Progression in understanding and implementing the cultural and linguistic appropriate services standards: five-year follow-up at an academic center.

In 2001, 14 national standards on Culturally and Linguistically Appropriate Services (CLAS) in health care were issued by the US Department of Health and Human Services Office of Minority Health to guide outcomes specific to disparities affecting patients with limited English proficiency. Additionally, demographic changes are rapidly occurring throughout the United States leading to more culturally and racially diverse communities, which have increased language barriers in the health care environment. This nonrandomized, cross-sectional study assessed changes and attitudes and applications of CLAS in an academic health care setting over a 5-year period (2006 to 2011). Results indicated that, in 2006, 72.6% participants reported they were "not at all familiar with CLAS" in comparison with 28.8% in 2011. In 2006, 16.5% participants strongly agreed to the question, "I know how to work with medical interpreters" compared with 24.9% in 2011. The same trend is seen with the question, "I use medical interpreters when I have a Spanish-speaking patient," in 2006, 25.5% strongly agreed in comparison with 35.4% in 2011. This study suggests that significant improvements occurred in the use of medical interpreters and understanding of CLAS as a result of educational activities implemented from 2006 to 2011.

Incorporating what promotoras learn: becoming role models to effect positive change.

Promotoras (community health workers) play an important health promotion role and must be continuously trained, but little is known about how much of their learning they actually put into practice. This non-randomized, longitudinal study examined knowledge and home environmental outcomes of an asthma and healthy homes training offered to promotoras using a train-the-trainer model. Eighty-five promotoras received the training and pre- and post-test surveys were used to measure training outcomes. Results showed a statistically significant increase in asthma and healthy home-related knowledge (P < .001). At 12-months post-intervention, a majority of the promotoras (69%) reported they made household changes to improve their indoor environment as a result of the training. This study suggests that effective trainings can improve promotoras knowledge and behaviors for the promotion of healthy homes in the community. Further evaluation is needed to investigate whether these trainings allow promotoras to serve as role models within their communities "by educating through example" and thereby enhance their credibility as health educators.

Associations between low literacy and health status measures: cross-sectional analyses of two physical activity trials.

Arthritis researchers have thoroughly documented a powerful relationship between years of education and health outcomes, but they have not documented the role of literacy. The authors examined the associations between literacy and arthritis health status measures. Participants were recruited from southeastern urban and rural areas. Rapid Estimate of Adult Literacy in Medicine, which provides an estimate of reading level in less than 3 minutes, was administered to 447 participants at baseline in 2 community-based randomized controlled trials of lifestyle interventions designed for aging sedentary adults with arthritis. Those who read below ninth grade were considered to have low literacy. Among the 447 study participants, the median sample age was 69 years. A majority of the participants were women (86%), Caucasian (80%), overweight or obese (72%). Of all participants, 20% had low literacy. Significantly more African Americans (54%) than Caucasians (12%) had low literacy levels (p < .001). Individuals with low literacy did not have significantly worse disability or arthritis symptoms than individuals with adequate literacy (all ps > .05). Among our study participants, 1 in 5 had low literacy, but literacy was not associated with health status in this population.

Multi-criteria assessment of county public health capability disparities.

OBJECTIVE: This paper proposes an analytical approach to the assessment of geographic population health disparities that are measured as the consolidation of public health related indicators into geographic-specific scores, and are representative of the level of public health capability within counties in the state of Mississippi. STUDY DESIGN: A multi-criteria decision model was employed to develop an additive scoring system that assigns a numerical score of public health capability disparities for a geographical area (county). METHODS: Routinely collected indicators were used to measure each county's current public health related concerns. These indicators include access, risks, health care quality, and outcomes data. Public health experts rated and ranked indicators to generate indicator weight. RESULTS: A county score was developed to rank Mississippi counties based on relative public health capability. This scoring system depicts population health disparities among Mississippi counties. CONCLUSIONS: The model is useful and ideal for establishing expectations and benchmarks for reduction or equalization of disparities. This information can be used to manage geographic population health disparities by guiding policy formulation and implementation.

Impacting Environmental and Public Health through the Use of Dual Targeted and Tailored Asthma Educational Interventions.

Home-based asthma environmental education for parents of asthmatic children is needed since many health professionals lack the time to offer it. However, developing targeted and tailored education is important in order to address the individual needs of participants. This nonrandomized longitudinal study examined knowledge on asthma with an Asthma and Healthy Homes educational intervention training offered to parents of children from low income families who reside in the Rio Grande Valley of Texas. Eighty-nine parents received the training and pre- and posttest surveys were used to measure knowledge outcomes. A standardized assessment on asthma triggers was used to identify the different triggers each child was exposed to, and a follow-up survey was conducted 6 months after the educational intervention to identify how many parents reported household and behavior changes as a result of the training. Results showed significant changes in behavior by participants as a result of the training received. This study suggests that these behavioral changes are attributed to the dual "targeted" and "tailored" educational interventions delivered to parents which resulted in a greater understanding of how to manage asthma by eliminating asthma triggers in their respective homes.

