Improving the quality and cost-effectiveness of publicly financed health care
Interpreting Success: One Consumer at a Time
Non-emergency use of the Emergency Department is not uncommon in many localities. Reasons are numerous, and may include, for Medicaid beneficiaries, lack of access to primary care or lack of information about how to use primary care. The Buncombe County, North Carolina Department of Social Services (BCDSS) catalyzed by a Covering Kids and Families Access Initiative Grant from The Robert Wood Johnson Foundation and administered by the Center for Health Care Strategies, set out to address the number of consumers using emergency services for primary care.
The $125,000 grant enabled BCDSS to investigate how many consumers were using the ED for non-emergencies, the reasons for this use, and to develop and implement a solution. Staff analyzed claims data for those insured by Medicaid with three or more emergency department visits, and also interviewed dozens of parents. The research revealed that some Latino families were using Emergency Services because there was no other way to obtain an interpreter. The research also uncovered that caregivers were often unable to determine, based on their child's symptoms, whether or not emergency care was necessary.
Interpreter Services
Once the problem was identified, BCDSS decided it would develop a community-supported interpreter bank. Working with a pilot health center, BCDSS began recruiting interpreters from the community. "We took out advertisements in the local newspapers. Through a rigorous interview, BCDSS narrowed the field from 30 to eight candidates," said Linda Kinney, Operations Manager at the Buncombe County Medical Society Foundation. The eight final candidates participated in medical interpreter training. Once they were trained they created a schedule of availability, which is maintained online through a Yahoo Calendar.
BCDSS connected the potential patients with the interpreters by putting a "referral specialist" at the health center. When a person called for an appointment or came into the health center, the referral specialist coordinated the appointment with one of the interpreters. The interpreter would meet the patient at the doctor's office and provide interpretation during the doctor visit. Lisa Eby of the Buncombe County Department of Social Services said, "The interpreter makes the physician's job so much easier, you could tell it was making a difference in patient care." The physicians agree. "It is very helpful having a trained interpreter in the room. It has improved our productivity," says Dr. Ellen Lawson who participated in the project.
The interpreters received $25 per hour compensation with a minimum of one hour billing. They are paid on a contract basis through the Health Center. The interpreters say it is a rewarding and vital job. "Many families aren't aware of the risks of having a family member, often a child, interpret for them in a medical setting. Even if you know some English, medical situations can get confusing," says Sarah Arredondo, an interpreter with the project.
Improve Health Literacy
When a child is sick, parents want action. And when parents or caregivers do not recognize symptoms, they may resort to emergency care when only a primary care visit is needed, or, worst-case scenario, might not notice symptoms that warrant urgent care.
For these caregivers, BCDSS created a laminated checklist to help parents determine when emergency care is necessary. The card, available in both English and Spanish, was given out in primary care provider offices, home visits, emergency room triage areas, and more. The laminated card featured a checklist of symptoms that would be useful to report to a nurse or physician, and information on fevers: what was normal, slightly high, high, or in the "danger zone." A digital thermometer was given with the handout, to facilitate easy reading and coordination with one of the fever zones.
"We found the fever information to be incredibly valuable in providing more efficient care," said Ms. Eby. "Instead of parents telling nurses and physicians, ‘My child is hot,' they're able to look at the thermometer and the checklist and better determine what type of care to seek. This allows dangerous fevers to be attended to more quickly, and non-emergent care to be sought when appropriate."
Take, for example, the case of a young boy who, unbeknownst to his caregiver, had suffered a ruptured appendix, telling his caregiver only that he did not feel well. Using the digital thermometer and the laminate, his caregiver knew that his fever was in the danger zone, and sought immediate care. Because he received care so quickly, a potentially dangerous situation was avoided; his caregiver credited the laminated checklist for the swift actions taken.
Results
Both providers and patients greatly benefited from the Buncombe County Department of Social Services' Health Literacy interventions. Due to the availability of interpreters at other points of care, 137 patients were diverted from the emergency department in a three-month period. These efforts will continue beyond the close of the grant period, ensuring improved health literacy and available interpreter services for Medicaid beneficiaries in Buncombe County.