AHRQ s Approach to Informing Latinos about Health Care Efficiency, Quality Safety

1. AHRQ�s Approach to Informing Latinos about Health Care Efficiency, Quality & Safety Ileana Mar�a Ponce-Gonz�lez, MD, MPH, CNC Scientific Review Officer Agency for Healthcare Research and Quality NHMA 14th Annual Conference Washington, DC � March 26, 2010

2. AHRQ Overview Agency within the US. Department of Health & Human Services Sister agency to the Centers for Disease Control (CDC) and the National Institutes of Health (NIH), etc Mission: To improve the quality, safety, efficiency and effectiveness of health care for all Americans HHS Agencies Administration for Children & Families Administration on Aging Agency for Healthcare Research & Quality Agency for Toxic Substances & Disease Registry Centers for Disease Control & Prevention Centers for Medicare & Medicaid Services Food & Drug Administration Health Resources & Services Administration Indian Health Service National Institutes of Health Substance Abuse & Mental Health Services Administration HHS Agencies Administration for Children & Families Administration on Aging Agency for Healthcare Research & Quality Agency for Toxic Substances & Disease Registry Centers for Disease Control & Prevention Centers for Medicare & Medicaid Services Food & Drug Administration Health Resources & Services Administration Indian Health Service National Institutes of Health Substance Abuse & Mental Health Services Administration

3. Language Proficiency About 52 million Americans (nearly 1 in 5) spoke a language other than English at home in 2000, up from 32 million in 1990 Nearly half reported not speaking English very well In 2003, almost 12 percent of the U.S. population (33.5 million people) was born outside of the United States � up from about 8 percent in 1990. About 40 percent of Hispanics in the United States were foreign-born. About 52 million Americans, or almost 1 of every 5, spoke a language at home in 2000 that was other than English. This is an increase over the 32 million who reported the same in 1990. Of these 52 million, 32 million spoke Spanish. Almost half the 52 million people who spoke a foreign language at home reported not speaking English very well. Among adults who had a doctor�s office or clinic visit within the last 12 months and who reported having communication problems with their providers, those who spoke a foreign language at home were more likely to have this difficulty than adults who spoke English at home (13.4 percent compared with 9.5 percent).In 2003, almost 12 percent of the U.S. population (33.5 million people) was born outside of the United States � up from about 8 percent in 1990. About 40 percent of Hispanics in the United States were foreign-born. About 52 million Americans, or almost 1 of every 5, spoke a language at home in 2000 that was other than English. This is an increase over the 32 million who reported the same in 1990. Of these 52 million, 32 million spoke Spanish. Almost half the 52 million people who spoke a foreign language at home reported not speaking English very well. Among adults who had a doctor�s office or clinic visit within the last 12 months and who reported having communication problems with their providers, those who spoke a foreign language at home were more likely to have this difficulty than adults who spoke English at home (13.4 percent compared with 9.5 percent).

4. Communication with Health Care Providers Adult Latinos were more than twice as likely as non-Hispanic adult whites to report language as the reason they had difficulty understanding their doctor (3.7 percent compared with 1.4 percent) Poor Latinos were four times more likely to have difficulty understanding their doctor than high-income Latinos (8.5 percent v. 2.2 percent)� Latinos age 18 and older were about twice as likely as Anglos to have difficulty understanding their doctor (5.5 percent v. 2.6 percent).Latinos age 18 and older were about twice as likely as Anglos to have difficulty understanding their doctor (5.5 percent v. 2.6 percent).

5. Health Care Disparities Among Latinos are Getting Worse Latinos are 38 percent less likely than non-Latinos to have visited the doctor within the past year More than a quarter of Latino adults have never had their cholesterol checked Two-thirds of Latinos over 50 have never had a colonoscopy More than half of Latinas over 40 have not had a mammogram within the last year. Poor and low-income Latinos age 50 and over had lower rates of ever having had colorectal cancer screening than high-income Latinos the same age (47 percent and 57.5 percent, respectively v. 68 percent). Disparities also existed among Latinos by income level for diabetes care Only 53 percent of adult Latinos age 50 and over with Medicaid or other public insurance had colorectal cancer screening, compared with 62 percent of privately insured Latino that age Only 32 percent of uninsured Latinos age 50 and over had colorectal cancer screening, compared to 63 percent of privately insured ones Poor and low-income Latinos age 50 and over had lower rates of ever having had colorectal cancer screening than high-income Latinos the same age (47 percent and 57.5 percent, respectively v. 68 percent). Disparities also existed among Latinos by income level for diabetes care Only 53 percent of adult Latinos age 50 and over with Medicaid or other public insurance had colorectal cancer screening, compared with 62 percent of privately insured Latino that age Only 32 percent of uninsured Latinos age 50 and over had colorectal cancer screening, compared to 63 percent of privately insured ones

