Cross-cultural skills improve health outcomes
By Brad Hall, Quality Improvement Specialist, Acumentra

Oregon’s population has seen tremendous growth in the number of immigrant residents, including many who speak languages other than English. Hispanics are the largest ethnic group in the state, representing more than 9 percent of the population. Between 1990 and 2000, the number of Oregon Hispanics increased by 144 percent. Oregon is expected to gain 197,000 people through international migration between 1995 and 2025.

What does this mean for your practice?

As family physician Robert C. Like, M.D., M.S., puts it, “Every encounter is a cross-cultural encounter.” More of our patients are going to be from cultures with languages or fundamental assumptions that may differ from our own—and this difference can impact every aspect of care and safety. Cultural and linguistic differences can contribute to serious problems in communicating about diagnosis, informed consent, treatment options, self-management activities, and adherence to treatment plans.

Growing evidence suggests that effective cross-cultural communication improves treatment adherence and health outcomes and increases patient satisfaction. Ensuring that services accommodate differences can also help physicians manage risk and gain a competitive edge in a growing marketplace. According to Dr. Like, “A business case is increasingly being made for providing culturally and linguistically competent health care."

Support for cross-cultural communication in primary care

Many Oregon health systems and health plans are actively involved in preparing practitioners and staff for more effective cross-cultural communication. Complementing their efforts, Acumentra Health (formerly OMPRO) is sponsoring the Culture and Medicine Project to provide cross-cultural communication resources for adult primary care practices in Oregon. The project helps practices accomplish the following:

• Apply standards for Culturally and Linguistically Appropriate Services (CLAS Standards), developed by the federal Office of Minority Health (OMH) to guide improvements in delivery of care across cultures.
• Learn approaches for improving cross-cultural communication at the organizational and practitioner levels, using an innovative online course developed by OMH.

The project welcomes participation from all practices that serve Medicare patients and have a high commitment to providing culturally and linguistically appropriate care. Participating practices will:

• Complete a brief “before and after” CLAS Standards self-assessment and work with Acumentra Health to enhance their strategies for delivering culturally and linguistically appropriate care
• Commit the time of one or more physicians or nurse practitioners to complete two modules of the online course related to cross-cultural care delivery and language access services
• Commit the time of one clinic administrator or physician to complete a third module on organizational readiness

Betty Evans, administrator of Oak Street Medical P.C. in Eugene, called the program “eye-opening.” Evans recently completed the entire online course, along with two clinic doctors who completed the modules for physicians. “This program would be beneficial for any office,” she says. “The content opened a different perspective on communication that happens, or doesn’t, when cultures are different.”

Incentives to participate

• Acumentra Health will provide resources at no cost.
• Physicians insured by Northwest Physicians Insurance Company can earn up to two points toward their patient safety premium credit.
• Physicians can earn up to nine AMA category 1 or AAFP Prescribed CME credits by completing the web-based curriculum. Credit is also available to nurses and nurse practitioners.
• Acumentra Health will publicly recognize clinics and individuals that demonstrate their commitment to culturally appropriate care by participating in this project.

Learn more

Contact Brad Hall at 503-382-3935 or bhall@acumentra.org, or visit www.acumentra.org and select the “Quick Link” for the Culture & Medicine Project.

This material was prepared by Acumentra Health, Oregon’s Medicare Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.