Hospital Language Services: Quality Improvement and Performance Measures

Hospital Language Services: Quality Improvement and Performance Measures
Marsha Regenstein, PhD, MCP; Jennifer Huang, MS; Catherine West, MS, RN; Holly Mead, PhD; Jennifer Trott, MPH; Melissa Stegun, MA

Abstract
For a growing segment of the U.S. population, language barriers affect patients’ ability to communicate effectively with health care providers. “Speaking Together” is the first national quality improvement (QI) collaborative focusing on improving operations of hospital-based language services. We employed a multistage process to develop quality performance measures for Speaking Together participants to use throughout the collaborative. The measures, which are grounded in the Institute of Medicine’s six domains of quality, underwent multiple levels of review prior to pilot testing. Early experiences with the measures highlight challenges with collecting information on patient care that has not previously been collected and the importance of engaging staff, including registration staff and senior management. Speaking Together hospitals have shown that QI efforts to measure and advance the delivery of high-quality language services represent challenging but important tasks for improving delivery of care for patients with limited English proficiency.

Introduction
In the United States, 21 million individuals speak English “less than very well” and are thus said to be limited English-proficient (LEP).1 For this growing segment of the population, poor health status and diminished access to health care are frequent challenges. As members of a racial, ethnic, or linguistic minority, people with LEP experience disproportionately high rates of infectious disease and infant mortality and are more likely to report risk factors for serious and often chronic diseases, such as diabetes and heart disease.2 Furthermore, individuals with LEP are less likely to have a regular source of primary care3 and to receive fewer preventive health services, such as mammograms.4
Language barriers can also adversely affect the delivery of care. For LEP populations, followup compliance,5 adherence to medication, and patient satisfaction are significantly lower than they are for English-speaking patients.6, 7 On the other hand, LEP patients who are provided with an interpreter make more outpatient visits, fill more prescriptions, and have higher satisfaction with care.8, 9 Thus, the ability to communicate with a health care provider can mean the difference between receiving higher or lower quality care.
Physicians who are unable to communicate effectively with their patients often compensate by engaging in costly practices, such as using more diagnostic resources or invasive procedures and overprescribing medications.10, 11

abrir aquí para acceder al documento AHRQ en pdf de 12 páginas:
http://www.ahrq.gov/downloads/pub/advances2/vol2/Advances-Regenstein_54.pdf.