Language & Communication Access Services in Research Public Research Education Program (PREP) Office of Community and Public Health June 2, 2015 Gila Klein, CCRC Elizabeth C. McCulloch, PhD, MS Ashley La Mariana, MHA
CME Disclosure Statement The North Shore LIJ Health System adheres to the ACCME s new Standards for Commercial Support. Any individuals in a position to control the content of a CME activity, including faculty, planners, and managers, are required to disclose all financial relationships with commercial interests. All identified potential conflicts of interest are thoroughly vetted by the North Shore-LIJ for fair balance and scientific objectivity and to ensure appropriateness of patient care recommendations. Course Director and Course Planner, Kevin Tracey, MD and Tina Chuck, MPH have nothing to disclose. Elizabeth McCulloch, PhD, Ashley La Mariana, MHA and Gila Klein have nothing to disclose
Objectives 1. Highlight what we know about patient safety and limited English proficient (LEP) populations. 2. Provide evidence as to why we should focus on LEP populations. 3. Identify common causes of adverse events for LEP patients in research. 4. Discuss strategies to improve communication with LEP patients.
Essential Components for Achieving Excellent Patient Outcomes Health Literacy & Patient Education Language Education Community Diversity & Inclusion Research Governance Excellent Patient Outcomes Humanism = Dignity &Respect Cultural Competence Patient Care Source: Modified from Dr. Marc Nivet s AAMC Plenary address 11/2010
Diversity, Inclusion & Health Literacy Mission: Established June 2010 To promote, sustain and advance an environment that supports principles of equity, diversity, inclusion, health literacy and community. Vision: To build a community of excellence where the affirmation of differences is clearly seen in the composition of North Shore-LIJ leadership, faculty, staff and students, reinforced through its policies, practices and organizational structure, and woven into the fabric of its interpersonal relationships.
True or False The inability of a health care provider to communicate with limited English proficient (LEP) patients could represent a form of national origin discrimination. Providers may require LEP patients to use family members as interpreters. Providers have a legal duty to provide competent interpreters at no cost to the LEP patient. Federal law requires that each and every written document that English-speaking patients receive must be translated into the preferred written language of the LEP patient. Must a health care provider pay for an interpreter even if the cost exceeds the provider s charge for the appointment?
What is Limited English Proficiency (LEP)? A limited ability to read, write, speak or understand English. LEP can also include those with hearing, language, or other disabilities who may also require interpretive services or assistive technology.
Magnitude of the Issue Business: Affordable Care Act. Changes in demographic composition. Medical: Racial and ethnic disparities and disease trajectories. Legal: Civil Rights Act. American with Disabilities Act.
Magnitude of the Issue Business Case Minority groups are a large and growing population. Nearly 60 Million people in the U.S. are defined as Limited English Proficient (LEP). Accounting for 1/3 of the U.S. Population. Fastest growing demographic. 2% 2% 27% Queens 28% 23% 18% Asian Black Hispanic Multirace Other White
Interpreter Phone Usage North Shore-LIJ Health System Italian, 1,627 Arabic, 2,036 Cantonese, 2,667 Korean, 3,052 Mandarin, 6,021 Punjabi, 1,497 Albanian, 1,464 Bengali, 1,946 Haitian Creole, 1,450 Polish, 1,336 Spanish, 63,244 Hindi, 1,023 Number of Interpreter Calls 2009-2014 51,207 55,629 67,614 86,481 102,985 132,916 Russian, 7,419 2009 2010 2011 2012 2013 2014
North Shore-LIJ Health System Research Participants by Race/Ethnicity Total NS-HS Raw Across Total NS-HS Pct American Indian/Alaska Native 113 0% Asian 1,176 3% Black/African American 2,622 8% Latino/Hispanic 1,621 5% Native Hawaiian/Pacific Islander 22 0% White 20,876 62% Other/Multi-race 7,265 22% * Total 33,695 100%
Languages Employees Speak at The Feinstein Institute for Medical Research
Case Study A Haitian woman in her 70s who spoke Haitian Creole was seen at a health center several times complaining of gaz. Providers thought she was talking about gas and prescribed Mylanta. They did not perform any tests. In fact, she was describing general stomach pains that moved around (which is the meaning of gaz in Creole). By the time she was diagnosed with stomach cancer, it was too late to treat it. Cambridge Health Alliance, Cambridge, MA
Magnitude of the Issue Medical Case Patient Safety, Quality and Cost Drivers Patient Safety, Quality and Cost Drivers (continued) Risk Management Longer hospital stays Greater risk of surgical delays Greater risk of readmissions. Less access to primary care. Less likely to receive follow-up appointments after ED visits. Less likely to understand their diagnoses, medications, and followup instructions. Less satisfied with care received. May not receive equivalent levels of preventive care. Multiple liability exposures Poor/inadequate informed consent. Improper use of medications.
