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Becoming Familiar with Hispanic Veterans Healthcare Fernando O. Rivera, FACHE Network Director, VISN 5 QUOTE OF THE DAY “Healthcare organizations and providers should adopt principles of both patient centeredness and cultural competence jointly, so that services are aligned to meet the needs of all patients, including people of color and other disadvantaged groups, whose needs and preferences may be overshadowed by those of the majority.” Somnath Saha, M.D., M.P.H., Mary Catherine Beach, M.D., M.P.H., Lisa A. Cooper, M.D., M.P.H. VA: The Best Care Anywhere VA: The Best Care Anywhere Veterans Health Administration Who are VA Patients? DIVERSITY in the US Diversity is the inclusion of things, people, and places that are different and unique to include race, socio-economic backgrounds, religions, culture and heritage. According to the Census Bureau: The U.S. population is becoming increasingly diverse. The majority population—Caucasian—is declining. Hispanics are the largest minority group, accounting for 15 percent of the U.S. population. Blacks comprise the second-largest minority group at 13.5 percent. Hispanics and Asians are the two fastest-growing minorities. % Percent of Total U.S. Population 100 US Population by Race & Hispanic Origin: 2008 & Projected 2050 Non-Hispanic White 90 African American 80 American Indian / Alaska Native 70 66 Asian 60 Hispanic/Latino 46 50 40 30 30 20 10 15 14 1.6 5.1 15 9.2 2 0 2008 2050 Source: U.S. Census Bureau, 2008 National Population Projections, August 14, 2008 http://www.census.gov/Press-Release/www/releases/archives/population/012496.html Who is Hispanic? According to the U.S. Census Bureau Hispanic refers to region, not race, and uses the term to describe any person, regardless of race, creed, or color, whose origins are Mexican, Puerto Rican, Cuban, Central or South American, or of some other Hispanic origin. Because Hispanic is classified as an ethnic origin and not a race tracking data becomes challenging as demographics is tracked by race. Hispanic Americans are not a monolithic ethnic group Hispanic population is composed of many different groups with diverse health needs and different barriers to accessing care. Hispanic and VA Healthcare FY 2008 364,028 Hispanics were enrolled in VA Healthcare, accounting for 5% of all enrollees. 204,244 Hispanics used VA Healthcare and represented 4.5% of users in all priority groups. FY 2007 348,336 Hispanics were enrolled in VA Healthcare, accounting for 4.8% of all enrollees. 230,369 Hispanics used VA Healthcare and represented 5.0% of users in all priority groups. Source: 2008 VHA Survey of Veteran Enrollees’ Health and Reliance Upon VA The Facts Several recent studies conducted by prestigious academic institutions to include Harvard Medical School; and Cornell University; and Health and Human Services, Health Resources and Services Administration (HRSA) report on gaps or disparities in the quality of health and health care across racial, ethnic, and socioeconomic groups. Some the cited examples of documented health care disparities are as follows: The average waiting time for African Americans needing kidney transplants is almost twice as long as that of white patients. Adult African Americans and Latinos have approximately twice the risk as whites of developing diabetes African-American women with breast cancer are 67 percent more likely to die from the disease than are white women. The mortality rate for African-American infants is almost 2.5 times greater than it is for whites. Health Disparities Communities of Color are Disproportionately Affected Leading Causes of Death Hispanic/Latinos, U.S., 2006 Heart Disease Cancer Unintentional Injuries Stroke Diabetes Chronic Liver Disease & Cirrhosis Homicide Chronic Lower Respiratory Disease Influenza & Pneumonia Certain Conditions Originating in the Perinatal Period Source: CDC, NCHS, Health, United States, 2008, Table 30. What the Research Suggests The need for diversity in healthcare providers Health care services that are respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of diverse patients can help bring about positive health outcomes. Healthcare Providers need to become culturally competent Cultural competency is one the main ingredients in closing the disparities gap in health care. It’s the way patients and doctors can come together and talk about health concerns without cultural differences hindering the conversation How is VA Responding to What the Research Suggests The Minority Veterans Program (Center for Minority Veterans) Cultural Competency Initiative One Standard of Care - Excellence Minority Veterans Program Goals Increase awareness of minority Veteran related issues. Support and initiate activities that educate and sensitize internal staff to the unique needs of minority Veterans. Develop strategies for increasing participation in existing VA benefits programs. Target & participate in outreach activities, educational and informational forums utilizing community networks. What is Cultural Competence? Cultural Competence: the ability of individuals and systems to respond respectfully and effectively to people of all cultures, classes, races, ethnic backgrounds and religions in a manner that recognizes, affirms and values the cultural differences and similarities and the worth of individuals, families and communities and protects and preserves the dignity of each. Everyone has a culture Cultural bias can influence diagnosis, treatment adherence and care seeking Patient Centered = Cultural Competency Solicit and respect the Veteran’s values, preferences and needs Empower Veterans through information and education Incorporate the nutritional, cultural and nurturing aspects of food Ensure emotional and spiritual support Encourage involvement of family and friends Source: Veterans Health Care: Leading The Way to Excellence Universal Services Task Force Report Cultural Competency - Workforce Team Care Diversity Inclusion Continuously Improving & Data Driven Decision Quality Problem Solving Innovation requires you to change the rules of engagement Cultural Competency – A Standard for Quality of Care Integral part of the patient-centered care model Healthcare industry standard that promotes: Communication Patient Safety Patient & Family Involvement in Care Critical element in preventing medical errors by accrediting/regulatory agencies Centers for Medicare & Medicaid The Joint Commission One Standard Of Care Electronic Health Record Hypertension Study Empowering veterans with technology Best Features of an EHR • Single, Integrated Computerized Patient Record System (CPRS) • Delivers an Integrated record covering all aspects of patient care and treatment • Used throughout VHA in all health care settings: inpatient, outpatient, long term care • Available at all workstations throughout hospital • All diagnostic images • Simplified data retrieval for reports Health Care Beyond Compare Hypertension Study – 15 Cities Anchorage, AL Portland, OR Fargo, ND Minneapolis, MN Boston, MS Philadelphia, PA New York, NY Chicago, IL Baltimore, MD Washington, DC Los Angeles, CA Houston, TX Honolulu, HI Miami, FL San Juan, PR 35 Months 2006-9 2006-6 2006-3 2005-12 2005-9 2005-6 55 2005-3 2004-12 2004-9 2004-6 2004-3 2003-12 2003-9 2003-6 2003-3 2002-12 2002-9 40 2002-6 60 2002-3 65 2001-12 2001-9 Percent Patients Controlling Hypertension by Race 80 75 70 Caucasian African American 50 45 Hispanic Personal Health Record Take Away Points The Hispanic population is composed of many different groups with diverse health needs and different barriers to accessing care. Hispanic veterans are increasing within our patient population and the new veteran cohort. VHA is ensuring that we are properly positioned to provide excellent care to all veterans to include Hispanic veterans with a culturally competent workforce and technology.