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The Patient Centered Medical Home: How Well Will They Serve Non-English Speakers?

The Patient Centered Medical Home: How Well Will They Serve Non-English Speakers?

Healthcare reform is gaining speed and both healthcare organizations and patients are becoming more familiar with the Affordable Care Act (ACA).  Increased attention is being paid to subjects such as patient-centered care, a model of care that has been around for years but is now gaining more traction as a result of the ACA.  Part of this discussion that should be getting more consideration is how limited-English proficient (LEP) patients will be served by these new care models as they become more widely implemented.

on-siteConsumer Reports just released the first in a series of ACA related reports: A doctor’s office that’s all about you.[i] It looks at the growing interest in the patient-centered medical home model, a very promising service model that aims to improve healthcare delivery by reducing costs, improving coordination of care, and involving patients more actively, among other things.  The report describes a number of promising practices to help achieve these objectives such as:

  • Sending patients automated prevention and checkup reminders.
  • Creating online patient portals to facilitate patient to provider communication.
  • Coordinating care so the patient can see multiple treatment team members in one day, preferably at one location.
  • Holding asthma or diabetes days where multiple specialists can be seen at one time.
  • Holding monthly patient support groups.

A question that immediately arises for any of us working with LEP populations is: will this model work for them?  Currently, many outpatient clinics lack comprehensive language services or are not using them effectively. Doctors and nurses often rely on untrained bilingual staff – who usually only speak the most frequently encountered languages – or count on the patient bringing a bilingual friend or family member to interpret.  The end result is that miscommunication often occurs, care can be compromised, and services are often delayed.

In its criteria for a Primary Care Medical Home (PCMH), the Joint Commission identifies “Consideration of the patient’s cultural, linguistic, language, and educational needs and preferences” as an essential element of patient-centered care.[ii]   Additionally, language services must be both comprehensive and timely.  Similarly, the NCQA PCMH Standards identify providing patient materials and services that meet the language needs of patients as a necessary step in increasing patient-centeredness.[iii]

Obviously, effective and comprehensive language service provision is an essential element of all healthcare services, but especially those models aimed at putting the patient’s needs first.  We hope that this issue becomes a more central part of the conversation as the patient centered medical home becomes the choice of more LEP patients

[i] A doctor’s office that’s all about you.  Consumer Reports. July, 2013.

[ii] The Joint Commission Primary Care Medical Home (PCMH) Model.  The Joint Commission.  June 21, 2011 < accessed June 3, 2013.>

[iii] Standards and Guidelines for NCQA’s Patient-Centered Medical Home (PCMH) 2011.  The National Committee for Quality Assurance (NCQA).  March 25, 2013.

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