2012 and again in mid-January 2013 did not yield any responses. Next, a list of all 1,329 critical access hospitals (CAHs) in the US was obtained from CMS. Their CEOs, CNOs or other executives’ names and email addresses were obtained from facility websites. Personal emails were sent to leaders of 1,116 CAHs (a letter template is shown in Appendix D). Some emails (13%) were returned as undeliverable. Between January 31, 2013 and March 13, 2013, an individual email was sent to 968 facilities with valid email addresses received one individual email with a follow-up reminder email approximately 10 days later, sent as a blind carbon copy (BCC) in batches of 10-50 addresses. There were 213 CAHs for which no email address was available and these facilities were not contacted. A follow up analysis indicated that contacted facilities and facilities that could not be contacted had an identical average number of beds (22.4 beds vs. 22.4 beds, respectively). Of the 968 facilities with deliverable emails, 270 (27.89%) opened the survey and 183 (18.90%) responded to the first question. Complete survey responses were obtained from 137 (14.15%) of the contacted CAHs and were analyzed to answer research questions.
  • Discuss data review – Prior to analysis the data was reviewed for normality. Histograms looked fairly normal, skewness and kirtosis calculations showed that data may not be normal. Transformation of data through square root transformation and Box-Cox transformation did not correct the data. Therefore, the original untransformed data was used for all data analysis.
  • Correlations were performed in SPSS using Pearson’s R which is a very popular correlation coefficient that quantitatively represents the linear relationship between two variables. When it is close to 1 there is a strong positive relationship, when it is close to 0 there is a weak relationship, when it is close to -1 there is a strong negative relationship.

Critical access hospital CLAS perspectives from the C-suite Critical access hospital CLAS perspectives from the C-suite Presentation Transcript

  • Critical Access Hospital CLAS perspectives from the C-Suite SHEILA KELTY, DHA, FACHE
  • Brought to you by: WWW.NCIHC.ORG
  • Background  The United States Supreme Court has interpreted Title VI of the Civil Rights Act of 1964 to mean that all healthcare providers who accept Medicare and Medicaid must provide culturally and linguistically appropriate services (CLAS) for their patients.  The United States Department of Health and Human Services’ Office of Minority Health issued a set of national standards for CLAS to “ensure that all people entering the health care system receive equitable and effective treatment in a culturally and linguistically appropriate manner Sources: Youdelman, 2008 ; United States Department of Health and Human Services Office of Minority Health, 2001.
  • Necessity for CLAS  Increase in diverse populations in rural areas  No reimbursement for CLAS expenses  Immigrants have higher rates of infectious diseases than established US populations  Physicians order more diagnostic testing when there is a language barrier  Lower patient satisfaction scores and decreased patient compliance when there is a language barrier without language services  Use of a professional trained interpreter results in less diagnostic testing, lower cost & shorter length of stay. Sources: Johnson, 2012; Armanda & Hubbard, 2010; Whitman & Davis, 2008; Hampers, Cha, Gutglass, Binns, & Krug, 2009
  • Language Services  Types of language services  Trained vs. Untrained  On-site vs. Off-site  Language concordant  Availability vs. Use  Clinical staff not encouraged to use language services  Depend on their own limited foreign language skills  Time and inconvenience Sources: Hudleson & Vilpert, 2009; Diamond, Schenker, Curry, Bradley, & Fernandez, 2009.
  • Culture  Required collection:  Race  Ethnicity  Primary Language  Cultural health disparities affect outcomes  Need for education, awareness and understanding of cultures in the patient population and community Sources: Graves, Like, Kelly, & Hohensee, 2007
  • Research Questions 1) Do CAHs that collect cultural and linguistic information from patients upon admission have more mechanisms in place to meet these cultural and linguistic needs than CAHs that do not collect cultural and linguistic information from patients upon admission?
  • Research Questions 2) Do CAHs that collect cultural and linguistic information from patients upon admission have more mechanisms in place to ensure this information follows the patient throughout the continuum of care than CAHs that do not collect cultural and linguistic information from patients upon admission?
  • Research Questions 3) Do CAHs that have larger non-white and non-English speaking populations have a greater number of CLAS specific employees and provide more training than CAHs that have smaller non-white and non-English speaking populations?
  • Research Questions 4) Do CAHs that have larger non-English speaking populations have a greater variety of language services available and use them more often than CAHs that have smaller non-white and nonEnglish speaking populations?
