Provider Cross-Cultural Medical Assessment (PCCMA)
The global pandemic has highlighted two glaring deficiencies in the U.S. healthcare system. First, with over 1.5 billion international travelers crossing international borders every year, the U.S. is increasingly susceptible to diseases of foreign origin. (This is particularly so given the fact that many diseases of foreign origin (like COVID-19) share similar symptoms as common diseases of domestic origin – namely fever and flu-like symptoms.) Second, only 38% of American medical schools teach global medicine and far fewer (16%) focus on it.
As a result, over 54% of all practicing physicians in the U.S. have never had any formal training in cross-cultural medical care. Medical journals report that many physicians do not feel prepared to provide specific aspects of cross-cultural care, including caring for patients whose health beliefs were at odds with Western medicine (25%), new immigrants (25%), and patients whose health beliefs affect treatment (20%).
To address these problems, BCT Partners has partnered with nationally and internationally known physicians from Harvard and the University of Minnesota Medical School’s Global Pathways Program to create a Provider Cross-Cultural Medical Assessment. These physicians are known for their expertise in internal medicine, travel medicine, tropical medicine, immigrant and refugee medicine, cross-cultural clinical competence, and language access.
The Focus of the Assessment
The focus of our PCCMA is not on cultural competence but rather on clinical competence in a globally mobile world. Our assessment does not focus on providers' attitudes towards disparities but rather on the practice behaviors they use when treating a wide variety of minority patient populations. In essence, our assessment asks and answers two key questions:
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Which minority patient populations are providers best/least prepared to treat?
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Do providers’ practice behaviors match what research shows to be population-specific, clinical best practices and current legal/regulatory requirements?
Content of the Assessment
Our PCCMA covers six major areas:
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The extent of formal training in cross-cultural medicine.
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Self-assessed preparedness to treat a wide variety of minority and non-traditional patient populations. (See below.)
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Knowledge of and adherence to language access laws and institutional policies and procedures regarding language access (including formal training on how to work with LEP patients through qualified interpreters).
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Knowledge of and adherence to national best practices in cross-cultural medicine.
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Ability to recognize, diagnose and treat many common illnesses and diseases of foreign origin.
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Interest in receiving additional training in cross-cultural medicine.
Patient Populations Covered by the Assessment
Patient populations include racial and ethnic minorities, Limited English Proficient and Deaf and Hard of Hearing patients, immigrants, refugees, LGBTQ patients, military veterans, international travelers, and patients with non-Western health beliefs.
Methodology
The PCCMA is a standardized, statistically validated, 41-item questionnaire that is administered using an online research survey and software analytics program (Qualtrics).
Customization
We are eager to partner with your organization to customize our assessment to meet your needs.
Length of Time to Administer
Our assessment is administered electronically to minimize the impact on physicians’ time. From past client experiences, completing our assessment should take no more than ten minutes of the providers’ time. Providers access and complete the survey by internet on their laptop, iPad, or mobile phone.
Previous PCCMA Hospital System Clients
Over time, we have administered the PCCMA to over 8,000 providers across nine states (MN, WI, ME, SC, NC, FL, TX, MO, MD) giving us a national database of thousands of MD’s and APP’s. In turn, that national database gives us the capacity to benchmark hospital systems against each other, benchmark hospitals within hospital systems against one another and benchmark providers by medical subspecialty across the U.S. and against physicians specially trained in global medicine.
Major Findings
When we have administered our PCCMA to physicians and other providers in the past we have found that 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. See Table 4 below.
Table 4: Sample PCCMA Findings
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97% of U.S. physicians treat LEP patients, but over 50% of more than 1,600 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.
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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.
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Most physicians are not familiar with language access laws and hospital language access policies or had formal training on how to work with qualified medical/ASL interpreters.
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Consequently, physicians’ practice behaviors with respect to LEP and Deaf and Hard of Hearing patients frequently raise concerns about patient communication, safety, informed consent, legal risk management, and medical malpractice issues.
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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.
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Over 80% of providers treat immigrant patients, but over 60% of providers 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. Few providers routinely ask immigrant patients about depression, although immigrants and particularly refugees are more likely to suffer from depression and even torture in their native countries.
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Ironically, providers throughout the U.S. feel most prepared to treat LGBTQ patients, but their actual practice behaviors fail to support that confidence. Few providers routinely ask patients about their sexual orientation, their gender identity, ask patients about their sexual partners or take a comprehensive sexual history.
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84% of U.S. providers believe that they are very well or well prepared to treat military veterans. Yet less than 25% of providers always ask whether patients served in the military, ask about which military era they served in, or whether military veteran patients were deployed overseas. Finally, most providers were unfamiliar with three of the top six infectious diseases or medical conditions affecting veterans.
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Few physicians have had any formal training in cross-cultural medicine, but the substantial majority would like to receive such training.
What happens after providers take the PCCMA?
After providers take the PCCMA, BCT Partners will analyze the data and produce a detailed report with recommendations for change and improvement. In the past, we have stratified PCCMA results for our clients at the system level, hospital level, and by medical sub-specialty. In addition, once providers take the PCCMA and hit the “submit” button to finalize their results, BCT Partners can generate an individualized feedback report which will appear in a .pdf format in providers’ e-mail within two minutes of completion.
What kinds of information is contained in the individualized provider feedback report?
The individualized feedback report contains:
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Comparisons against clinical best practices.
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Insights from leading clinicians.
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Practice improvement tips to improve the quality and safety of care.
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Legal/risk management strategies and advice
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Statistical comparisons against peers by medical sub-specialty.
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Clinical effectiveness ratings (excellent, good, fair, or poor) for LEP and Deaf and Hard of Hearing patients