NCQA Launches Minority Health Project

Multicultural health has become an increasingly more important area of study in today’s healthcare industry, with some states jumping ahead of the curve by enforcing mandates that require physicians to complete certain courses regarding minority health before gaining licensure. For instance, New Jersey implemented such a mandate in March 2005, when then-governor Richard J. Codey signed a law stating that “doctors must take cultural competency training before they can get medical licenses” and that the “30,000 physicians who already have a license will have to complete the training to renew their licenses.”

In addition, California has also established itself as a state dedicated to making sure it’s healthcare providers have a background in cultural competence, calling for physicians to complete training courses in this area, as well as linguistic training.

With more mandates on cultural competency comes more attention, and with more attention come more programs designed to help everyone from the solo physician to the group practice on becoming better acquainted with this developing area of study. One such emerging program is the National Committee for Quality Assurance’s (NCQA) Technical Assistance Project (TAP). This program, supported by The California Endowment, “provides demonstration grants to small physician practices to undertake new efforts to improve care for minority patients” to help “reduce health care disparities.”

Although the NCQA has administered physician-recognition programs on specific conditions in the past, this is the first program they have created that focuses specifically on culturally and linguistically appropriate services, and if all goes well, the NCQA is looking to expand the program into larger scale projects. MDNG recently had the opportunity to speak with Sepheen Byron, Assistant Director of Performance Measurement for the NCQA. She explained that the NCQA has been “exploring this area of culturally and linguistically appropriate services for a while,” and that it fell “right in line with our mission of improving quality and improving healthcare.” The first step of the program was to award grants of up to $25,000 to 20 small practices in California and New Jersey; these practices were then instructed to implement a focused, 12-month project that would seek to improve care for minority patients. The idea behind these programs is to, as Byron states, teach “methods such as small tests of change, do something on a small scale at first; evaluate it; see if it works; and then do it on a larger scale for the whole practice.” By providing these practices the liberty of zoning in on a specific area of study (eg, hypertension, diabetes, depression) in specific populations (eg, African American, Latino, Asian), the TAP program sought to collect a great deal of data.

By agreeing to take part in the program, practices were required to spend part of their grant funds to send a physician and office staff member to attend a full-day, local, project-launch training workshop; complete a 4-6-hour training workshop; attend a monthly, hour-long, web-assisted conference call for technical assistance; complete practice and staff assessments; submit a project plan and budget, along with quarterly progress and budget reports; complete final practice assessment and participate in a site visit at the project’s end; and use part of the grant funds to attend a national conference to share completed project findings with peers. With this data, NCQA will be able to determine which processes worked, and which ones were not effective in helping improve the quality of healthcare.

MDNG asked Byron how the TAP program went about defining “quality healthcare,” and about the barriers and deficiencies that have been encountered throughout the program. “It’s less a focus on clinical outcomes and more of a focus right now on processes, so if they are able to implement a change and see that they’re able to, for example, collect data on their outcomes rather than focusing specifically on the outcomes, we view that as a success because a lot of these practices don’t even have the information to make a decision about how they should be caring for their minority patients.” In other words, any data is good data, since there aren’t many proven methods when it comes to improving minority healthcare. Another problem the TAP program faced was that these participants were a part of small-scale or solo practices, and this created a problem of not being able to spend time with a project like this. “Often, there are only one or two physicians in the whole practice, and they have to focus all their time on caring for patients,” says Byron. “Being able to set aside time, resources, etc to do some sort of focused project on their patient population is difficult for them.” However, in the end, the practices that took part in this project were able to find ways to help contribute to the program. In fact, many practices (all of which had a fairly substantial minority population) understood that they were helping to unearth some data on a field of study that desperately needed some investigating, and they were happy to put in the extra time necessary to contribute.

Programs like TAP are destined to enjoy more success with time. When asked whether she thought programs like the ones initiated by TAP’s grants would catch on across the nation, Byron explains that many of the initiatives to study minority health “were stimulated by the Institute of Medicine report that came out a few years ago, looking at culturally and linguistically appropriate services. It triggered [the need for such initiatives] in a lot of people’s minds, and now you see it spreading across the country, and with the increasing diversity of the US, we think it’s going to be a very important area.” In this regard, the NCQA’s Technical Assistance Project is carefully constructing the foundation of a new era of medical knowledge and is helping to unearth evidence from the anecdotal data that has gone ignored for too long.

The TAP program is now scheduled to undergo a full-scale evaluation, at which point the NCQA will determine which programs initiated by these small practices have shown to be the most successful. Once complete, the NCQA will focus its attention on taking these successful programs to a larger scale, and then, ultimately, will evaluate that step as well. Be sure to look for a comprehensive article in Focus on Multicultural Healthcare (FOMCH) later this year, detailing the TAP program’s evaluation, which is scheduled to be released in June/July.

Programs Initiated by TAP Grants

Practice: Med One Medical Group, Inc. (California)

Project: Adherence to Hypertension Treatment and Measurement

Aim: To educate hypertensive patients who speak English, Arabic, or Vietnamese about managing their hypertension and the importance of adhering to treatment recommendations.

Description: The project team is providing understandable patient education materials that describe steps to checking blood pressure and effectively managing hypertension. The team is creating and testing processes to identify and flag patients who prefer materials in Arabic and Vietnamese. Educational materials are available in Arabic, Vietnamese, and English and also take into account the cultural differences of these patient groups.

Practice: Clinica Western (California)

Project: Overweight Reduction and Patient Tracking

Aim: To improve the health among overweight or obese Latino and Asian patients.

Description: In this project, Latino and Asian patients who are diagnosed as overweight or obese receive education and participate in motivational interviewing techniques to help them achieve a healthier weight. The project team is employing techniques learned through TAP to encourage patients to become involved in their health care. In addition, the team distributes patient education materials that are culturally and linguistically appropriate for these two populations.

Practice: Practice of M.A. Sarraf, MD (New Jersey)

Project: Tracking HbA1c in Minority Diabetics as a Quality Improvement Process

Aim: To measure and record HbA1c levels at set intervals in African American and Latino patients with diabetes.

Description: The project team is implementing a process to identify African American and Latino patients who have diabetes. The team will check for the date of the patient’s last HbA1c measurement and, if one has not been performed in the last quarter, will conduct the test. The team also distributes culturally and linguistically appropriate educational materials to teach patients how to manage their diabetes and about the importance of regular HbA1c testing.

Practice: California Coast Medical Center

Project: MAGIC — Medication Analysis Generated Into Compliance

Aim: To increase medication adherence and patient follow-up using information in English and Spanish.

Description: The project team is educating patients to improve medication management, particularly in Latinos with limited English proficiency. The team approach includes personalized teaching in Spanish, communication tools, and visual aids. The team stresses patient understanding of conditions, knowledge of medications, and the importance of completing treatment and follow-up visits. In this way, the team hopes to increase understanding and decrease missed appointments among Latino patients.

Go here for more information on additional TAP programs.