Health literacy, cultural competence, and language access services are distinct but inextricably linked concepts for delivering equitable care to all members of the increasingly diverse population of the United States. As a previous workshop discussed (NASEM, 2016), these concepts are linked, but they developed via different paths, and each has its own unique focus with regard to enabling every individual to obtain the ability to process and understand basic health information and services needed to make appropriate health care decisions. Fragmentation of these disciplines has impeded implementation of relevant measures for quality improvement and accountability. As Bernard Rosof, chief executive officer of the Quality in Healthcare Advisory Group, explained, “Measurement for performance improvement implies accountability—accountability to the patient, accountability to the public, and accountability to the health care team.”
To foster an integrated approach to health literacy, cultural competency, and language access services, the Roundtable on Health Literacy initiated a project with three components: a commissioned paper to propose a frame-
1 The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop was prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.
2 This section is based on the presentation by Bernard Rosof, chief executive officer of the Quality in Healthcare Advisory Group, and the statements are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
work for integrating measurements of health literacy, cultural competency, and language access; a workshop to review and discuss the framework; and a second commissioned paper that will provide a roadmap for integrating health literacy, cultural competency, and language access services as well as a revised measurement framework. The commissioned paper (see Appendix C) with its accompanying exhibits (see Appendix D), prepared by the National Committee for Quality Assurance, was released on April 24, 2017 (French et al., 2017), and was the main topic of discussion at the May 4, 2017, workshop organized by an ad hoc committee (see Box 1-1).
An independent planning committee organized this workshop in accordance with the procedures of the National Academies of Sciences, Engineering, and Medicine. (See Appendix A for the workshop agenda.) This publication summarizes the workshop’s presentations and discussions, and it highlights the reactions to the proposed framework from a broad range of stakeholders that will inform preparation of the roadmap for integrating these domains and a revised measurement framework. Chapter 2 describes the presentation by the principal author of the proposed framework and subsequent open discussion with the workshop participants. Chapter 3 provides the reactions to the proposed framework by a panel of developers and users. Chapters 4 and 5 provide the highlights of two moderated discussions conducted in a question-and-answer format among different stakeholders. Chapter 6 recounts the roundtable members’ reflections on the lessons learned at this workshop.
In accordance with the policies of the National Academies, the workshop did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on issues identified by the speakers and workshop participants.
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