Serving Diverse Communities in Hospitals and Health Systems

• Edward L. Martinez, M.S.• Linda Cummings, Ph.D.• Lindsay A. Davison• Ingrid A. Singer, M.H.S.• Donna Sickler, M.P.H.• Arsenio DeGuzman,

M.P.A.• Marsha Regenstein, Ph.D.

The National Association of Public Hospitals and Health Systems (NAPH)

• Represents over 100 of the largest metropolitan area hospitals & health

systems

• Advocates on behalf of safety net hospitals & health systems that share

a mission of making their services available to all regardless of ability to

pay

• The National Public Health & Hospital Institute (NPHHI), the research &

education affiliate of NAPH, conducts research into areas affecting

safety net institutions, such as health disparities

NAPH Members Provide Extraordinary Volumes of Care

NAPH members…

• Provide over 25 percent of the uncompensated care in the U.S., while representing fewer than two percent of acute care hospitals in the country

• Provide nearly 31 million outpatient visits annually. NAPH hospitals average nearly 17,000 inpatient admissions and over 375,000 outpatient visits annually

• Provide high proportions of specialized, but often under-compensated, services such as neonatal intensive care, emergency psychiatric care, and burn care

The National Association of Public Hospitals and Health Systems

NAPH Patient Population

Source: NAPH Ambulatory Care Survey, 2001

Difference in Ambulatory Care Visits by Race

0%

20%

40%

60%

80%

100%

Total LAC+USC RMC SFGH

White

AfricanAmerican/BlackHispanic

Asian/PacificIslanderOther

Source: 2001 NAPH Ambulatory Care Survey

Patient Deliveries by Mother’s Country of Birth

Mexico33%U.S.

36%

South America

8%

Carribean7%

Europe1%

Central America

7%

Asia/Pacific Islands

7%

Africa 1%

Source: NPHHI Barriers to Prenatal Care Survey, March 2003

# Women Speaking a Language Other than English from Selected Hospitals

50%

10% 14%

75%

0%

20%

40%

60%

80%

CHA Elmhurst CookCounty

SFGH

Source: NPHHI Barriers to Prenatal Care Survey, March 2003

Percent of Non-English Speaking Diabetic Patients at Selected Hospitals

96%

70%

66%

40%

36%

23%

5%

0% 20% 40% 60% 80% 100%

LAC+USC

Queens

MHS

CHNSF

CHA

HMC

LSU

Source: NPHHI Consortium for Quality Improvement at Safety Net Hospitals Survey

Addressing Disparities - Serving Diverse Communities

To highlight the critical role of safety net hospitals and health systems in expanding access to quality health care to diverse communities

To identify significant strategies and to present findings and lessons learned in a practical and adaptable manner

To focus on the role of executive leadership in providing quality health care to diverse populations

Report to DHHS/ Office of Minority Health

Methodology

• Structured interviews with key hospital staff • Developed case studies based on:

– Interesting work and promising practices in cultural competence

– Track record of integrating cultural competence practices into clinical and administrative procedures

– Geographical representation

– Size of the institution and degree of patient diversity

Case Studies Highlighting Cultural Competence Practices

• Role of leadership

• Clinical care tailored to diverse populations

• Community outreach

• Workforce training

• Language services

• Technology

Key Areas for Research and Training

• Identify the core competencies that make up culturally and linguistically appropriate practices

• Develop performance metrics

• Measure and monitor performance through self-assessment tools and benchmarks

• Identify models of effective practices

• Build the case for cultural competence practices internally (strategic planning, staff training and staff development) and externally (patient and community relations and business case)

www.NAPH.org

www.NPHHI.org