3/5/2013. (CDC Policy Guidance November, 2011) Juan F. Gutierrez Sanin MA MPH The Cross Cultural Health Care Program

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1 Juan F. Gutierrez Sanin MA MPH The Cross Cultural Health Care Program Established in 1992 Home of Bridging The Gap: A Basic Training for Medical Interpreters, the gold standard of medical interpreter trainings in the US We have a network of 75 licensed agencies, in 29 States, and the District of Columbia We are Launching Bridging The Gap: Patient Guides training, as the next steps for medical interpreters Overview of the roles of the Patient Guide (or patient navigator) and the Medical Interpreter Make the case for training i medical interpreters as Patient Guides Outline the basic aspects of our Patient Guides training program Very similar to: Community Health Workers Patient Navigators Health Care Guides Promotores de Salud Health Coaches Care Coordinators Peer Counselors Others Well known in the context of cancer care (Freeman, ) We prefer the term Patient Guides because: Avoids the potential confusion due to very broad use of Patient Navigators Emphasizes the transitional care and system education functions of the guide Empowers the patient by highlighting the collaborative nature of the role Is easy to remember and self-explanatory Trusted members of the community Knowledgeable of the health care system Work within specific hospital s guidelines and resources Empower patients and communities Connect communities with the system Connect patients with providers (CDC Policy Guidance November, 2011) 1

2 Work with specific patients needs Highly consistent with Planetree philosophy Serve as cultural brokers Serve patients with complex care needs Serve as interpreters (Brownstein et al 2011) Must be professionally trained as medical interpreters Being bilingual is not enough (Flores, 2012) Listen to patients to understand the barriers to care they experience Inform patients about services available Interpret for patients and family members Help patients seek financial services Assist patients with directions and connect them with transportation services Fill out forms Inform patients of any reschedules or delays. Give second opinions about health services Counsel Diagnose patients Suggest treatments. Provide physical, speech or occupational therapy. Replace social workers Replace clinicians (Volkmann & Castañares 2011) Low income, low literacy patients Patients with chronic conditions and high frequency users Ethnic minority status and limited English proficiency patients Research Shows: Evidence of improved clinical outcomes Reduced admission rates Reduced complications Reduced length of stays Reduced missed appointments Generate significant cost savings Patients behavioral change: healthier lifestyles, more appropriate usage of health care resources Clinical success: recovery rates closer to those of the general population Patients satisfaction with care Return on investment: Reflected in savings from more cost-efficient use of the system, and recovery of uncompensated care costs 2

3 Routine Administrative Duties 11% Travel / Remote Activities 77% Assistance with care coordination Assessing needs, phone calls, medication lists Patient education, system navigation and social support (Volkmann, Castañares, 2011). Most clinicians perceive navigators as performing tasks not done by anyone else (Ferrante, 2010) Mandated by law (Title VI Civil Rights Act) Can serve the same populations as patient guides, not only LEP, when trained as Patient Guides Main role is to provide culturally and linguistically effective access Need to be screened, trained, and certified Connected with the community Connect patients with providers Connect communities with the system Serve as cultural brokers Advocacy functions defined by codes of ethics Natural transition to Patient Education System navigation and social support Various coordination functions depending on setting Effectiveness clearly depends on professional training (Flores et al 2003, Flores et al 2012) Shorten lengths of stay and reduce readmission rates Improve time and resource allocation by reducing medical errors Reduce Emergency Department return rates Return on investment reflected on savings. Seattle Children s Case Spanish and Somali speaking families Patient navigators, trained as interpreters by the Cross Cultural Health Care Program $210, investment Generated 1.2 million in savings (5.8-1 ROI) Reduced admission rate, lengths of stay and missed appointments 20% of families graduated, and are navigating the system on their own Patient Guides in Health Care Reform: The Affordable Care Act reauthorizes Patient Navigator Programs Navigators are mandated to assist patients in overcoming barriers to health services ACA requires navigators to meet minimum core competencies 3

4 7 years of research on the role of patient navigators 15 + years of experience defining the role of medical interpreters Substantial feedback form interpreters, providers, and communities National Advisory Board and Licensed Trainers 2012 Survey How familiar are you with the concept of Patient Guides or Personal Health Navigators? 18% 17% a. Not familiar at all b. Vaguely familiar c. Familiar d. Very familiar e. Expert In your opinion how appropriate is it for Professional Medical Interpreters to act as Patient Guides? In your opinion, how likely are Patient Guides to save money for healthcare institutions? 24% a. Very innapropriate b. innapropriate 41% a. Very unlikely b. Unlikely c. Somewhat likely c. Borderline 41% d. likely e. Very likely d. Approrpate e. Very appropriate In your opinion, how qualified is the team at the Cross Cultural Health Care Program (CCHCP) to develop and implement this type of program? In your opinion how likely are health care institutions to offer this kind of training to their medical interpreters? a. Very unlikely 59% 29% a. Definitely unqualified b. Unqualified c. Somewhat qualified d. Qualified 18% b. Unlikely c. Somewhat likely e. Definitely qualified 35% d. Likely e. Very likely 4

5 In your opinion, which institutions will be MOST likely to adopt and/or disseminate this kind of training? How attractive is this training to your organization as presented today? a. Government / Private Hospitals. a. Not attractive at all 35% b. Urgent Care / PCPs 24% b. Unattractive c. Community Based Organizations (i.e. AHECs) c. Indifferent d. Local Health Departments 53% d. Attractive e. Institutions of Higher Education e. Very attractive f. Other (Specify) In your experience with similar programs, how much should this training cost per student? The cost should include the textbook and related materials What incentives would make it more likely for your organization to consider this program? a. Consulting/support services a. $400 or less. b. On-line availability. 53% b. $400-$600 41% 18% c. Flexibility in delivery schedule. c. $600-$800 d. Training of Trainers / Licensure program d. $800-$1000 e. Others (Explain) 24-hour, comprehensive, interactive. Uses existing workforce Career ladder for active medical interpreters Builds on 20 years of experience of BRIDGING THE GAP Medical Interpreter training program Customizable to the needs of individual facilities Will offer Training of Trainers and licensure program Flexible delivery according to needs of individual institutions Priced at around $450 per student plus travel costs 5

6 Based on competency acquisition in four main domains: Outreach and Coalition Building Cultural Competency Transitional Care and System Navigation Health Promotion and System Education Visit our website Join us on Facebook Sign up for our monthly e-newsletter Call: