February 19, 2015 | Tags: Blog | Tags: OHA PCPCH , Maintenance of Certification , PCPCH Standards , Patient Engagement
All practices applying for recognition as a Patient-Centered Primary Care Home (PCPCH) must meet Measure 6.A.0 of the 2014 PCPCH Recognition Criteria which states:
PCPCH offers and/or uses either providers who speak a patient and family’s language at time of service in-person or telephonic trained interpreters to communicate with patients and families in their language of choice.
Measure 6.A.0 falls under the Person and Family-Centered Care Core Attribute of the PCPCH model. For patients this means their PCPCH should “Recognize that we are the most important part of the care team - and that we are ultimately responsible for our overall health and wellness.”
Communicating with patients in their preferred language is an important component of providing high quality, patient-centered care. This blog post describes the significance of Measure 6.A.0 to patient communication and engagement, and describes how your practice can meet this Must Pass PCPCH measure.
The Importance of Language/Cultural Interpretation
In order for Limited English Proficient (LEP) patients to feel like a recognized member of the care team, they must be able to play an active role in the visit and effectively communicate with the provider and clinic staff.
If proper interpretation services are not available, however, this simply isn’t possible.
Evidence suggests that language barriers contribute to an increase in health disparities and compromised quality of care, which can be costly, and can lead to poor adherence of treatment and follow up.
Language barriers could contribute to a lack of comprehension of diagnoses, treatment and understanding preventive measures, and could leave patients at greater risk of being discharged from an emergency department without appropriate follow-up.
Providing language interpretation services to LEP patients equalizes health care utilization and leads to better clinical outcomes, increased patient satisfaction, and higher quality care.
When trained, professional interpreters are available, patients:
- Receive and better understand how to take their medications
- Are less likely to have unnecessary laboratory tests done
- Are more engaged and ask more questions about their care
- Are more comfortable discussing sensitive or embarrassing issues
- Have better physical functioning, less pain and higher psychological well-being
How to Meet Measure 6.A.0
Know Your Patients. The first step to meet the intent of Measure of 6.A.0 is to become informed about which patients in your practice have a language preference other than English. LEP patients will likely prefer to speak in their first language, such as Spanish for example. Patients who are deaf, hard of hearing, or speech-impaired may prefer to communicate with Text Telephone (TTY).
Document Language Preference. Next, document a patient’s language preference in the EHR, practice management software or in paper records. While not a specific requirement to meet 6.A.0, documenting a patient’s preferred language will assist your clinic in developing a plan for communicating with LEP patients. (Note: documenting language preference partially fulfills Must Pass Measure 4.C.0 - Organization of Clinical Information).
Develop Your Plan. Your clinic should have established protocols in place for providing services to patients in the language of their choice. At a verification site visit your clinic will be asked to produce written protocols and a list of interpreter services used at the clinic.
Interpreter services could include the following:
- A contract with an interpretation services company that provides on site, telephone, video and written language interpretation such as www.passporttolanguages.com or www.pacificinterpreters.com. There is often no charge to establish a contract, only a fee if interpretation services are used.
- Bilingual employees to communicate with patients or family members in their language of choice throughout their office visit and during telephone encounters. It is strongly recommended employees providing interpretation services have Native Bilingual Proficiency or be a Qualified or Certified Health Care Interpreter. Please visit the Oregon Health Authority Office of Equity and Inclusion Health Care Interpreter Program for more information.
Why use a Qualified or Certified Health Care Interpreter?
Evidence indicates that the quality of care for LEP patients is often not as high when ad-hoc interpreters (family members, friends, medical and nonmedical staff, and strangers) are used. Some examples of adverse effects on quality when ad-hoc interpreters are used include:
- Lower likelihood of having medication side effects explained
- High risk of interpretation errors, omissions, distortions, redundancy, and irrelevant questions
- Greater likelihood of committing interpreter errors with potential clinical consequences
- Decreased satisfaction with care
- Distortions in psychiatric encounters associated with over identification, normalization of pathologies, interpretation errors, and inaccurate assessment of affect and thought processes
In summary clinics should know their patient population, document language preferences, and have a plan in place to provide services to patients in the language of their choice. Not only will you meet standard 6.A.0, but you will also be contributing to improving the quality of patient care and ensuring that all of your patients feel recognized as an important member of the care team.
If you have additional questions about language/cultural interpretation contact the PCPCH Program at PCPCH@state.or.us.
Jill Boyd, MPH, CCRP is a Practice Enhancement Specialist for the Oregon Health Authority Patient-Centered Primary Care Home program. Jill joined OHA in August 2014 and has previously worked with the Oregon Health and Science University at the Oregon Rural Practice-based Research Network (ORPRN). Jill received her Master of Public Health from the University Of Pittsburgh Graduate School Of Public Health and has experience in clinical and community-based research through the University of Pittsburgh Medical Center and the Mayo Clinic. Most recently, Jill’s area of interest has been around research integrating medical home transformation into primary care, specifically around quality improvement, practice workflow, patient engagement and care coordination.
- Karliner, Leah S et al. “Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature.” Health Services Research 42.2 (2007): 727–754. PMC. Web. 22 Jan. 2015.
- Flores, G. 2005. ‘‘The Impact of Medical Interpreter Services on the Quality of Health Care: A Systematic Review.’’ Medical Care Research and Review 62: 255–99.