Addressing Issues

Please note: Some links on this page take you outside the Better Diabetes Care website. The NDEP does not endorse or otherwise guarantee the accuracy of links that take you out of this website.

Tufts University's Health Sciences Library Health Resource for Asian Americans

spiral.tufts.edu

This resource is for Asian Americans whose first language is not English. Dubbed SPIRAL for "Selected Patient Information Resources in Asian Languages," it is a Web site with detailed health information including diabetes in seven Asian languages: Chinese, Hmong, Khmer, Korean, Laotian, Thai and Vietnamese. It is a unique multi-language health information site because it is for both physicians and patients.

The Health Literacy: Help Your Patients Understand Educational Kit

www.ama-assn.org/ama/pub/category/9913.html

The American Medical Association Foundation offers a health literacy Continuing Education toolkit for health care providers.

The kit includes a documentary and instructional video and an in-depth manual for clinicians. 

Continuing Medical Education credit*

Learning objectives for this education program are to:

• understand the full scope of health literacy
• recognize health system barriers faced by patients with low health literacy
• improve verbal and written communications to patients
• create a "shame-free" environment for patients.

Kits can be purchased on an individual basis for $35 through AMA Press or by calling (800) 621-8335 for AMA Press Item #0P221002. The AMA Foundation is providing free health literacy toolkits to organizations that make a formal commitment to launch health literacy educational programs.

Unequal Treatment: Confronting Racial And Ethnic Disparities In Healthcare (2002) Institute of Medicine. BD Smedley, AY Stith and AR Nelson, Editors, Committee on Understanding and Eliminating Racial and Ethnic Disparities in health Care, Board on Health Science Policy.
bob.nap.edu/books/030908265X/html

This is a report of an IOM study requested by congress to assess differences in the kind and quality of health care received by racial and ethnic minorities and non-minorities in the United States. The study committee defines disparities in healthcare as racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of the intervention. The committee's analysis is focused at two levels: 1) the operation of healthcare systems and the legal and regulatory climate in which health systems function; and, 2) discrimination at the individual patient-provider level. Discrimination, as the committee uses the term, refers to differences in care that result from biases, prejudices, stereotyping and uncertainty in clinical communication and decision-making. A chapter on “The Rationing of Health Care and Health Disparity for American Indians/Alaska Natives by Jeannie R. Joe, PhD, MPH can be located at books.nap.edu/books/030908265X/html/528.html.

Click here for a summary of the Institute of Medicine (IOM) Study Findings.
Click here for a summary of the Institute of Medicine (IOM) Study Recommendations to Reduce Racial and Ethnic Disparities in Health Care.

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U.S. Department of Health and Human Services, Office of Minority Health. National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care Comprehensive Final Report and Executive Summary (March 2001).
www.omhrc.gov/clas/index.htm
www.omhrc.gov/omh/programs/2pgprograms/finalreport.pdf

Based on an analytical review of key laws, regulations, contracts, and standards currently in use by Federal and State agencies and other national organizations, 14 national standards for culturally and linguistically appropriate services in health care were developed and refined with significant input from a nationwide public comment process and the guidance of two national project advisory committees.

Purpose of the Standards
The culturally and linguistically appropriate services (CLAS) standards are proposed as one means to correct inequities that currently exist in the provision of health services and to make these services more responsive to the individual needs of all patients/consumers.

The standards are intended to be inclusive of all cultures and not limited to any particular population group or sets of groups. However, they are especially designed to address the needs of racial, ethnic, and linguistic population groups that experience unequal access to health services. Ultimately, the aim of the standards is to contribute to the elimination of racial and ethnic health disparities and to improve the health of all Americans.

The CLAS standards are primarily directed at health care organizations, however, individual providers are also encouraged to use the standards to make their practices more culturally and linguistically accessible. The principles and activities of CLAS should be integrated throughout an organization and undertaken in partnership with the communities being served.

The CLAS standards serve several purposes. They provide a common understanding and consistent definitions of culturally and linguistically appropriate services in health care. They offer a practical framework for the implementation of services and organizational structures that can help health care organizations and providers be responsive to the cultural and linguistic issues presented by diverse populations.

