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Case Study: Health Equity

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Clients

BCT Partners has worked successfully with eight leading hospitals and hospital systems across eight states to administer our Provider Cross Cultural Medical Assessment. This gives us a national database of thousands of provider responses and allows us to compare hospital systems to each other and compare providers based on medical subspecialty.    

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Challenges

Given dramatic increases in global migration and travel, what we previously considered global medicine has become localized. As the pandemic showed us, international travel means the disease can make its way across the globe faster and with potentially catastrophic results – particularly when healthcare professionals in one region are unfamiliar with and unprepared to treat diseases of foreign origin.

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Similarly, many healthcare professionals are not versed in meeting other patients' specialized needs, such as those who are limited English proficient, deaf, hard of hearing, or LGBTQ+. Addressing the special needs of these communities globally is vital, but many medical facilities and practitioners lack the knowledge and tools to best help these patients. 

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Unfortunately, less than 50% of U.S. hospitals collect patient race, ethnicity, and language data to then tie that data to patient outcomes. In effect, that means most hospitals do not know who their patients are demographically, what kinds of outcomes diverse patients receive, how satisfied they are with their care, and how to improve the quality of service to these communities.

 

Scope of Services

Working with leading physicians from the CDC and World Health Organization and other providers who are experts in cross-cultural medical care, BCT Partners has created a ground-breaking tool called the Provider Medical Assessment on Cross-Cultural Medical Care (PCCMA).

 

  1. Our PCCMA quickly identifies which minority patient population providers (MDs, APPs, others) are best prepared and least prepared to treat.

  2. The Assessment examines providers’ effectiveness in treating seven non-traditional patient populations, including Limited English Proficient and Deaf and Hard of Hearing patients; immigrants and refugees; international travelers and LGBTQ patients and racial and ethnic minorities.

  3. The Assessment is electronically administered over the internet and can be taken via cellphone or by a personal computer. Most providers complete the assessment in as little as 10 minutes.

  4. Within two minutes of submitting their answers, providers receive an extensive individualized feedback report comparing their practice behaviors in treating various minority patients against population-specific, clinical best practices and legal and regulatory requirements.

  5. As a result, providers receive immediate feedback on best practice techniques that they can use to improve the quality and safety of the patient care that they provide, as well as tips to avoid legal and regulatory exposure.

  6. In short, our Assessment tool is diagnostic in nature. It can tell us what problems exist in delivering effective cross-cultural medical care, where those problems exist (by the hospital, medical clinic, or location), and who (what types of providers by medical sub-specialty) are best prepared and least prepared to treat various non-traditional patient populations.

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Results

Here are some of the findings from our Provider Cross Cultural Medical Assessment:

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  1. Two of the patient populations that providers throughout the United States feel least prepared to treat are Limited English Proficient (LEP) and Deaf and Hard of Hearing patients. Ironically, these are the two patient populations most likely to sue providers on language access grounds.

  2. 97% of U.S. physicians treat LEP patients but 49% of over 1,800 U.S. physicians feel “less than well prepared” to treat this population effectively. Primary care physicians who see LEP patients most frequently are the least prepared to treat them.

  3. Large numbers of U.S. physicians do not use qualified medical interpreters when treating LEP patients. Instead, they use untrained bilingual staff, untrained adult family members and friends and minor children as interpreters. This practice produces not just medical quality and safety issues but also legal and civil rights violations.

  4. If providers are less than well prepared to treat LEP patients, they are even less prepared to treat Deaf and Hard of hearing patients who file the most language access lawsuits.

  5. 87% of physicians treat immigrant patients but 47% of physicians feel less than well prepared to do so. Their practice behaviors confirm their doubts. Few providers routinely ask immigrant patients about their country of origin or travel history or are familiar with the five most common infectious diseases that immigrants and refugees bring to the United States.

  6. 85% of physicians in our national sample believe themselves to be very well or well prepared to treat LGBTQ patients but their actual practice behaviors fail to support that confidence. Few physicians (<20%) routinely ask patients about their sexual orientation, their gender identity, ask patients about their sexual partners or take a comprehensive sexual history. Additionally, when physicians were asked for which of eleven common medical conditions they would have a heightened index of suspicion when treating LGBTQ+ patients, they failed to identify seven of the eleven most common medical conditions

  7. Sadly, in our national sample of over 1,800 physicians, we found that fully 54% had never had any formal training on cross-cultural medicine.

 

Additional Outcomes

​For additional information about how your organization can implement the PCCMA, please contact David Hunt, Senior Director of Health Equity: dbhunt@bctpartners.com OR by phone (612) 558-0028.

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