A Proposed Framework for Integration of Quality Performance Measures for Health Literacy, Cultural Competence, and Language Access Services Proceedings of a Workshop (2018) / Chapter Skim
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Appendix D: Accompanying Exhibits to the Commissioned Paper
Appendix D: Accompanying Exhibits to the Commissioned Paper
Pages 121-144
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Appendix D Accompanying Exhibits to the Commissioned Paper 121
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Department of Health Language Assistance and services; for example, and Human Services (HHS) , sign language, braille, oral Office on Minority Health.
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EXHIBIT 2 Integrated, Patient-Centered Framework CLAS Standards Health Literacy Language Patient-Centered Care Organization CLAS Standard 2: Advance and Provide incentives to encourage The patient-centered medical Culture and sustain organizational governance employees to use good home fosters an environment Values and leadership that promotes communication practices.b of trust and respect.d CLAS and health equity through Health care system needs to Patient-centered care policy, practices, and allocated be more proactive and take includes an interdisciplinary resources.a responsibility to meet the care team, which is led needs of the people it serves by a qualified provider of by reducing the health literacy the patient's choice who demands placed on individuals.c guides care in a continuous, accessible, comprehensive, and coordinated manner.d continued 123
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EXHIBIT 2 Continued 124 CLAS Standards Health Literacy Language Patient-Centered Care Accountability CLAS Standard 10: Conduct Employ monitoring and Physicians in the practice and Quality ongoing assessments of the accountability for health literacy accept accountability Improvement organization's CLAS-related policies and practices.e for continuous quality activities and integrate CLAS- improvement through related measures into assessment voluntary engagement in measurement and continuous performance measurement quality improvement activities.a and improvement.f CLAS Standard 11: Collect and Patients and families maintain accurate and reliable participate in quality demographic data. When linked improvement activities at the with other data, health and practice level.f health care organizations can Routinely undertakes efforts make increased data-informed to identify and eliminate any decisions and improve the quality disparities in the quality of of care, consistent with quality care received by its patients.d improvement activities.a CLAS Standard 15: Communicate the organization's progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public.a Workforce CLAS Standard 3: Recruit, Support changes to improve Training physicians to be promote, and support a public health professionals' more mindful, informative, culturally and linguistically health literacy skills.c and empathic transforms diverse governance, leadership, Professional continuing their role from one and workforce responsive to the education programs in health characterized by authority population in the service area.a and related fields should to one that has the goals CLAS Standard 4: Educate and incorporate health literacy into of partnership, solidarity, train governance, leadership, and their curricula and areas of empathy, and collaboration.g workforce in culturally and competence.e
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linguistically appropriate policies and practices on an ongoing basis.a Assessment Individual CLAS Standard 11: Collect and Health literacy assessment Assess the language Collects data on race, maintain accurate and reliable should be a part of health care assistance needs ethnicity, sex, primary demographic data to monitor and information systems and quality of current and language, and language evaluate the impact of CLAS on data collection.e potential customers services for each patient and health equity and outcomes and to Evaluate the effectiveness of to inform policy and records that information in a inform service delivery.a communications.c processes necessary to manner that can be reported Ensure that health information implement language and used to plan and respond is relevant to the intended users' assistance services to the health and language social and cultural contexts.h that increase access to needs of patients in the programs and services practice.d for all populations.i Community CLAS Standard 12: Conduct Consider the current literacy Health care regular assessments of community level of the intended audience organizations should health assets and needs and use and design messages based on maintain a current the results to plan and implement that level.c demographic, services that respond to the cultural, and cultural and linguistic diversity of epidemiological populations in the service area.a profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area.c continued 125
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Collaborate with patient and This includes fostering broad, family advisors in quality interdisciplinary approaches to improvement and practice health literacy.e redesign.d Communication Materials CLAS Standard 8: Provide easy-to- Present health information understand print and multimedia in varied forms/mediums or materials and signage in the written in clear, everyday terms languages commonly used by the so that people can take needed populations in the service area.a action.e Use plain language, including key elements.c, h Supplement instructions with pictures.h, j Make written communication look easy to read.h, j
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Improve the usability of information on the Internet.h, j Consider the communication capacities of the intended users, including those with communication disorders/challenges. Tailor communication strategies to their needs and abilities.h Consider the current literacy level of the intended audience and design messages based on that level.c Be sure the materials and messages reflect the age, social and cultural diversity, language, and literacy skills of the intended users.
