Friday, April 12, 2013

Breaking barriers to hear all voices

LABOR OF LOVE: From left, Baretto, Donelan and Lenny Lopez, MD, MDiv, MPH, senior faculty of The Disparities Solutions Center

In 2004, the newly formed MGH Disparities Committee surveyed MGH patients about issues related to race, ethnicity and their health care. At the time, 21 percent of black patients and 25 percent of Hispanic/Latino patients at the MGH reported they thought they received a lower quality of care than white patients. In a survey conducted in 2012, fewer than 10 percent of black and Hispanic/Latino patients held those views. 

“These data make me, and should make all of us, really proud,” said Karen Donelan, ScD, EdM, senior scientist at the Mongan Institute for Health Policy at the MGH. “The perception of fair and respectful treatment has continued to grow over the past eight years, and we’ve made great progress. But we still have work to do, especially for patients with limited English proficiency. We want our mission, credo and ‘excellence every day’ applied every day to all of our patients and their families.”

Donelan spoke during the “Racial and Ethnic Disparities: Keeping Current Seminar Series” hosted by The Disparities Solutions Center. The April 4 presentation, “Hearing All Voices: Race, Ethnicity, Language and the MGH Patient Experience,” explored trends in patient satisfaction connected to racial, ethnic and linguistic disparities in health care. 

Measuring patient-reported outcomes is an essential component of quality assessment, Donelan explained. The 2004 survey was one of the first projects undertaken by the MGH Disparities Committee as a way to measure minority patients’ perceptions of their care, because routine patient experience surveys often exclude or under represent these populations. Donelan said her research team – including Joseph Betancourt, MD, director of the Disparities Solutions Center; Elizabeth Mort, MD, senior vice president for Quality and Safety; Esteban Barreto, senior research assistant; and eight bilingual interviewers – worked to ensure a higher response rate by using special survey methods including statistical sampling techniques, bilingual study materials, and telephone interviews conducted by trained bilingual interviewers. Many MGH departments and an expert advisory team also helped to support the effort, Donelan said.

The 2012 follow-up survey was funded by the Center for Quality and Safety and reached out to samples of black, Hispanic/Latino, and Asian patients, as well as patients who speak Spanish, Arabic, Khmer, Portuguese and Chinese. The survey sample included 1,700 patients of all ages who visited MGH primary care practices and health centers in January 2012. Donelan said the survey included standard quality measures – whether patients thought doctors and nurses spent enough time with them; if clinicians explained things in a way they understood; if patients felt welcomed by staff; and if they felt they received the same quality of care as fellow patients.

“This work is a labor of love,” Donelan said. “For me, this is the heart of why we think about engaging patients in assessing the quality of their care. We are all guided by the needs of our patients and their families, and we want to ensure they have a good experience each time they come to MGH.” 

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