Organizational Changes to Promote Health Literacy and Cultural Competency: The NewYork-Presbyterian Hospital Experience Roundtable on Health Literacy and Cultural Competency Institute of Medicine J. Emilio Carrillo, M.D., M.P.H. V.P. Community Health Development, NYP Associate Professor of Clinical Public Health and Medicine Weill Cornell Medical College March 29, 2007
Health Literacy and Cultural Competence are Complementary and Interdependent Health Literacy represents the patient s ability to understand and adopt healthcare Cultural Competence represents the provider s ability to offer healthcare that is understandable and meaningful to patients
Hospital Organizational Changes that Promote Health Literacy and Cultural Competency 1. Leadership driven modification of internal operations 2. Partner with external community 3. Promote staff s Cross-Cultural Cultural awareness and capabilities by training, creating incentives and tracking 4. Create Human Resources that function as agents for Cultural Competence and Health Literacy 5. Establish metrics and ongoing monitoring
Teaching Hospital of Weill-Cornell Medical College and Columbia University School of Medicine 5 facilities 2,335 Beds Emergency Visits 202,154 Outpatient Visits 828,136 Ranked # 6 in U.S. News & World Report s 2006 America s Best Hospitals survey NYP is both a leading academic medical center and community hospital serving an inner-city immigrant community
1. Leadership driven modification of internal operations Adoption of Patient-Centered mission Senior leadership designated Serving the Community as a top strategic initiative for 2007 2005 LEP initiative 2006 LEP Regional Conference The Allen Pavilion Model
New York Presbyterian Interpreter Services 2006 130,000 interpretations in 2006 Over 82 languages serviced in 2006 Spanish, Russian, Mandarin/Cantonese, Arabic, Korean and Polish- Top languages New York Presbyterian Speaks your Language Campaign, Patient posters, I speak Cards and staff reminder posters created Limited English Proficiency Committee
Allen Pavilion
Northern Manhattan
Allen Pavilion Model Language and culture of community is the language and culture of the staff Food Community Physicians
2. Partner with External Community I. Community Diagnosis II. Outreach & Prevention III. Education & Training IV. Population Health Management
Washington Heights has the largest numerical concentration of immigrants in New York City. The Largest Immigrant Neighborhoods in NYC, 2000 100,000 80,000 60,000 40,000 20,000 0 90,300 86,900 84,700 78,600 74,600 Washington Heights Flushing Astoria Bay Ridge- Bensonhurst Elmhurst Source: The Newest New Yorkers, New York City Department of City Planning, 2000
Language and Education Washington Heights is much more linguistically isolated than both h NYC as a whole and the predominantly Latino communities of East Harlem and Hunts Point. Low education attainment- 23% of adults attained less than a 9 th grade education. Language Percent 80 70 60 50 40 30 30 71 40.46 61.64 36.89 27 52.4 47.6 23.7 24.5 44.8 20 14.7 10 0 WAHI NYC English only Language other than English at home Language other than English; speak English less than "very well" Speak Spanish at home Percent of Spanish speakers who speak English less than "very well" Percent of linguistically isolated households* Census 2000, Washington Heights only for all categories other than percent of linguistically isolated households which was taken from NYCDOMH and includes Inwood. *Linguistically isolated household= one in which all members 14 years old and over have at least some difficulty with English.
Major Health Challenges Cancer Heart disease Accidents and injuries Mental illness Diabetes Prenatal care and pregnancy HIV/AIDS Asthma Assault and Homicide These health challenges are consistently the leading causes of hospitalization and/or death for the district. Those that are bolded have significantly higher hospitalization and/or death rates compared to NYC. Source: Washington Heights-Inwood Neighborhood Health Profile, Department of Health and Mental Hygiene, 2003
Livery Cab Driver Event Of the 265 persons screened 86% were found to have an abnormal test. t Most participants had elevated readings in more than one test category. Elevated Blood Pressure 45% High Cholesterol 54% High Glucose 15% Obesity 33% Vision Screenings: 54 tested and 49 eyeglasses dispensed.
WIN for Asthma WIN for Asthma works directly with high risk asthmatic children and their parents education, tracking and referral. Care is optimized through collaborations with community based organizations, local schools, day care centers, managed care organizations and community physicians.
SERVING THE COMMUNITY I. Outreach and Prevention II. Education and Training III. Population Health Management
Lang Youth Medical Program To inspire and support young people from Washington Heights to develop intellectual habits of mind and life skills that position them to attend college and to become future leaders in the sciences and their Communities. MISSION
Healthy School Healthy Families (HSHF) Facilitate access to health services for children with identified health needs, Cultivate a culture of physical fitness, good nutrition, and healthy lifestyle behaviors, Coordinate the services for children with chronic conditions and mental health problems
SERVING THE COMMUNITY I. Outreach and Prevention II. Education and Training III. Population Health Management
Population Health Management: NYP Ambulatory Care Medical Home RN Case Manager Diabetes CBO Social Services Community Health Workers Parish RN DM Workshops Peer Support
3. Promote staff s Cross-Cultural Cultural awareness and capabilities by training, creating incentives and tracking Staff training with Oasis of Respect Physician training with Patient Based Cross-Cultural Communication
Creating an Oasis of Respect Course Objectives Understand the NYP Values & Behaviors: Respect, Empathy and Teamwork Recognize that respecting differences is a critical skill for effectiveness today Be more aware of our assumptions and responses to differences and how to manage them Understand the importance of cultural competence and have a greater understanding of cultural sensitivities and needs and how to respond Learn a process for managing responses to different perspectives and how to create win/win partnerships Learn and practice skills that facilitate communication and productivity
Patient Based Cross-Cultural Care Training 1. Language interpretation 2. Understand local population 3. Avoid cultural categorization 4. Identify and address areas of cross-cultural cultural sensitivity 5. Serve the individual Be aware of you own personal perspective and pre- conceptions Explore the patient s perspective Explore the patient s expectations Engage the patient, Earn the trust
4. Create Human Resources that function as agents for Cultural Competence and Health Literacy Interpreters Community Health Workers Parish Nurses and Health Ministers
5. Establish metrics and ongoing monitoring R/E entered as required field in Eagle Registration System Community Health Outcomes tracked quantitatively and qualitatively with focus groups Press-Gainey Spanish language satisfaction measures tracked HEDIS/QARR Data from NYP sponsored Medicaid Health Plan
Mean Score 100 90 80 70 60 50 40 30 20 10 0 NewYork-Presbyterian/Columbia (Milstein) Adult Inpatient Satisfaction on Selected Indicators (Composite) English Spanish Difference 2Q02 3Q02 4Q02 1Q03 2Q03 3Q03 4Q03 1Q04 2Q04 3Q04 4Q04 1Q05 Quarter 90 80 70 60 50 40 30 20 10 0-10 English vs Spanish diff mean score
Next Steps 1. Standardize and test R/E collection 2. Train CHWs,, Interpreters and Parish Nurses with Health Literacy Curriculum 3. Identify Quality Improvement opportunities