6. The Involved Patient: What the Research Shows The average doctor visit lasts�less than 20 minutes Patients who share in decisionmaking about their health care tend to get better care and be more satisfied with their care The average patient asks 1.5 questions per visit, including questions about parking

7. AHRQ Outreach Designed for the Latino Community AHRQ Spanish-speaking physicians are regularly interviewed by networks like Univision, Telemundo and CNN In 2009, AHRQ shipped nearly 400,000 copies of Spanish-language materials to fill orders from medical practices, hospitals, health departments, health plans, other types of organizations, and from individual consumers AHRQ Spanish-speaking physicians are regularly interviewed by networks like Univision, Telemundo and CNN In 2009, AHRQ shipped nearly 400,000 copies of Spanish-language materials to fill orders from medical practices, hospitals, health departments, health plans, other types of organizations, and from individual consumers

8. Patient-Engagement: Superh�roes Campaign Emphasis on preventive care Main message: Tu no eres un superh�roe (You�re not a superhero) AHRQ has an ongoing national multi-media campaign that is designed to encourage people to become engage in their own health care. The campaign was developed in collaboration with the Ad Council, focusing on a variety of audiences. Superh�roes is a multi-media campaign that we developed and launched two years ago, in collaboration with the Ad Council. It is still played on Spanish-language television. Approximately 2,000 people a month visit the Web page for this campaign. This is the version of the campaign targeted to women. There is also a Superheroes for men. AHRQ has an ongoing national multi-media campaign that is designed to encourage people to become engage in their own health care. The campaign was developed in collaboration with the Ad Council, focusing on a variety of audiences. Superh�roes is a multi-media campaign that we developed and launched two years ago, in collaboration with the Ad Council. It is still played on Spanish-language television. Approximately 2,000 people a month visit the Web page for this campaign. This is the version of the campaign targeted to women. There is also a Superheroes for men.

9. Superh�roes Web Page Encourages Hispanics to make periodic doctor visits an integral part of a healthy lifestyle Provides assistance in locating HRSA-funded health centers In 2008, AHRQ and the Ad Council also debuted the �Superheroes� campaign. This is aimed at Hispanic men and women. Drawing on the strength of the Hispanic family, the campaign encourages men and women to take time out of their busy lives to take care of themselves. In 2008, AHRQ and the Ad Council also debuted the �Superheroes� campaign. This is aimed at Hispanic men and women. Drawing on the strength of the Hispanic family, the campaign encourages men and women to take time out of their busy lives to take care of themselves.

10. Informing Latinos About Health Care Effectiveness, Quality & Safety Antidepressant Medicines Choosing Pain Medicine for Osteoarthritis Comparing Two Kinds of Blood Pressure Pills: ACEIs and ARBs Pills for Type 2 Diabetes AHRQ has more than 40 printed and Web-based publications for consumers/patients in Spanish and English. AHRQ has more than 40 printed and Web-based publications for consumers/patients in Spanish and English.

11. Guides for Clinicians Summarizes clinical research on commonly used antidepressants for adults with major depression Selective serotonin reuptake inhibitors and other agents Includes confidence ratings based on quantity and quality of clinical evidence

12. Videos for Consumers/Patients 10-minute video helps patients understand how they should use anticoagulant drugs Basic information about blood thinners medications including reasons why a clinician might prescribe it Tips on diet, medicines and foods to avoid and precautions for some daily activities

