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Serving Diverse Communities in Hospitals and Health Systems
• Edward L. Martinez, M.S.• Linda Cummings, Ph.D.• Lindsay A. Davison• Ingrid A. Singer, M.H.S.• Donna Sickler, M.P.H.• Arsenio DeGuzman,
M.P.A.• Marsha Regenstein, Ph.D.
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The National Association of Public Hospitals and Health Systems (NAPH)
• Represents over 100 of the largest metropolitan area hospitals & health
systems
• Advocates on behalf of safety net hospitals & health systems that share
a mission of making their services available to all regardless of ability to
pay
• The National Public Health & Hospital Institute (NPHHI), the research &
education affiliate of NAPH, conducts research into areas affecting
safety net institutions, such as health disparities
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NAPH Members Provide Extraordinary Volumes of Care
NAPH members…
• Provide over 25 percent of the uncompensated care in the U.S., while representing fewer than two percent of acute care hospitals in the country
• Provide nearly 31 million outpatient visits annually. NAPH hospitals average nearly 17,000 inpatient admissions and over 375,000 outpatient visits annually
• Provide high proportions of specialized, but often under-compensated, services such as neonatal intensive care, emergency psychiatric care, and burn care
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The National Association of Public Hospitals and Health Systems
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NAPH Patient Population
Source: NAPH Ambulatory Care Survey, 2001
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Difference in Ambulatory Care Visits by Race
0%
20%
40%
60%
80%
100%
Total LAC+USC RMC SFGH
White
AfricanAmerican/BlackHispanic
Asian/PacificIslanderOther
Source: 2001 NAPH Ambulatory Care Survey
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Patient Deliveries by Mother’s Country of Birth
Mexico33%U.S.
36%
South America
8%
Carribean7%
Europe1%
Central America
7%
Asia/Pacific Islands
7%
Africa 1%
Source: NPHHI Barriers to Prenatal Care Survey, March 2003
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# Women Speaking a Language Other than English from Selected Hospitals
50%
10% 14%
75%
0%
20%
40%
60%
80%
CHA Elmhurst CookCounty
SFGH
Source: NPHHI Barriers to Prenatal Care Survey, March 2003
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Percent of Non-English Speaking Diabetic Patients at Selected Hospitals
96%
70%
66%
40%
36%
23%
5%
0% 20% 40% 60% 80% 100%
LAC+USC
Queens
MHS
CHNSF
CHA
HMC
LSU
Source: NPHHI Consortium for Quality Improvement at Safety Net Hospitals Survey
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Addressing Disparities - Serving Diverse Communities
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To highlight the critical role of safety net hospitals and health systems in expanding access to quality health care to diverse communities
To identify significant strategies and to present findings and lessons learned in a practical and adaptable manner
To focus on the role of executive leadership in providing quality health care to diverse populations
Report to DHHS/ Office of Minority Health
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Methodology
• Structured interviews with key hospital staff • Developed case studies based on:
– Interesting work and promising practices in cultural competence
– Track record of integrating cultural competence practices into clinical and administrative procedures
– Geographical representation
– Size of the institution and degree of patient diversity
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Case Studies Highlighting Cultural Competence Practices
• Role of leadership
• Clinical care tailored to diverse populations
• Community outreach
• Workforce training
• Language services
• Technology
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Key Areas for Research and Training
• Identify the core competencies that make up culturally and linguistically appropriate practices
• Develop performance metrics
• Measure and monitor performance through self-assessment tools and benchmarks
• Identify models of effective practices
• Build the case for cultural competence practices internally (strategic planning, staff training and staff development) and externally (patient and community relations and business case)
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www.NAPH.org
www.NPHHI.org