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Provider Cultural Toolkit

Gateway Practitioner E-Learning Resource Toolkit for Cultural and Linguistic Gaps in Healthcare

Gateway HealthSM understands that in order to best improve the quality of life of our members, we must be cognizant of their cultural and linguistic differences.  For this reason we have made a commitment to address racial and ethnic disparities.  A collaborative and trusting patient-provider relationship is the key to reducing the gaps in health care access and outcomes.

Gateway has assembled a list of resources and web-based tools to assist you and your office staff in providing care that is sensitive to the cultural and linguistic differences of your patients.

Links to current articles and events:

  More Screenings May Explain Higher Chlamydia Rates Among Minorities
  Race Plays Role in Weight-Related Counseling among Obese Patients
  Physician Performance Ranking Tied to Patient Traits
  IOM Demographic Changes, a View from California
  Grading and Reporting Health and Health Disparities
  The Role of Public Health in Addressing Racial and Ethnic Disparities in Mental Health and Mental Illness
  Suburban Poverty and the Health Care Safety Net

Additional articles on disparities found at PubMed:

  Albert, N. M., K. Trochelman, et al. (2010). "Characteristics associated with racial disparities in illness beliefs of patients with heart failure." Behavioral Medicine 35(4): 112-125.
  Guerrero AD, Chen J, Inkelas M, Rodriguez HP, Ortega AN. Racial and ethnic disparities in pediatric experiences of family-centered care. Med Care. 2010 Apr;48(4):388-93. PubMed PMID: 20220533.
  Michael V. Maciosek, Ashley B. Coffield, Thomas J. Flottemesch, Nichol M. Edwards, and Leif I. Solberg. “Greater Use Of Preventive Services In U.S. Health Care Could Save Lives At Little Or No Cost.” Health Affairs 29(9): 1656-1660
  Shi, L., J. Tsai, et al. (2009). "Racial/ethnic and socioeconomic disparities in access to care and quality of care for US health center patients compared with non-health center patients." Journal of Ambulatory Care Management 32(4): 342-350.
  Weaver KE, Rowland JH, Bellizzi KM, Aziz NM. Forgoing medical care because of cost: assessing disparities in healthcare access among cancer survivors living in the United States. Cancer. 2010 Jul 15;116(14):3493-504. PubMed PMID: 20549763.

Facts about Health Care Disparities

A report by the Institute of Medicine in 2002, confirmed the existence of racial and ethnic disparities in health care.  Unequal Treatment found racial differences in the type of care delivered across a wide range of health care settings and disease conditions, even when controlling for socioeconomic status factors such as income and insurance coverage.

Key Facts on Race, Ethnicity and Health Care in the U.S.

  • Racial/ethnic disparities in health persist today even when comparing groups of similar socioeconomic status.  For example, the infant mortality rate for college educated Black women is higher than that for White women with similar education (11.5 vs. 4.2 per 1,000 live births).
  • The rate of new AIDS cases in 2003 was 3 times higher among Hispanics and 10 times higher among African Americans than among Whites (26 and 75 per 100,000 vs. 7 per 100,000).
  • Black and Latino adults are less likely to rely on a private physician for their medical care than White adults (62% and 44% vs. 77%).
  • African American children have a rate of hospitalization for asthma that is 4 to 5 times higher than the rate for White children (527 per 100,000 vs. 144 per 100,000).
  • Disparities in quality of care are not getting smaller. Over time, the gap between Whites and African Americans, Hispanics, Asians, and AI/ANs has either remained the same or worsened for more than half of the core quality measures being tracked.

Additional Resources to learn more about health care disparities:

  Click here to view the AHRQ National Healthcare Disparities Report
  Click here to view the IOM Unequal Treatment Report

What you can do:

  Assessment tools for evaluating your practice:
  Cross-cultural clinical practice implementation resource guide for Medicaid practitioners
Office of Minority Health Cross Cultural Clinical Practice Guidelines
  Cultural Competence Health Practitioner Assessment Tool
Click here to be linked to the National Center For Cultural Competence
  Communication Regulations and resources:
  TITLE VI of the Civil Rights Act of 1964 Practitioners are expected to comply with Title VI of the Civil Rights Act of 1964 that prohibits race, color or national origin discrimination in programs receiving Federal funds.  Practitioners are obligated to take reasonable steps to provide meaningful access to services for members with limited English proficiency, including provision of translator services as necessary for these members.

