NQF draws on AMA toolkit to gauge patient-friendly communication

The metrics aim to help patients from diverse backgrounds who have trouble understanding medical information and receive lower-quality care.

By Kevin B. O’Reilly — Posted Aug. 28, 2012

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The National Quality Forum in August endorsed a dozen measures of physician group and hospital performance in improving communication with patients who have poor health literacy or limited English proficiency.

Seven of the metrics were developed by the American Medical Association’s Ethical Force Program and are used as part of its Communication Climate Assessment Toolkit (link).

The toolkit, publicly launched in 2008, features surveys to be used with patients, executive leaders, physicians, nurses and nonclinical staff. Patients grade their experiences in understanding elements such as signage, forms, receptions and their communications with doctors and other health professionals. The survey of staff asks for their assessment of how well the health system or clinic does in providing interpreter services and training.

“Effective, patient-centered communication is critical in delivering quality health care, but illness, fear, low literacy and diverse languages and cultures can make it difficult for health care professionals to communicate successfully with patients,” said AMA President Jeremy A. Lazarus, MD. “We created this tool to help organizations evaluate and improve their communications with a diverse patient population, and we are proud that measures included in this toolkit have received NQF endorsement.”

Nearly 100 million Americans do not read well enough to completely understand a prescription label, and more than 34 million patients receiving care in the U.S. are foreign-born, said a 2006 report published by the AMA’s Ethical Force Program. More than 22 million patients speak English less than “very well,” the report said.

The Institute of Medicine’s 2003 report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” helped highlight the evidence showing that racial and ethnic minorities receive worse care than white patients (link).

Despite widespread attention to the issue, progress has been slow. Black patients received worse quality care than white patients on 41% of nearly 200 measures included in the Agency for Healthcare Research and Quality’s 2011 “National Healthcare Disparities Report.” Hispanics, meanwhile, fared worse than whites on 39% of quality metrics (link).

“Accurate and meaningful metrics to measure care quality for populations adversely affected by disparities are critically needed,” said Laura J. Miller, interim CEO of the National Quality Forum, a multistakeholder standards-setting organization based in Washington. Forum-endorsed measures are widely used in quality initiatives, hospital and physician ratings, pay-for-performance programs and public reporting.

The forum’s Healthcare Disparities Project also includes metrics developed by George Washington University and AHRQ. These measure elements of care such as the percentage of hospital patients who receive trained interpreter services at initial assessment and discharge, and the percentage of patients screened for the language they prefer to speak.

The public has until Sept. 10 to file an appeal asking the forum to reconsider its decision on these metrics.

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