INTEGRATING HEALTH LITERACY,
CULTURAL COMPETENCE, AND
LANGUAGE ACCESS SERVICES
WORKSHOP SUMMARY
Joe Alper, Rapporteur
Roundtable on Health Literacy
Board on Population Health and Public Health Practice
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by contracts between the National Academy of Sciences and AbbVie Inc.; the Aetna Foundation; the Agency for Healthcare Research and Quality (HHSP23337024); American Dental Association; Bristol-Myers Squibb; East Bay Community Foundation (Kaiser Permanente); Eli Lilly and Company; Health Literacy Missouri; Health Literacy Partners; Health Resources and Services Administration (HHSH25034011T); Humana; Institute for Healthcare Advancement; Merck & Co., Inc.; National Institutes of Health (HHSN26300054); National Library of Medicine; North Shore–Long Island Jewish Health System; Office of Disease Prevention and Health Promotion (HHSP23337043); and UnitedHealth Group. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-44237-4
International Standard Book Number-10: 0-309-44237-0
Digital Object Identifier: 10.17226/23498
Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2016 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Integrating health literacy, cultural competence, and language access services: Workshop summary. Washington, DC: The National Academies Press. doi: 10.17226/23498.
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PLANNING COMMITTEE ON INTEGRATING HEALTH LITERACY, CULTURAL COMPETENCY, AND LANGUAGE ACCESS SERVICES1
MARIN P. ALLEN, Deputy Associate Director for Communications and Public Liason and Director of Public Information, Office of the Director, National Institutes of Health
WILMA ALVARADO-LITTLE, Principal and Founder, Alvarado-Little Consulting, LLC
DENNIS ANDRULIS, Senior Research Scientist, Texas Health Institute, and Associate Professor, University of Texas School of Public Health
IGNATIUS BAU, Independent Policy Consultant, Health Policy Consultation Services
GEM DAUS, Public Health Analyst, Office of Health Equity, Office of Special Health Affairs, Health Resources and Services Administration ALICIA FERNANDEZ, Professor of Clinical Medicine, Department of Medicine, Division of General Internal Medicine, University of California, San Francisco
SUZANNE LELAURIN, Senior Vice President, International Institute
JANET OHENE-FREMPONG, President, J O Frempong & Associates
WINSTON WONG, Medical Director, Community Benefit, Disparities Improvement, and Quality Initiatives, Kaiser Permanente
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.
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ROUNDTABLE ON HEALTH LITERACY1
BERNARD ROSOF (Chair), Chief Executive Officer, Quality in Healthcare Advisory Group LLC
MARIN P. ALLEN, Deputy Associate Director for Communications and Public Liason and Director of Public Information, National Institutes of Health
WILMA ALVARADO-LITTLE, Principal and Founder, Alvarado-Little Consulting, LLC
SUZANNE BAKKEN, Alumni Professor of Nursing and Professor of Biomedical Informatics, Columbia University
CINDY BRACH, Senior Health Policy Researcher, Agency for Healthcare Research and Quality
GEM DAUS, Public Health Analyst, Office of Health Equity, Office of Special Health Affairs, Health Resources and Services Administration
TERRY DAVIS, Professor of Medicine and Pediatrics, Louisiana State University Health Sciences Center
CHRISTOPHER DEZII, Director, Healthcare Quality and Performance Measures, Bristol-Myers Squibb
JENNIFER DILLAHA, Medical Director for Immunizations, Medical Advisor, Health Literacy and Communication, Arkansas Department of Health
JAMES (JAY) DUHIG, Head, Risk Communication and Behavioral Systems, Office of Patient Safety, AbbVie Inc.
ALICIA FERNANDEZ, Professor of Clinical Medicine, Department of Medicine, Division of General Internal Medicine, University of California, San Francisco
LAURIE FRANCIS, Senior Director of Clinic Operations and Quality, Oregon Primary Care Association
LORI HALL, Advisor-Health Literacy, U.S. Medical Staff, Eli Lilly and Company
LINDA HARRIS, Director, Division of Health Communication and ehealth Team, U.S. Department of Health and Human Services
BETSY L. HUMPHREYS, Acting Director, National Library of Medicine
MARGARET LOVELAND, Senior Director, Global Medical Affairs, Merck & Co., Inc.
LAURIE MYERS, Global Health Literacy Director, Merck & Co., Inc.
CATINA O’LEARY, President and Chief Executive Officer, Health Literacy Missouri
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.
