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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2 A Proposed Framework
2 A Proposed Framework
Pages 5-16
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From page 5... ...
She began her remarks by making the case for what is needed for integration to occur. She noted that health literacy, cultural competence, and language access are each important in their own right, and they do share many goals; address overlapping, though not identical, populations; and have similar implications for the way providers approach delivery of care and services.
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From page 6... ...
Similarly, the enhanced CLAS standards consider language access to go beyond the obvious service of translating and interpreting for people with limited English proficiency and include other types of language challenges that arise from a hearing, visual, or cognitive impairment. The enhanced CLAS standards also refer to understandable care and services as a means of getting to the broader issue of how an organization can make its services accessible through communications to a variety of patients, including those with low health literacy and other language concerns.
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From page 7... ...
. TABLE 2-1 The Common Domains of Health Literacy, Cultural Competence, Communication and Language Assistance, and PatientCentered Care Communication Health Cultural and Language Patient-Centered Domain Literacy Competence Assistance Care Culture and Values X X X Accountability and Quality X X X Improvement Workforce X X X X Assessment X X X X Community Engagement X X X X Communication X X X X Patient Engagement X X X SOURCES: Adapted from a presentation by Jessica Briefer French at the Workshop on Quality Performance Measures for Integrating Health Literacy, Cultural Competence, and Language Access Services on May 4, 2017.
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From page 8... ...
identified several approaches to patient engagement, including providing time for communicating with patients and asking patients questions within the context of the therapeutic relationship. The enhanced CLAS standards address patient engagement through language services and being able to help patients both understand and participate in health care decision making.
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From page 9... ...
NCQA's most recent update of its PCMH recognition program has strengthened health literacy and communication standards, and, while this program is used widely, French said that "performance on the standards related to cultural competence, language services, and health literacy are not required to achieve recognition. There is a disconnect." MIPS includes quality improvement activities, and 4 of the nearly 100 possible activities providers can choose from address health equity specifically.
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From page 10... ...
The first and quickest strategy would be to use the available structural measures to build organizational capacity to measure and improve performance specifically related to communication and cultural competence. "This is a good way to get at issues related to organization culture and values, the training and diversity of the workforce, and community engagement," she explained.
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From page 11... ...
Measures for capturing patient experience exist, and research has validated them, said French, but there are challenges to implementing them. Survey tools for assessing patient experience related to health literacy, communication, and cultural competence are available, but they have achieved little traction so far.
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From page 12... ...
While organizations are building a capacity to collect demographic and social risk data and stratify existing quality measures using those data, the field can develop methods to capture patient experiences and develop packages tailored to various subpopulations. As she noted earlier, the enhanced CLAS standards integrate the concepts of health literacy, cultural competence, and language access, but their adoption continues to lag.
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From page 13... ...
French said she did not think so because the ICSI measure is a good example of a measure that can be used in the clinical setting for quality improvement purposes. "I think the best approach to accountability in health literacy lies with some combination of these patient experience measures and a set of process measures that address an organization's approach to delivering understandable care and services," she said.
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From page 14... ...
. For cultural competence, they referred primarily to the enhanced CLAS standards blueprint, and for communication and language assistance they relied on the U.S.
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Terry Davis from the Louisiana State University Health Sciences Center noted the importance of including the caregiver in these metrics because the caregiver's perspective and experience can differ from those of the patient. French agreed and said it is one of the gaps in the existing suite of measures on patient experience.
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From page 16... ...
Rosof concluded the discussion by agreeing with Kelly that this should be part of the ongoing discussion about the proposed framework.
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