Case Study 13 yr. old, Anna (whose parents speak limited English) developed severe abdominal pain, her parents took her to the hospital. Anna was too sick to interpret and the hospital did not provide an interpreter. Her Spanish-speaking parents were told, without an interpreter, to bring her back immediately if her symptoms worsened, and otherwise to follow up with a doctor in three days. However, what her parents understood from the conversation was that they should wait three days to see the doctor. After 2 days, Anna s condition deteriorated and they felt they could no longer wait, and rushed her to the ED. Doctors discovered she had a ruptured appendix. She was airlifted to a nearby medical center in Phoenix, where she died a few hours later.
Magnitude of the Issue Legal Case Federal laws require providers to provide LAS to LEP and disabled patients. Title VI of Civil Rights Act of 1964 Americans with Disabilities Act CMS CLAS Laws in all 50 states require providers to provide LAS to LEP patients and families. Joint Commission. Patient-Centered Communication Standards.
The Story of Willie Ramirez An Intoxicating Error Results of not having an appropriate interpreter: Misunderstanding of intoxicado False cognate Probable intentional drug overdose Cultural deference to authority. Quadriplegic teen. $71 million lawsuit.
Display Signage of Services LEP Poster Patient Bill of Rights Main points of entry Patient care units
Patient s Preferred Language The language in which a patient prefers to communicate regarding health care. Assess at first point of patient contact. Document patient s preferred language in medical record.
Facilitate Use of Free Interpretation Services Offer free medical interpretation services. Explain the importance of using professional medical interpretation services. Cost for facility is $0.73 per minute for Spanish calls and $0.78 per minute for all other languages.
Interpreting Process of understanding a spoken message and re-expressing it accurately and objectively in another language, taking the cultural and social context into account. Interpreting is not the same as translation. Translation is used with the written word, whereas Interpreting is used with the spoken word.
The Risks of Using Untrained Interpreters If the patient refuses free medical interpretation services, consider Age and competency of Ad Hoc interpreter. Confidentiality. Conflict of interest.
Vital Documents Available Languages Albanian Arabic Bengali Chinese Farsi French Greek Haitian Creole Hebrew Hindi Italian Korean Mandarin Polish Portuguese Russian Spanish Tagalog Urdu
Language Access and Research Consents NSLIJHS HRPP Policies and Procedures
How to Consent LEP Subjects for Your Study Use an IRB-approved translated version of the English consent OR if authorized by the IRB, a short generic foreign language consent form along with the English consent form. Inform potential subject of their right to free interpretation services. Utilization of interpretation services should be documented in the medical record. If potential subject refuses services, an Ad Hoc interpreter can serve as a witness. Ad Hoc interpreter must be: Fluent in English and the preferred language, 16 years +, free of conflict
How to Consent LEP Subjects for Your Study Translated Consent Form (TCF) Short Form + English Consent Form (ECF) Bilingual approved investigator LEP subject Witness (anyone but the investigator) Investigator signs the ECF LEP subject signs the short form. Bilingual interpreter signs as witness to the process on both the ECF and short form. If bilingual interpreter is used: LEP signs TCF Interpreter signs as a witness on both TCF & ECF Investigator signs ECF If telephonic interpreter is used: There will be no witness on either TCF or ECF. Telephonic ID# should be documented on TCF with a detailed enrollment note. If telephonic interpreter is used: An in-person bilingual witness must sign as the witness to the process on both the ECF and the short form.
Tips for Working with an Interpreter 1. Allow the interpreter to greet you and to provide an interpreter ID number. 2. Write the interpreter ID number in the patient s file or progress notes for documentation. 3. Provide the interpreter with a brief explanation of the call. 4. Allow the interpreter to introduce him/herself to the patient. 5. Speak directly to your patient and make eye contact. 6. Speak in the first person. 7. Use short but complete phrases. 8. Avoid slang, jargon or metaphors. 9. Remember that everything is repeated and kept confidential.
Video Remote Interpreting American Sign Language and Spanish Interpreters available 24/7. Arabic, Cantonese, Korean, Mandarin, Nepali, Portuguese, Russian, Somali, and Vietnamese available Monday Friday, 5am- 8pm.
Language Access Coordinator Feinstein Institute for Medical Research Gila Klein, CCRC Community Relations, Manager North Shore-LIJ Health System The Feinstein Institute for Medical Research 350 Community Drive, Manhasset, NY 11030 Tel:516-562-1264 Email:gklein@nshs.edu
Thank you! Contact Information: Office of Community and Public Health North Shore-LIJ Health System 1981 Marcus Avenue, Suite E110 Lake Success, New York 11042 Office of Diversity, Inclusion and Health Literacy Telephone: 516-881-7081
Staff Cultural Resource CultureVision TM An online database that provides information about 47 different cultural groups Go to HealthPort Cultural Resource
Staff Education Health Literacy Educational Module Health Literacy: Partnering for Patient Centered Care Go to HealthPort Education and Research Health Literacy Online Education Program *CME and CEU Available
Staff Education Cross Cultural Educational Module Quality Interactions Go to HealthPort Departments Center for Learning and Innovation Cross-Cultural Online Educational Program *CME Available