The CLAS standards are also presented as guidelines for:

• Policymakers: to draft consistent and comprehensive laws, regulations and contract language. This audience would include Federal, state and local legislators, administrative and oversight staff, and program managers.
• Accreditation and credentialing agencies: to assess and compare organizations that say they provide culturally competent services, and to assure quality for diverse populations. This audience would include the Joint Commission on Accreditation of Healthcare Organizations, the National Committee on Quality Assurance, professional organizations such as the American Medical and Nurses associations, and quality review organizations such as Quality Improvement Organizations.
• Purchasers: to advocate for the needs of ethnic consumers of health benefits and to leverage responses from insurers and health plans. This audience would include government and employer purchasers of health benefits, including labor unions.
• Patients: to be able to understand their right to receive accessible and appropriate health care services, and to evaluate whether health care organizations and providers can offer such services.
• Advocates: to promote quality health care for diverse populations, and to assess and monitor care being delivered by health care organizations and providers. The potential audience is quite wide, including legal services and consumer education/protection agencies; local and national ethnic, immigrant and other community-focused organizations; and local and national nonprofit organizations that address health care issues.
• Educators: to incorporate cultural and linguistic competence into their curricula and to raise awareness about the impact of culture and language on health care delivery. This audience would include health care professions educators and training institutions, as well as legal and social services professions educators.

The health care community in general: to debate and assess their applicability and adoption into standard health care practice.

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A Practical Guide for Implementing the Recommended National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care: Summary and Links to Currently Available On-line Sections.
www.omhrc.gov/clas/guideintro.htm

This is a practical, flexible, and easy-to-use, step-by-step guide to facilitate the implementation of the CLAS standards by health care organizations and providers. It is a work in progress, with sections posted online to receive comments, feedback, and suggestions.

Cultural Competence Works: Using Cultural Competence To Improve the Quality of Health Care for Diverse Populations and Add Value to Managed Care Arrangements. Health Resources and Services Administration, U.S. Department of Health and Human Services, 2001
www.hrsa.gov/financeMC/ftp/cultural-competence.pdf

This resource explains HRSA's experience in developing culturally appropriate programs and shows that practicing cultural competence -- the set of behaviors, attitudes, skills and policies that help organizations and staff work effectively with people of different cultures -- can help expand and improve access to quality health care.

A Primer for Cultural Proficiency: Towards Quality Health Services for Hispanics. The National Alliance for Hispanic Health.
www.hispanichealth.org/pdf/primer.pdf

This thorough primer on cultural competency for medical care providers seeks to move the discussion beyond cultural competency, towards cultural proficiency. Delivering quality care is more than being competent in the practice of a narrow set of skills. Delivering quality health services to Hispanics is about being proficient in the art of listening and communicating with patients from a variety of backgrounds; understanding that health occurs in a holistic environment; incorporating an understanding of a person's unique family, work, spiritual, and physical environment into health services; and, ensuring that the institutional structures of health services act to encourage rather than discourage access to care.

To support the application of the lessons in the primer, there is a companion workbook for health providers. Together, they provide an important resource for training and application of new skills in the art of culturally proficient health services delivery.

The Agency for Healthcare Research and Quality (AHRQ)
AHRQ and has a fact sheet, "Diabetes Disparities Among Racial and Ethnic Minorities," that provides summary information on diabetes disparities, a chronic disease self-management program being used in at least 31 states, and related AHRQ projects on improving care in different populations.
www.ahrq.gov/research/diabdisp.htm#Overview

HTML www.ahrq.gov/research/diabdisp.htm

PDF www.ahrq.gov/research/diabdisp.pdf

National Healthcare Disparities Report

See the National Healthcare Disparities Report for information on disparities in care for diabetes:

www.ahrq.gov/qual/nhdr06/nhdr06.htm

The Commonwealth Fund
www.cmwf.org/aboutus/aboutus.htm

The Commonwealth Fund is a private foundation that supports independent research on health and social issues and makes grants to improve health care practice and policy. The Fund is dedicated to helping people become more informed about their health care, and improving care for vulnerable populations such as children, elderly people, low-income families, minority Americans, and the uninsured.

The Fund's two national program areas are improving health insurance coverage and access to care and improving quality of health care services,  An international program in health policy  is designed to stimulate innovative policies and practices in the U.S. and other industrialized nations. The Fund also make grants to improve health care in New York City, its own community. Recent publications on minority health are featured in the quality improvement section.

