Our current quarterly newsletter, CONNECT, focuses on language barriers in healthcare. (Not on our mailing list? Send an email to audrey.miller@atkinsinternational.com and include your name and email or mailing address.)
Our blog this week will continue with this theme.
A study led by Z. Jennifer Huang at the Department of International Health at Georgetown University supports the conclusion that simply having and affording medical insurance does not guarantee healthcare usage in this country. Language in fact can be a barrier to being healthy.
Ms. Huang studied 76 families from 3 different socioeconomic groups in the metropolitan D.C. area (42% of this area’s immigrant families are Asian.) To qualify for the study, families had to have both parents born in China and speaking Mandarin as their primary language.
From suburban areas there were 20 families in the low-income bracket, 45 in the middle to high income bracket and 11 urban families in the low income bracket from D.C.’s Chinatown area. Most families had access to either private or public health insurance coverage.
Families were asked if in the past year there was a time their child was sick and they chose not to seek health care. Anyone responding with a “yes” received a more detailed inquiry as to why.
According to Ms. Huang, the researchers were “surprised to find out the delayed care is more common in this population, especially the middle income group.” Since many in this group were insured, the researchers looked for issues beyond insurance coverage that affected healthcare utilization.
Ms. Huang found most parents did not get care because they could not find a Chinese speaking doctor or were unable to find an interpreter.
“Not many recent immigrant families know they can request translation service at clinics with federal funding.” Huang said.
More detailed reporting of this study can be found in the May 2009 issue of the Journal of Healthcare for the Poor and Underserved.
http://www.press.jhu.edu/journals/journal_of_health_care_for_the_poor_and_underserved/
by Sherry Dineen
Wednesday, July 15, 2009
Monday, July 13, 2009
Understanding is Key to Staying Out of the Hospital - Part II
Monday’s Blog discussed how many Medicare patients end up being readmitted to the hospital in part due to lack of understanding of follow-up care.
Another recent study by the Northwestern University Feinberg School of Medicine, found 78% of patients do not fully understand their discharge instructions before leaving the emergency department. To make matters worse, they found that 80% of the time patients were not even aware they did not understand their discharge instructions.
Kirsten Engel, M.D., lead study author and instructor of emergency medicine at the Feinberg School of Medicine said, “Patients who fail to follow discharge instructions may have a greater likelihood of complications after leaving the emergency department.”
The study assessed 138 patients from Anne Arbor, Michigan according to four categories of comprehension (diagnosis and cause, emergency department care, post-emergency department care and return instructions.) Fifty-one percent did not fully understand what they were told in 2 or more categories.
According to Engle, “The bottom line is that we need better strategies for identifying patients who are having difficulty understanding their care instructions in the emergency department… When you are in the emergency department, be honest and don’t be afraid to ask questions.”
It turns out understanding what you should do at home after leaving a doctor’s care is important for your recovery. Yet many patients do not fully understand their post-hospital care instructions and are not even aware of their misunderstanding.
As far as we know the study did not account for language difficulties so we assume the study participants were English speakers. Imagine what the study would find for Non-English speakers…
By Sherry Dineen
This study was published online in July of 2008 by the Annals of Emergency Medicine.
www.annemergmed.com/
Another recent study by the Northwestern University Feinberg School of Medicine, found 78% of patients do not fully understand their discharge instructions before leaving the emergency department. To make matters worse, they found that 80% of the time patients were not even aware they did not understand their discharge instructions.
Kirsten Engel, M.D., lead study author and instructor of emergency medicine at the Feinberg School of Medicine said, “Patients who fail to follow discharge instructions may have a greater likelihood of complications after leaving the emergency department.”
The study assessed 138 patients from Anne Arbor, Michigan according to four categories of comprehension (diagnosis and cause, emergency department care, post-emergency department care and return instructions.) Fifty-one percent did not fully understand what they were told in 2 or more categories.
According to Engle, “The bottom line is that we need better strategies for identifying patients who are having difficulty understanding their care instructions in the emergency department… When you are in the emergency department, be honest and don’t be afraid to ask questions.”