Scenario-based assessment of physicians' information needs.

Physicians' information needs routinely arise during their practice. Several studies have demonstrated that a useful way to understand the nature of the needs is to examine questions posed by physicians during the course of medical care. This paper presents an analysis of clinical questions collected when physicians were engaged in reviewing clinical cases. The main objective of the study was to investigate characteristics of the physicians' information needs to provide insight into the development of a conceptual guidance approach in information retrieval. The analysis focused on categories, search contexts, and patterns of the questions with respect to the scenarios. The results of the study showed that physicians' information needs exhibited distinct characteristics according to the scenarios, and that their needs could be expressed with a relatively small number of question patterns. These observations supported our approach of using patterns of information needs in facilitating digital information access.

Personal health records and hypertension control: a randomized trial.

PURPOSE: To examine the impact of a personal health record (PHR) in patients with hypertension measured by changes in biological outcomes, patient empowerment, patient perception of quality of care, and use of medical services. METHODS: A cluster-randomized effectiveness trial with PHR and no PHR groups was conducted in two ambulatory clinics. 453 of 1686 (26.4%) patients approached were included in the analyses. A PHR tethered to the patient's electronic medical record (EMR) was the primary intervention and included security measures, patient control of access, limited transmission of EMR data, blood pressure (BP) tracking, and appointment assistance. BP was the main outcome measure. Patient empowerment was assessed using the Patient Activation Measure and Patient Empowerment Scale. Quality of care was assessed using the Clinician and Group Assessment Score (CAHPS) and the Patient Assessment of Chronic Illness Care. Frequency of use of medical services was self-reported. RESULTS: No impact of the PHR was observed on BP, patient activation, patient perceived quality, or medical utilization in the intention-to-treat analysis. Sub-analysis of intervention patients self-identified as active PHR users (25.7% of those with available information) showed a 5.25-point reduction in diastolic BP. Younger age, self-reported computer skills, and more positive provider communication ratings were associated with frequency of PHR use. CONCLUSIONS: Few patients provided with a PHR actually used the PHR with any frequency. Thus simply providing a PHR may have limited impact on patient BP, empowerment, satisfaction with care, or use of health services without additional education or clinical intervention designed to increase PHR use. CLINICAL TRIAL REGISTRATION NUMBER: http://ClinicalTrials.gov Identifier: NCT01317537.

Using the "customer service framework" to successfully implement patient- and family-centered care.

Despite the growing momentum toward patient- and family-centered care at the federal policy level, the organizational literature remains divided on its effectiveness, especially in regard to its key dimension of involving patients and families in treatment decisions and safety practices. Although some have argued for the universal adoption of patient involvement, others have questioned both the effectiveness and feasibility of patient involvement. In this article, we apply a well-established theoretical perspective, that is, the Service Quality Model (SQM) (also known as the "customer service framework") to the health care context, to reconcile the debate related to patient involvement. The application helps support the case for universal adoption of patient involvement and also question the arguments against it. A key contribution of the SQM lies in highlighting a set of fundamental service quality determinants emanating from basic consumer service needs. It also provides a simple framework for understanding how gaps between consumer expectations and management perceptions of those expectations can affect the gap between "expected" and "perceived" service quality from a consumer's perspective. Simultaneously, the SQM also outlines "management requirements" for the successful implementation of a customer service strategy. Applying the SQM to the health care context therefore, in addition to reconciling the debate on patient involvement, helps identify specific steps health care managers could take to successfully implement patient- and family-centered care. Correspondingly, the application also provides insights into strategies for the successful implementation of policy recommendations related to patient- and family-centered care in health care organizations.

Incorporating patient perspectives into the personal health record: implications for care and caring.

Electronic personal health records (ePHRs) can potentially maximize access and coordination of health information and improve patient/clinician collaboration, patient self-management, and health outcomes. Most ePHRs are designed by vendors, physicians, and other proprietary partners and have neglected the patient perspective. This study sought to incorporate patient feedback into an existing ePHR system. Patients participated in a semistructured interview after one to two weeks of using an ePHR. Interviews addressed strengths and weaknesses of the PHR. Two iterations of interviews, referred to as Wave 1 and Wave 2, occurred sequentially. An iterative process of theme identification was used, and three theme categories (User, System Acceptance, and Technology) were identified in the two waves. Seven technology themes with 40 specific questions were identified and were rank ordered by importance and feasibility, and 20 suggestions were subsequently implemented into the ePHR. Thus, incorporating patient feedback on specific utilities and functionality into an existing ePHR is possible.