Saturday, November 19, 2005
If you do ethics (or other) consults in a multi-ethnic, multilingual environment, you know how crucial it is to have a great translator. But what makes a health care translator great? Here's an answer, courtesy of the Commonwealth Fund:
The National Council on Interpreting in Health Care (NCIHC) has developed the first set of national standards for medical interpreting professionals in the United States. The 32 standards provide guidance on the qualifications and proper role of the interpreter and define what constitutes good practice. They are designed to promote better communication between patients and health professionals who do not share a language and improve the quality of care for these patients.
The Issue: Although in recent years, health care facilities and agencies across the United States have made strides in providing linguistically appropriate services, there has been little clarity about what constitutes appropriate training, qualifications, and performance for bilingual health care interpreters, who facilitate communication between patients and providers. As a result, health care interpreting across the country is uneven and inconsistent, leaving many patients with limited English proficiency at risk of having incomplete and inaccurate communication with their health care professionals, which studies suggest can result in higher costs and poorer outcomes.
In 2004, the NCIHC published the National Code of Ethics for Interpreters in Health Care. Building on that code of ethics, these standards of practice define the characteristics and competencies of medical interpreters. They also describe what is considered "best practice" by the profession, helping to ensure consistency and quality across medical settings.
Organization: The NCIHC Standards, Training and Certification committee, with funding from The Commonwealth Fund and The California Endowment
Target Populations: Health care interpreters and those who train, employ, and work with interpreters
The Intervention: After commissioning an international environmental scan of current practices and existing published standards, the NCIHC Standards, Training, and Certification committee conducted a series of seven targeted focus groups across the country. Once they analyzed the focus group and environmental scan results, the committee drafted an initial standards document. The draft standards were presented to the health care community for feedback through a national survey of interpreters and those who work with them. The final document incorporates changes made by the committee after careful consideration of all the input from survey respondents.
The 32 standards—which are grouped into nine categories that are each associated with a corresponding ethical principle—are expected to be used in training, hiring, performance monitoring, and as a basis for discussion on the merits of a certification process to assess the qualifications of interpreters working or preparing to work in health care settings.
The new national standards provide guidelines on the following nine issues:
- Accuracy: To enable other parties to know precisely what each speaker has said.
- Confidentiality: To honor the private and personal nature of the health care interaction and maintain trust among all parties.
- Impartiality: To eliminate the effect of interpreter bias or preference.
- Respect: To acknowledge the inherent dignity of all parties in the interpreted encounter.
- Cultural Awareness: To facilitate communication across cultural differences.
- Role Boundaries: To clarify the scope and limits of the interpreting role, in order to avoid conflicts of interest.
- Professionalism: To uphold the public's trust in the interpreting profession.
- Professional Development: To attain the highest possible level of competence and service.
- Advocacy: To prevent harm to parties whom the interpreter serves.
Thursday, November 17, 2005
Modern Healthcare's Daily Digest (requires free registration) reported Thursday that a new report set the extra health care costs of nosocomial infections in Pennsylvania hospitals at nearly $2 billion in 2004:
Infections acquired in Pennsylvania hospitals resulted in extra charges of about $1 billion to Medicare, $370 million to Medicaid and $600 million to commercial insurers in 2004, according to the Pennsylvania Health Care Cost Containment Council. The Hospital & Healthsystem Association of Pennsylvania criticized the state's methodology and conclusions, saying reimbursement equals only a fraction of charges, and denied that hospitals were underreporting infections. Council Executive Director Marc Volavka challenged individual hospitals to release specific infection data and corresponding charges and collections. The state counted about 11,700 nosocomial infections -- pneumonia, surgical site, urinary tract or bloodstream -- at 173 acute-care hospitals, a rate of about 7.5 hospital-acquired infections per 1,000 admissions. Mortality was about 16% among Medicare and Medicaid patients with nosocomial infections but was 3.7% and 1.1%, respectively, among other Medicare and Medicaid patients.
According to its website, "the Pennsylvania Health Care Cost Containment Council is an independent state agency responsible for addressing the problem of escalating health costs, ensuring the quality of health care, and increasing access for all citizens regardless of ability to pay."
In a related story, Utne magazine reports in today's issue that hospital-acquired infections kill more people than breast cancer or car accidents, and its rate in patients has shot up 36 percent since 1975. [tm]
We've received the following fellowship announcement from Alex Boni-Saenz, a law student at Harvard:
The Petrie-Flom Center - Fellowship Program
The Petrie-Flom Center Announces its 2006-2007 Fellowship Program for post-graduate and mid-career fellows.
To ensure rich intellectual exchange and encourage the movement of top current and future scholars into issues of health care law and policy, the Center will sponsor research fellows at all stages of their academic and professional careers, from law and graduate students to scholars and practitioners who are experts in their fields.
Post-Graduate and Mid-Career Fellows
Petrie-Flom post-graduate fellows will be selected from among recent graduates and mid-career academics and practitioners who are committed to spending up to two years at the Center pursuing publishable research that is likely to make a significant contribution to the field of health law policy. The first group of up to five post-graduate fellows will start in September 2006, followed by a second group in September 2007.
Program: The Petrie-Flom Post-Graduate fellowships are full-time, residential fellowships for two full years starting in September 2006. Fellows will devote their full time to research activities in furtherance of their own research proposals. No teaching obligations are associated with this fellowship, although teaching opportunities might be available to interested fellows with the Center's permission. Fellows will be expected to attend and participate in research workshops on health law policy and other similar events designated by the Center, and to present their research at least once per year in one of a variety of forums, including academic seminars, speakers panels or conferences. They also will be expected to provide opportunities for interested students to consult with them about their areas of research.
Salary and Benefits: Fellows will enjoy access to the full range of resources offered by Harvard University. Fellows will be provided with office space, library privileges, appointment fees, health benefits, a research budget, and a salary of up to $60,000 per full year.
Eligibility: Applicants must hold a degree in law or some other graduate discipline that they intend to apply to issues of health law policy and bioethics. The Center particularly encourages applications by those who intend to pursue careers as law professors, but will consider any applicant who demonstrates an interest and ability to produce outstanding scholarship in the areas of health policy, biotechnology or bioethics during the term of the fellowship. Applicants will be evaluated by the quality and probable significance of their research proposals, and by their record of academic and professional achievement.
Application: If you plan to apply for a fellowship starting in September 2006, please submit an Application Cover Sheet and download a copy of the Call for Applications (PDF) that contains additional information about the application process.
The website for the Center is: http://www.law.harvard.edu/programs/petrie-flom/ and the website for the fellowship program is http://www.law.harvard.edu/programs/petrie-flom/fellowship.php. [tm]
Wednesday, November 16, 2005
Sunday, November 13, 2005
The Milwaukee Journal Sentinel is reporting that the Wisconsin AG will file complaints against hospitals for charging uninsured patients more than they charge managed care companies for the same service. If you have followed the Scruggs cases, most federal complaints have been dismissed but the state law complaints have created some issues for hospitals.
Here's a link to the story: Wisconsin AG