It turns out understanding what you should do at home after leaving a doctor’s care is important for your recovery. Yet many patients do not fully understand their post-hospital care instructions and are not even aware of their misunderstanding.
As far as we know the study did not account for language difficulties so we assume the study participants were English speakers. Imagine what the study would find for Non-English speakers…
By Sherry Dineen
This study was published online in July of 2008 by the Annals of Emergency Medicine.
www.annemergmed.com/
Understanding is Key to Staying Out of the Hospital - Part I
A recent study by the Northwestern University Feinberg School of Medicine examined the frequency of rehospitalization, the risk of readmission and the frequency of follow-up outpatient doctor visits before being discharged from the hospital. The study looked at fee-for-claims service data for roughly 12 million Medicare patients discharged from a hospital in the years 2003 and 2004.
What the study found was astounding.
One out of five Medicare patients is readmitted to the hospital. The healthcare tab for readmissions in 2004 was 17 billion dollars. More than half of the patients that are rehospitalized within 30 days did not see a physician as an outpatient after being released the first time.
The study found that the rate of readmission increases as time passes from the first hospitalization. Thirty-four percent of patients were readmitted within 90 days of release and that number increases to 56.1 percent after one year of release.
Of those readmitted, 70 percent suffered from complications that could easily have been prevented by follow-up doctor visits such as urinary tract infections or pneumonia.
The study co-author, Mark Williams, M.D., chief of hospital medicine for Northwestern’s Feinberg School of Medicine and Northwestern Memorial Hospital, commented that Medicare does not pay doctors or pharmacists to spend time with patients to make sure they understand their discharge and medication instructions when they leave the hospital. “They pay for quantity of service, not quality.” He further adds, “They [Medicare] do not target payments to improve patient understanding of their care and their need for follow-up.”
“When patients and their caregivers understand the goals of their care, they commonly get better relief from their symptoms and use less health care services at their request,” Williams said.
Creating understanding for all patients regardless of their age or language spoken is the key to reducing our country’s healthcare costs by keeping needless hospital readmissions to a minimum.
Check back on Wednesday for Part II and read about another study linking understanding with improved healthcare.
by Sherry Dineen
The study was published in the New England Journal of Medicine on April 2, 2009 and can be found using the following link:
http://content.nejm.org/cgi/content/full/360/14/1418
Mr. Williams’ comments can be found at: http://www.northwestern.edu/newscenter/stories/2009/04/medicare.html
What the study found was astounding.
One out of five Medicare patients is readmitted to the hospital. The healthcare tab for readmissions in 2004 was 17 billion dollars. More than half of the patients that are rehospitalized within 30 days did not see a physician as an outpatient after being released the first time.
The study found that the rate of readmission increases as time passes from the first hospitalization. Thirty-four percent of patients were readmitted within 90 days of release and that number increases to 56.1 percent after one year of release.
Of those readmitted, 70 percent suffered from complications that could easily have been prevented by follow-up doctor visits such as urinary tract infections or pneumonia.
The study co-author, Mark Williams, M.D., chief of hospital medicine for Northwestern’s Feinberg School of Medicine and Northwestern Memorial Hospital, commented that Medicare does not pay doctors or pharmacists to spend time with patients to make sure they understand their discharge and medication instructions when they leave the hospital. “They pay for quantity of service, not quality.” He further adds, “They [Medicare] do not target payments to improve patient understanding of their care and their need for follow-up.”
“When patients and their caregivers understand the goals of their care, they commonly get better relief from their symptoms and use less health care services at their request,” Williams said.
Creating understanding for all patients regardless of their age or language spoken is the key to reducing our country’s healthcare costs by keeping needless hospital readmissions to a minimum.
Check back on Wednesday for Part II and read about another study linking understanding with improved healthcare.
by Sherry Dineen
The study was published in the New England Journal of Medicine on April 2, 2009 and can be found using the following link:
http://content.nejm.org/cgi/content/full/360/14/1418
Mr. Williams’ comments can be found at: http://www.northwestern.edu/newscenter/stories/2009/04/medicare.html
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