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EXHIBIT 2 Continued 128 CLAS Standards Health Literacy Language Patient-Centered Care Oral CLAS Standard 6: Inform all Health practitioners Information and education to individuals of the availability of communicate clearly during all facilitate autonomy, self-care, language assistance services clearly interactions with their patients and health promotion.i and in their preferred language, using everyday vocabulary.e A more active invitation for verbally and in writing.a Avoid jargon and explain involvement.g CLAS Standard 5: Offer language technical or medical terms.h Tailored communication to assistance to individuals who have Ask open-ended questions patients' needs to permit limited English proficiency and/ instead of those that can be meaningful deliberation and or other communication needs answered with "yes" or "no."j shared mind.g at no cost to them to facilitate Use the teach-back method timely access to all health care and to ensure the message is services.a understood and remembered.j Ensure health information and services are appropriate, actionable, and easy to understand and use.c CLAS Standard 1: Provide effective, Patients should receive care Acknowledge patients as equitable, understandable, and whenever they need it and in persons in context of their respectful quality care and services many forms, not just face-to- own social worlds who that are responsive to diverse face visits.e are listened to, informed, cultural health beliefs and practices, Provide health information in respected, involved in their preferred languages, health literacy, a manner appropriate to the care, and whose wishes are and other communication needs.a audience.e honored (but not mindlessly Allow ample time for enacted) .g discussions between patients Provide emotional support and health care providers.e and alleviation of fear and Patients feel free and anxiety.i comfortable to ask questions as Caregivers' patient-centered part of the healing relationship.e care considers both the art of
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. National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care: A Blueprint for Advancing and Sustaining CLAS Policy and Practice.
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c Set priorities and quality for the for performance population served. improvement and Staff is oriented to patient health cultural diversity based outcomes.
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APPENDIX D 131 Community Engagement Assessment Communication Patient Engagement Community Information Cross-cultural Individual engagement engagement collection communication Language services Health literacy Community Data collection, Patient–provider Care delivery engagement public accountability communication and supporting and quality mechanisms improvement Leaders involve staff The needs of the Provide language Evaluate the patient's and patients in the population served interpreting and understanding of the design of new or guide decisions about translation services. education and training modified services of which services will Provide information provided.
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d objectives for serving Demonstrate quality cultural and linguistic a culturally and improvement. member needs linguistically diverse Quality improvement population.
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health literacy, communication and Patient self vision and hearing language assistance management tools are limitations, and services at no cost used. other communication for member services, needs.
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(NCQA) e culturally diverse disparities Supports practitioners membership Assesses the use of in providing competent and experience with language services.
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Collects and publishes information about practitioner languages and language services. Supports practitioners in providing language services.
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universal precautions, Medical Home engages patients on Stratifies performance provides health [PCMH]
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community resource Documents language Works with patients/ list by selecting five needs in its records. families/caregivers topics or community Provides to develop selfservice areas of comprehensive management importance to the health assessment.
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Retrieved from http://www.qualityforum.org/News_And_ Resources/Press_Releases/2012/NQF_Endorses_Healthcare_Disparities_and_Cultural_ Competency_Measures.aspx (accessed February 21, 2018)
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. NOTE: CAHPS = Consumer Assessment of Healthcare Providers and Systems; CLAS = C ulturally and Linguistically Appropriate Services; HEDIS = Healthcare Effectiveness Data and Information Set; LTSS = long-term services and support; NCQA = National Committee for Quality Assurance; QCDR = Qualified Clinical Data Registry; QI = quality improvement.
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Hospital The percentage of patient visits and The George Washington admissions where preferred spoken University School of Public language for health care is screened Health and Health Servicesc and recorded.
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Patients Receiving Both Initial Assessment and Discharge Instructions Supported by Assessed and Trained Interpreters or from Bilingual Providers and Bilingual Workers/Employees Assessed for Language Proficiency. National Quality Measures Clearinghouse)
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Retrieved from https://www.ahrq.gov/cahps/surveys-guidance/ item-sets/cg/index.html (accessed February 21, 2018)
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Retrieved from https://www.ahrq.gov/cahps/surveys-guidance/ item-sets/cg/index.html (accessed February 21, 2018)
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