Articles

Bridging Gaps in Care

by Scott Suckow, FACHE

Imagine you are on an overseas business trip to someplace like Seoul, South Korea. In the middle of the night, you suddenly start feeling very ill. You find your way to a local hospital and check-in at the ER. The clerk doesn’t speak English, and you don’t speak Korean, so communicating the reason for your visit is difficult. The doctor who sees you seems empathetic, but only knows a few English words, like pain, and where. You can’t explain what you are feeling or give any of your health history. The doctor orders labs and an x-ray, later returns, and hands you a bottle of pills. The label is in Korean, and so is the discharge paperwork. You don’t know what the medication is, or how often to take it. You get the idea you are supposed to take two tablets, so you do. You leave and hope for the best.
This kind of scenario happens every day in hospitals across the US. Patients with language barriers often struggle to communicate with care teams, leading to 27% higher rates of readmission, 47% higher rates of returning to an ED, and inpatient stays that average 1.5 days longer. Often these patients are uninsured or under-insured, making any return ED visits and readmissions even more impactful to the hospital. 
Within Colorado and Wyoming, the percentage of individuals with Limited English Proficiency ranges from as low as 2-3% in some areas, to a high of 12-13% in Denver and Aurora, where some 150 different languages are spoken at home. These percentages have increased in recent years.

Fortunately, many hospitals invest in language access resources like video interpretation, telephonic interpretation, in-person interpreters, and bilingual staff. While not reimbursed, these services enable hospitals to comply with legal requirements and accreditation standards. More importantly, they level the playing field for these patients and allow them to fully participate in their care. Patients who are provided language assistance see shorter lengths of stay, return to the ED less, and enjoy better patient experience.
Over the past 20 years, hospitals across the US have made great progress in providing language access. It is now commonplace for care teams to be able to access telephonic or video interpreters in several hundred languages, on-demand, day or night. Many telehealth and virtual care modalities have interpretation resources built-in.
Important barriers still persist, however. The telephone remains the “front door” to hospitals and doctors’ offices for many patients, and those facing a language barrier often have trouble making appointments, canceling them, or inquiring about a family member. Medication labels and discharge instructions are commonly printed in English. Patient portals are available in English and sometimes Spanish, but not other languages. Social determinants of health like transportation, housing and insurance often block access to follow-up care and specialty services.

Recent advances in artificial intelligence bear great promise for these kinds of barriers. As AI solutions spring forward, though, it is important to keep a close eye on the accuracy, cultural context, and legal compliance of the information they provide.
With support from healthcare leaders, new and innovative solutions will emerge that close communication gaps, and enable patients with language barriers to take charge of their healthcare, and reap the benefit of all that our hospitals and clinics have to offer.

Scott Suckow, FACHE - Senior Director, UCHealth Language Services

Addressing Healthcare Inequities in Black and LGBTQ+ Communities

Danielle Jackman, PhD, CDP and Dennis McWhorter MHA

June represents a time to honor and celebrate some big historical wins. It is a time when people take to the streets to celebrate Juneteenth, African Americans' emancipation from slavery, and march for continued LGBTQ+ equality. It's a time to join the festivities, eat fantastic soul food, and walk alongside our Black and LGBTQ+ colleagues. However, these celebrations cannot overshadow the growing concerns about health inequities in Black and LGBTQ+ communities. The problem is even more significant for individuals with multiple intersecting identities.

Addressing the Suicide Crisis Among Black Youth

National statistics highlight rising suicide rates among Black children and youth. In 2019, suicide was the second leading cause of death among Black youth aged 10 to 14, and the third leading cause of death among teenagers ages 15 to 19. Black youth make up 13% of the Black communities and account for approximately 37% of deaths by suicide. In fact, according to the National Institute of Mental Health, Black children were at higher risk of dying by suicide than their White counterparts but less likely to receive treatment.

The reasons contributing to the lack or limited treatment of mental health concerns, including depression and suicide among Black communities, are nuanced and complex. Researchers suggest institutional racism is a significant factor. Institutional racism in healthcare suggests that the health concerns of Black people are seen as less severe than their White counterparts. Therefore, this results in late diagnoses and late treatment.

Additionally, the CDC suggests that Black youth are less likely to see a doctor due to multiple structural barriers. Such barriers include access to a hospital or healthcare facility, high costs, lack of transportation, and a low number of providers of color. These healthcare inequities are further emphasized in Black LGBTQ+ communities.

The LGBTQ+ community is facing a significant healthcare crisis. Many states, including Florida and Utah, have passed laws restricting youth from receiving gender-affirming care. Many other states are hoping to pass similar laws. These laws also indicate penalties for any person perceived to have their child receive gender-affirming care. This law, coupled with other laws such as those that grant doctors and insurers the ability to deny any person from receiving care based solely on "conscience," placed an increased burden and suffering on Black LGBTQ+ youth.

Ways to Support Black LGTBQ+ Youth

While many Colorado healthcare institutions have done a lot to support LGBTQ+ and Black communities separately, more work needs to be done to help and elevate the needs of Black LGBTQ+ youth. As healthcare leaders, we are responsible for better serving the people we often see and elevating our spaces to be welcoming for those we do not often see. Consider the following approaches in doing so. This is not an exhaustive list, but it can offer a start to those unsure where to turn.

1. Provide continuous and iterative anti-racism and anti-oppression listening sessions, training, and workshops for healthcare practitioners.
2. Hire more practitioners of color. This should include but is not limited to: doctors, surgeons, nurses, and other mental/behavioral health specialists such as psychiatrists and psychologists.
3. Conduct a cultural audit of your healthcare facility.
4. Provide staff space, budget, and guidance to establish and/or increase Employee Resource Groups.
5. Advocate for your Board of Directors to be gender, ethnically, and diverse in other groups or forms.

Most importantly, it is time for us to end silencing the pains of our Black youth and keep at the helm that healthcare is a right, not a privilege, and everybody deserves to be served.

References

• Racial and ethnic differences in depression: current perspectives - PMC (nih.gov)
• NIMH » Addressing the Crisis of Black Youth Suicide (nih.gov)
• full_taskforce_report.pdf (house.gov)
• https://focus.psychiatryonline.org/doi/10.1176/appi.focus.20210034
• https://ebrary.net/211748/health/problem_heteronormativity_medicine
• Rights & Protections | HealthCare.gov
• Florida bill expanding a doctor's ability to refuse services based on 'conscience' sparks debate | Health News Florida (usf.edu)