13. Spanish-Language Web Page The Agency�s enhanced Spanish-language Web pages include more than 35 consumer guides on health care quality, surgery, health conditions and diseases, quitting smoking, safe use of medicines, understanding health insurance options, and prevention and wellness. This page was visited more than 420,000 times last year. Consejos de Salud Para Ti, monthly online health advice column by AHRQ physician, Illeana Ponce-Gonzales, M.D. Provides tips on preventive health, safe and appropriate use of medications and other medical therapies, ways to get better health care, and other key health care issues It is published by an average of 30 Spanish-language newspapers with a combined readership of an estimated _____. In the box above my column, you see a link to Healthcare 411. This is an audio podcast series produced by the Agency to share news and information in concise 60-second audio news programs that feature current research on important health care topics. These podcasts are available in English and Spanish. About 600 Spanish-language radio stations regularly broadcast our twice-monthly Healthcare 411 en espa�ol podcasts on health news and advice ( According to Arbitron 70% of all Spanish dominant Hispanics 12+ are loyal to Spanish language radio) The Agency�s enhanced Spanish-language Web pages include more than 35 consumer guides on health care quality, surgery, health conditions and diseases, quitting smoking, safe use of medicines, understanding health insurance options, and prevention and wellness. This page was visited more than 420,000 times last year. Consejos de Salud Para Ti, monthly online health advice column by AHRQ physician, Illeana Ponce-Gonzales, M.D. Provides tips on preventive health, safe and appropriate use of medications and other medical therapies, ways to get better health care, and other key health care issues It is published by an average of 30 Spanish-language newspapers with a combined readership of an estimated _____. In the box above my column, you see a link to Healthcare 411. This is an audio podcast series produced by the Agency to share news and information in concise 60-second audio news programs that feature current research on important health care topics. These podcasts are available in English and Spanish. About 600 Spanish-language radio stations regularly broadcast our twice-monthly Healthcare 411 en espa�ol podcasts on health news and advice ( According to Arbitron 70% of all Spanish dominant Hispanics 12+ are loyal to Spanish language radio)

14. Opportunities: NHMA & AHRQ Encourage health care consumers to use AHRQ�s patient-engagement and patient-education materials for Latinos Use AHRQ information and tools for clinicians in areas including preventive health and medication adherence Explore opportunities to create a network involving AHRQ, Latino health service providers and Hispanic advocacy groups

15. Ordering Information Phone: Toll-free: 800-358-9295 Callers outside of the U.S.: 703-437-2078 E-mail: AHRQpubs@ahrq.hhs.gov Mail: P.O. Box 8547, Silver Spring, MD 20907-8547 On-line: AHRQ Publications online store: http://ahrqpubs.ahrq.gov All the materials that I�ve talked about today are, of course, available on our web site. You can also order any of our publications by contacting us at the information on this slide. If you�re interested in co-branding opportunities, the clearinghouse can help you out with that too. For other AHRQ consumer publications, the maximum free copy limit for organizations and health professionals is 100 copies; then the customer must pay for additional copies (cost varies on the "type of pub"). Consumers are allowed 3 copies free; then must pay for additional copies. �� For the Effective Health Care (clinician and consumer) publications only: �Organizations can get 500 free copies of summary guides (an increase from our normal 100 free). If they want more, the cost is $12.50 per pack of 25, plus shipping, with a maximum purchase of 1,000. For more than 1,000 copies, organization must enter into a Reprint Agreement to obtain the graphic files on a CD-ROM to take to the commercial printing vendor of its choice to print the desired quantity. (See the end of this email for language to suggest a reprint agreement.) Individual clinicians or health care professionals can get 200 free copies (an increase from our normal 100 free). If they want more, they would need to follow the same purchase policy as organizations. �Likewise, for more than 1,000 copies, individual clinicians or health care professionals must enter into a Reprint Agreement. ������� For consumers, the policy remains unchanged: Consumers can get 3 free copies, with the same purchase and reprint requirements outlined above.All the materials that I�ve talked about today are, of course, available on our web site. You can also order any of our publications by contacting us at the information on this slide. If you�re interested in co-branding opportunities, the clearinghouse can help you out with that too. For other AHRQ consumer publications, the maximum free copy limit for organizations and health professionals is 100 copies; then the customer must pay for additional copies (cost varies on the "type of pub"). Consumers are allowed 3 copies free; then must pay for additional copies. �� For the Effective Health Care (clinician and consumer) publications only: �Organizations can get 500 free copies of summary guides (an increase from our normal 100 free). If they want more, the cost is $12.50 per pack of 25, plus shipping, with a maximum purchase of 1,000. For more than 1,000 copies, organization must enter into a Reprint Agreement to obtain the graphic files on a CD-ROM to take to the commercial printing vendor of its choice to print the desired quantity. (See the end of this email for language to suggest a reprint agreement.) Individual clinicians or health care professionals can get 200 free copies (an increase from our normal 100 free). If they want more, they would need to follow the same purchase policy as organizations. �Likewise, for more than 1,000 copies, individual clinicians or health care professionals must enter into a Reprint Agreement. ������� For consumers, the policy remains unchanged: Consumers can get 3 free copies, with the same purchase and reprint requirements outlined above.