What a Difference an Interpreter Can Make. The Access Project of the Center for Community Health Research and Action of the Heller School for Social Policy and Management at Brandeis University, 2002.
www.accessproject.org

This report, based on a survey of 4,161 uninsured respondents who received health care between May and August of 2000 at 23 primarily safety-net hospitals in 16 cities, compares the perceptions and experiences of adults who needed and easily got an interpreter with those who needed and did not get an interpreter (or had difficulty getting one), and with other uninsured who did not need an interpreter.

Overall, the uninsured who received an interpreter had similar or more positive experiences at the hospital where they received care than the uninsured without language barriers. However, adults who needed and did not get an interpreter had more negative perceptions about their health care experiences than those who either got interpreter services or did not need them.

The Provider's Guide to Quality & Culture, Bureau of Primary Health Care, HHS
erc.msh.org/mainpage.cfm?file=1.0.htm&module=provider&language=English
This web site is designed to assist health care organizations throughout the United States in providing high quality, culturally competent services to multi-ethnic populations. One section focuses on the needs of African Americans, Asian Americans, Hispanic/Latinos, Native Americans, and Pacific Islanders. This website is extremely comprehensive and a very useful tool for healthcare providers.

Bayer Institute for Health Care Communicationoffers trainings and videos on communication skills including cultural competency issues.
www.bayerinstitute.com

Pfizer Health Literacy Initiative
www.pfizerpublichealth.com/healthliteracy.aspx
The Pfizer Health Literacy Initiative is a multi-faceted initiative supported by Pfizer Inc and the Pfizer Foundation. The Pfizer Foundation supports innovative community-based interventions that increase health literacy in underserved populations. The website has information of health literacy, what it means, what to do to address it, fact sheets and statistics. It includes diabetes control and self-management programs in the Chinese, Chinese American and African-American communities.

Michigan Diabetes Research and Training Center Videotapes

www.med.umich.edu/mdrtc/education/profedu.htm#cbv
This is a set of videotapes and a discussion guide for diabetes educators who want to provide culturally sensitive and relevant diabetes education for urban African Americans with diabetes.7

Migrant Clinicians Network (MCN)
www.migrantclinician.org/resources/
The Migrant Clinicians Network is a national clinical network of health care providers who serve migrant farm workers and other underserved mobile populations. A Track II Program facilitates the transfer of medical records as well as phone based case management.

Contact information is provided to access a diabetes resource that provides information on diabetes and migrants as well as an in-depth look at how to effectively utilize the Track II Diabetes Tracking and Referral Program.

MCN Streamline is a bimonthly clinical newsletter that addresses current clinical, political, and educational issues pertinent to migrant farm workers and other underserved populations. www.migrantclinician.org/news/streamline/

The Diabetes Resource Pack was created as a mechanism for distributing information on migrant diabetic care to clinicians. MCN diabetes staff created the Moving Pack to provide an additional tool for clinicians who serve migrant workers with diabetes. The information in the Moving Pack is provided in English and Spanish at a basic reading level. There is information specific to the concerns of patients in the process of moving.

The Henry J. Kaiser Family Foundation

The Race/Ethnicity and health Care Program
The Foundation's activities in race/ethnicity and health care are focused on efforts to reduce disparities in health care access and quality. Through policy research and analysis, and media and public education activities, the Foundation seeks to improve knowledge and understanding of the problems contributing to the poorer health care outcomes of people of color. A major part of the Foundation's work has been a focus on the particular health challenges facing American Indians and Alaska Natives (AI/ANs).

Kaiser Compendium of Cultural Competence Initiatives in Health Care

The foundation has developed a Compendium of Cultural Competence Initiatives in Health Care, to describe these activities related to cultural competence in a single document. The compendium was prepared in response to the many requests from the media and others to define cultural competency and identify efforts underway in this emerging field. This publication is available at www.kff.org/uninsured/6067-index.cfm.

American Association of Diabetes Educators
This organization has issued a position statement to help diabetes educators deliver culturally sensitive care. Cultural sensitivity: definition, application, and recommendations for diabetes educators. Diabetes Educator, 2002;28(6):922-7.

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