Access and Interpreters for Disabled Members Practitioner offices are expected to address the need for interpreter services in accordance with the Americans with Disabilities Act (ADA).  Each practitioner is expected to arrange and coordinate interpreter services to assist members who are hearing impaired. Gateway will assist practitioners in locating resources upon request.  Gateway offers the Member Handbook and other Gateway information in large print, Braille, on cassette tape, or computer diskette at no cost to the member.  Please instruct members to call Member Services at 1-800-392-1147 to ask for these other formats.

  Practitioner offices are required to adhere to the Americans with Disabilities Act guidelines, Section 504, the Rehabilitation Act of 1973 and related federal and state requirements that are enacted from time-to-time.
  Practitioners may obtain copies of documents that explain legal requirements for translation services by contacting Gateway’s Provider Services Department at 1-800-392-1147.

For interpreter services, please contact a qualified medical interpretation service such as Voiance or Language Line Services. Language Line Services can be reached at 1-800-752-6096.  Gateway has partnered with Voiance Language Services to offer interpreter services at a reduced rate.  Please click here  to obtain more information about how to receive the special reduced rate of $1.00 per minute.

  Better Communication, Better Care: Provider Tools to Care for Diverse Populations from the Industry Collaborative Effort (ICE)
  Click here to be linked to Better Communication Better Care: Provider Tools to Care for Diverse Populations
  Health Care Language Services Implementation Guide from the Office of Minority Health, to better serve patients with limited English proficiency
Click here to be linked to OMH Health Care Language Services Guide
  Index of CMS Resources by Languages CMS provided by Office of Minority Health (CMS/OMH), is a webpage for language resources
Click here to read the Index of CMS Resources by Language
  Healthy Roads Media provides health information in many languages and multiple formats including handouts, audio, multimedia, web-video, and iPod video.
  Click here to be linked to Healthy Roads Media
  More on providing interpretation:
  Appropriate Use of Medical Interpreters  October 2014

Incorporating Medical Interpretation Into Your Practice May-Apr 2014


  Using Bilingual Staff Members as Interpreters Jul/Aug 2004-Family Practice Management
  Health Literacy:
  Ask Me 3 from the Partnership for Clear Health Communication is tool for improving communication between providers and patients
  Click here to be linked to the Ask Me 3 Tool
  Health Literacy: Past, Present, and Future: Workshop Summary Aug. 2015
  The Center for Health Care Strategies, Inc. produces a series of nine fact sheets created for those who are designing patient education materials for patients with low health literacy skills.  The sheets define health literacy, describe its impact on health outcomes, provide strategies to prepare appropriate educational materials to assist low-literate consumers, and provide resources for additional health literacy information and publications.
  Click here to link to CCHHS Health Literacy Fact Sheets
  Learn more about the cultures you serve:
  Information on selected cultural groups, available in the Provider’s Guide to Quality & Culture from the Management Sciences for Health
  Click here to view Provider's Guide to Quality & Culture
  US Census Bureau
  Click here to visit the US Census Bureau website

Web-based modules for continuing education credit:

  A Physician’s Practical Guide to Culturally Competent Care from the U.S. Department of Health & Human Services’ Office of Minority Health (9.0 CMEs)
  Click here to visit Think Cultural Health Physician's Guide to Culturally Competent Care
  Quality Interactions for Physicians from Manhattan Cross Cultural Group (MCCG) is accredited by Tufts University School of Medicine (2.5 CME). There are also similar courses designed for non-clinical staff, nurses, and care managers.
  Click here to learn more about the Quality Interactions Course
  Diversity Rx offers webinars on various topics that will help your practice meet the cultural and linguistic needs of your practice.  In addition, Diversity Rx provides information on models of practice, legal issues and policies.
  Click here to visit DiversityRx Website

Disease Specific Interventions:

  The Department of Health and Human Services (HHS) has selected six focus areas in which racial and ethnic minorities experience serious disparities in health access and outcomes.  Learn more about promising interventions and management strategies:
  OMHD About Eliminating Disparities