  • Research Questions 5) Do CAHs that have written policies and procedures for CLAS allocate money to CLAS related services more often than CAHs that do not have written policies and procedures for CLAS?
  • Methods  Population: 1,329 Critical Access Hospitals located in the United States  As designated by Centers for Medicare and Medicaid Services  Connecticut, Delaware, Maryland, New Jersey, and Rhode Island do not have CAHs.
  • Methods  Web-based Electronic Survey (Qualtrics)  Invitation through National Rural Health Association e-newsletter (December 2012 & January 2013)  Emails to CEOs, CNOs, or other executives at 1,116 CAHs  Reminder emails sent 10 days after original email
  • Methods  Each CAH was asked questions about CLAS in their facility that corresponded to the following categories:         Collection of cultural and linguistic information from patients Mechanisms in place to meet cultural and linguistic needs Mechanisms in place to ensure cultural and linguistic information follows patient throughout continuum of care Percentage of race/ethnicity and primary languages of patient base Established multicultural services departments and human resources/employee training in CLAS Variety of language services available and frequency of use Written plans and policies for CLAS Funding for CLAS
  • Results  270 CAHs opened the survey  183 CAHs responded to the first question  137 CAHs completed the survey (10.31% of U.S. CAH population; 14.15% of contacted CAHs)  All of the survey questions were answered by 78 of the CAHs (8.06% participation rate, 5.87% of all CAHs)
  • Results  Less than 10% of the patients served by the CAHs responding to the survey have a primary language other than English  Less than 20% of the patients served by the CAHs responding to the survey are not white
  • Results  85.5% of the CAHs participating in the survey have a written patient care policy addressing provision of language services  51.3% of the CAHs participating in the survey have a written patient care policy addressing provision of culturally appropriate services  68.0% of the CAHs participating in the survey are certified by their State Department of Health, 22.7% are certified by The Joint Commission
  • Results CAHs that always use interpreter, by interpreter type and patient population 18.00% 16.00% 14.00% 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0.00% CAHS with higher percentage of patients who don't speak English (> 8.00% , median n=62) CAHS with lower percentage of patients who don't speak English (> 8.00% , median n=76) Trained External Interpreter Trained Internal Interpreter Untrained External Interpreter Untrained Internal Interpreter
  • Results 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% CAHs that never use interpreter, by interpreter type and patient population CAHS with higher percentage of patients who don't speak English (> 8.00% , median n=62) CAHS with lower percentage of patients who don't speak English (> 8.00% , median n=76) 0.00% Trained External Interpreter Interpreter Trained Internal Untrained External Interpreter Interpreter Untrained Internal
  • Results 1) Do CAHs that collect cultural and linguistic information from patients upon admission have more mechanisms in place to meet these cultural and linguistic needs than CAHs that do not collect cultural and linguistic information from patients upon admission?  There is a significant positive relationship between collecting cultural and linguistic information from patients and the availability of mechanisms to address the cultural and linguistic needs of the patients.
  • Results 2) Do CAHs that collect cultural and linguistic information from patients upon admission have more mechanisms in place to ensure this information follows the patient throughout the continuum of care than CAHs that do not collect cultural and linguistic information from patients upon admission?  There is a significant positive relationship between collection of cultural and linguistic information from patients and having mechanisms in place to ensure this information follows the patient throughout the continuum of care.
  • Results 3a) Do CAHs that have larger non-white populations have a greater number of employees with CLAS specific duties than CAHs that have smaller non-white and non-English speaking populations?  There is a significant positive relationship having a larger non-white populations and having a greater number of employees with CLAS specific duties than CAHs that have less diverse populations.  There is a significant positive relationship having a larger non-English speaking populations and having a greater number of employees with CLAS specific duties than CAHs that have less diverse populations.
  • Results 3b) Do CAHs that have larger non-white populations provide more CLAS specific training than CAHs that have smaller non-white and non-English speaking populations?  There is not a significant relationship having a larger nonwhite populations providing more CLAS specific training than CAHs that have less diverse populations.  There is not a significant relationship having a larger nonEnglish speaking populations and providing more CLAS specific training CAHs that have less diverse populations.
  • Results 4) Do CAHs that have larger non-English speaking populations have a greater variety of language services available and use them more often than CAHs that have smaller non-English speaking populations?  There is a significant positive relationship between having a larger non-English speaking populations and having a greater variety of and more frequent use of language services.