MARYLYNN OSTROWSKI, Executive Director, Aetna Foundation
MICHAEL PAASCHE-ORLOW, Associate Professor of Medicine, Boston University School of Medicine
TERRI ANN PARNELL, Principal and Founder, Health Literacy Partners
KIM PARSON, Strategic Consultant, Proactive Care Strategies, Humana
KAVITA PATEL, Managing Director for Clinical Transformation and Delivery, The Brookings Institution
ANDREW PLEASANT, Senior Director for Health Literacy and Research, Canyon Ranch Institute
LINDSEY A. ROBINSON, Thirteenth District Trustee, American Dental Association
STACEY ROSEN, Associate Professor of Cardiology, Hofstra North Shore–Long Island Jewish School of Medicine, and Vice President, Women’s Health, The Katz Institute for Women’s Health
RIMA RUDD, Senior Lecturer on Health Literacy, Education, and Policy, Harvard School of Public Health
STEVEN RUSH, Director, Health Literacy Innovations, UnitedHealth Group
PAUL M. SCHYVE, Senior Advisor, Healthcare Improvement, The Joint Commission
MICHAEL VILLAIRE, Chief Executive Officer, Institute for Healthcare Advancement
EARNESTINE WILLIS, Kellner Professor in Pediatrics, Medical College of Wisconsin
MICHAEL WOLF, Professor, Medicine and Learning Sciences, Associate Division Chief–Research Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University
WINSTON WONG, Medical Director, Community Benefit, Disparities Improvement, and Quality Initiatives, Kaiser Permanente
Consultant
RUTH PARKER, Professor of Medicine, Pediatrics, and Public Health, Emory University School of Medicine
Roundtable Staff
LYLA HERNANDEZ, Senior Program Officer
MELISSA FRENCH, Associate Program Officer
EMILY VOLLBRECHT, Senior Program Assistant
ROSE MARIE MARTINEZ, Senior Board Director, Board on Population Health and Public Health Practice
Reviewers
This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:
SHARRON BARRETT, Health Literacy Staff Consultant
CINDY BRACH, Agency for Healthcare Research and Quality
ROBERT A. LOGAN, National Library of Medicine
YOLANDA PARTIDA, Hablamos Juntos
Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Hugh H. Tilson, University of North Carolina. He was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteur and the institution.
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Acknowledgments
We are grateful to the sponsors of the Roundtable on Health Literacy who made it possible to plan and conduct the workshop on integrating health literacy, cultural competence, and language access services, which this report summarizes. Federal sponsors from the U.S. Department of Health and Human Services are the Agency for Healthcare Research and Quality, Health Resources and Services Administration, National Institutes of Health, National Library of Medicine, and the Office of Disease Prevention and Health Promotion. Nonfederal sponsorship was provided by AbbVie Inc.; the Aetna Foundation; the American Dental Association; Bristol-Myers Squibb; East Bay Community Foundation (Kaiser Permanente); Eli Lilly and Company; Health Literacy Missouri; Health Literacy Partners; Humana; Institute for Healthcare Advancement; Merck & Co., Inc.; North Shore–Long Island Jewish Health System; and UnitedHealth Group.
The workshop presentations were both interesting and stimulating, and we would like to thank each of the speakers for their time and effort. Speakers were Wilma Alvarado-Little, Dennis Andrulis, Marshall Chin, Sarah de Guia, Alicia Fernandez, Jessica Briefer French, Guadalupe Pacheco, Stacey Rosen, and Michael Wolf. Thanks also go to the excellent moderators, Ignatius Bau, Bernard Rosof, and Winston Wong, and small-group discussion facilitators, Gem Daus, Janet Ohene-Frempong, and Andrew Pleasant.
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Box, Figures, and Tables
BOX
FIGURES
2-1 Hypothetical scenarios for addressing language, literacy, and culture
2-3 State-level cultural competency legislation
4-1 Reporting of data on race, ethnicity, and language needs, 2014
4-2 Race/ethnicity of Medi-Cal enrollees
4-4 A conceptual model for health care disparities
TABLES
3-1 Language-Discordant Care Leads to Suboptimal Communication
3-2 The Present and Future of Language Barriers in Hospitals
4-2 Limited English Proficient Population Enrolled in Medi-Cal
Acronyms and Abbreviations
| ACA |
Patient Protection and Affordable Care Act |
| ACO |
accountable care organization |
| AHRQ |
Agency for Healthcare Research and Quality |
| CAHPS |
Consumer Assessment of Healthcare Providers and Systems |
| CLAS |
Culturally and Linguistically Appropriate Services |
| CMS |
Centers for Medicare & Medicaid Services |
| CPEHN |
California Pan-Ethnic Health Network |
| DMHC |
California Department of Managed Health Care |
| DSRIP |
delivery system reform incentive payment |
| EHR |
electronic health record |
| HEDIS |
Healthcare Effectiveness Data and Information Set |
| HHS |
U.S. Department of Health and Human Services |
| HIPAA |
Health Insurance Portability and Accountability Act |
| HITECH |
Health Information Technology for Economic and Clinical Health |
| HRSA |
Health Resources and Services Administration |
| IOM |
Institute of Medicine |
| NCQA |
National Committee for Quality Assurance |
| PCORI |
Patient-Centered Outcomes Research Institute |
| SAMHSA |
Substance Abuse and Mental Health Services Administration |