  • Scatter Plot of Correlation between Language Services & Non-English Speaking Population
  • Results Descriptive statistics (M & SD) and inter-correlations Median 1 2 3 4 5 6 7 8 9 1 .330** .408** .090 -.021 .202* .104 .410** .108 131 124 129 130 129 116 87 129 131 1 .351** .250** .290** .331** .185* 141 139 128 127 118 87 .543**130 141 1 .093 .060 .191* .132 .513** .281** 150 135 134 125 87 137 150 1 .751** .217** .045 .131 .306** 138 137 121 87 134 137 1 .173* -.012 .242** .371** 137 120 87 133 136 1 .074 .266** .247** 128 78 124 128 1 .398** .137 89 88 89 1 .387** 139 139 1. Collect cultural & linguistic info 7.00 2. Meet cultural & language needs 1700 .860** 3. Follow continuum of care 2.00 4. Serve nonwhite population 5. Serve nonEnglish population 10.00 4.00 6. Employ CLAS FTEs 0.05 7. Provide CLAS training 8.00 8. Maintain written policies for CLAS 6.00 9. Offer language services 1 8.00 Notes: * p >0.05; ** p > 0.01 179
  • Limitations  Sample size  Response rate  CAHs may not be representative of other larger or non-rural hospitals
  • Conclusion & Discussion  There is a positive correlation between CAHs that gather information regarding race, ethnicity, and language from the patient CAHs that have more mechanisms in place to meet the CLAS needs of patients.  There is a positive correlation between CAHs that gather information regarding race, ethnicity, and language from the patient and CAHs who pass this information on throughout the continuum of care within their facility. This could be due to the use of electronic health records.
  • Conclusion & Discussion  There is a positive correlation between CAHs with larger non-white or non-English speaking patient populations and CAHs who provide more language services for their patients.  There is no significant correlation between CAHs with larger non-white or non-English speaking patient populations and CAHs who provide more CLAS training for their employees. This could be because many hospitals do not use their own staff to provide language services.
  • Conclusion & Discussion  CAH executives should review how they use the race, ethnicity, and language information they are collecting from their patients to determine how they could use this information to better meet the CLAS needs of these patients  CAH executives should review the mechanisms in place for meeting CLAS standards and determine how to implement more mechanisms to better meet the CLAS needs of their patients.  CAH executives should review the need to offer more CLAS education provided to their employees and determine how to measure CLAS competency of their staff.
  • References          Armanda, A.A., & Hubbard, M.F. (2010) Diversity in healthcare: Time to get REAL! Frontiers of Health Service Management, 26(3), 3-17. Diamond, L.C., Schenker, U., Curry, L., Bradley, E. H., & Fernandez, A. (2009) Getting by: Underuse of interpreters by resident physicians. Journal of General Internal Medicine, 24(2), 256262. Graves, D. L., Like, R. C., Kelly, N., & Hohensee, A. (2007) Legislation as intervention: A survey of cultural competence policy in healthcare. Journal of Health Care Law & Policy, 10, 339-361. Hampers, L.C., Cha, S., Gutglass, D.J., Binns, H.J., & Krug, S.E (1999) Language barriers and resource utilization in a pediatric emergency department. Pediatrics, 103(6), 1253-1256. Hudelson, P., & Vilpert, S. (2009). Overcoming language barriers with foreign-language speaking patients: a survey to investigate intra-hospital variation in attitudes and practices. BMC Health Services Research, 9(187). Johnson, K. M. (2012). Rural demographic change in the new century: slower growth, increased diversity. The Carsey Institute at the Scholar's Repository, (159). United States Department of Health and Human Services Office of Minority Health (2001). National standards for culturally and linguistically appropriate services in health care: Final report. Retrieved June 13, 2010 from http://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf Whitman M.V., & Davis, J.A (2008). Cultural and linguistic competence in healthcare: The case of Alabama general hospitals. Journal of Healthcare Management, 53(1), 26-40. Youdelman, M.K. (2008). The medical tongue: U.S. laws and policies on language access. Health Affairs, 27(2), 424-443.
  • Questions Spurningar 질문 Вопросы Kysymyksiä Fragen 有問題嗎 Vprašanja Câu hỏi
  • Contact Info Sheila Kelty, DHA, FACHE LinkedIn: http://www.linkedin.com/pub/sheila-kelty/19/4a8/47 Email: sheilakelty@gmail.com
  • WWW.NCIHC.ORG