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Objectives Retained As Is From Healthy People 2010
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HC/HIT HP2020–1:
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Increase the proportion of persons who report that their health care providers have satisfactory communication skills.
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a. Increase the proportion of persons who report that their health care provider always listened carefully to them.
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b. Increase the proportion of persons who report that their health care provider always explained things so they could understand them.
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c. Increase the proportion of persons who report that their health care provider always showed respect for what they had to say.
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d. Increase the proportion of persons who report that their health care provider always spent enough time with them.
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Status: Retained Healthy People 2010 objective 11-6.
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View Objective Comments
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Objective Clarification:
the American College of Obstetricians and Gynecologists supports activities that involve a partnership between provider and patient, including strengthened, culturally-competent, communication between provider and patient, and increasing health literacy among patients. Sharing information and enhancing communication can lead to improved patient health care and satisfaction.
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Objective Clarification, Objective Text:
The National Council on Disability has reported that communication barriers are frequently cited as problems that prevent access to care or reduce the quality of care that people with disabilities receive. In “The Current State of Health Care for People with Disabilities” (2009), NCD reports that for many people with disabilities, poor communication with providers and limited time for office visits reduces the quality of care they receive and may impede diagnosis of new health conditions and prolong or leave untreated chronic health problems.
Communications difficulties have long been reported by people who are deaf or hard of hearing. Standard English is not the primary language for many people who become deaf prelingually. People who become deaf prelingually constitute a distinct cultural and linguistic minority, and they do not always communicate effectively in English. Their primary language is likely to be American Sign Language (ASL); yet interpreters frequently are not provided during medical visits. As a consequence, people who are deaf often have significant difficulty communicating effectively with their health care providers and receiving health care information and instructions.
In general, women who are deaf reported that they avoided visiting a health care provider because of the lack of effective communication, although they also reported positive experiences with some practitioners who use qualified interpreters. Studies comparing the prenatal health care of women who are deaf and women without hearing impairments reveal significant differences between the two groups. Women who were deaf were less satisfied with their prenatal care than hearing women, and they expressed less satisfaction with the quality of communication with their health care provider. When deaf patients had access to ASL interpreters and to providers who understand cultural aspects of deafness, screening rates for colorectal, cervical, and breast cancer were similar to rates for the general population.
People who are hard of hearing often have difficulty communicating effectively with health care professionals, who may be unaware of appropriate techniques for communication and who rarely provide accommodations, such as conducting an examination in a room with limited ambient noise, offering assistive listening devices, or scheduling additional time to ensure that the patient has understood the information being provided.
Other people with disabilities, including people who are blind, report that medical providers sometimes do not speak to them directly and do not make prescription information, return appointment, and other health care instructions available in formats that are accessible. Diabetes care training can be difficult to obtain for people who are blind or have vision disabilities, because some diabetes care professionals are not aware of blood glucose testing equipment that provides an audio output of readings.
People with developmental disabilities also report difficulty communicating with some health care providers, because too little time is available during standard office visits for discussion of complex health issues or the appropriate, understandable presentation of information so that people with developmental disabilities can participate in their health care decisions and become informed about wellness and prevention activities.
To begin to address some of these communication barriers, in “The Current State of Health Care,” NCD recommends that Centers for Medicare and Medicaid Services (CMS) establish a mechanism to pay for American Sign Language Interpreters (ASL) when they are required for deaf or hard-of-hearing beneficiaries of Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), and other federally funded health care to ensure that people who are deaf or hard-of-hearing who use sign language receive effective services from health care providers.
Further, NCD recommends that the U.S. Surgeon General lead an effort with other Federal agencies concerned with health care quality for people with disabilities—including the Department of Health and Human Services (HHS) Office of Disability, the Centers for Medicare & Medicaid Services (CMS), the National Institute on Disability and Rehabilitation Research (NIDRR), the Agency for Healthcare Research and Quality (AHRQ), the Access Board, and the Administration for Children and Families (ACF)—in a joint project that will establish principles of universal design for health care facilities and programs. Goals and objectives should be established and key stakeholder actions identified. Drawing on the well-established principles of universal design for the built environment, this collaboration should bring together Federal agency experts, disability and health policy researchers, leading disability and health practitioners (e.g., physicians who specialize in caring for women with disabilities, people who are deaf or hard of hearing, and people with intellectual and developmental disabilities, as well as vision rehabilitation experts), and people with disabilities to participate in the process. The Surgeon General should publish a report of findings that builds on previous publications, such as "Call to Action To Improve the Health and Wellness of Persons with Disabilities," "Closing the Gap: A National Blueprint To Improve the Health of Persons with Mental Retardation," and "Report of the Surgeon General’s Conference on Health Disparities and Mental Retardation."
See: National Council on Disability, “The Current State of Health Care for People with Disabilities” (2009), http://www.ncd.gov/newsroom/publications/2009/HealthCare/HealthCare.html.
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Objective Clarification, Objective Text:
The Hearing Loss Association of America (HLAA) is the nation’s leading grassroots organization representing the rights of people with hearing loss. It is important to note that health care providers are rarely taught how to communicate with people who have a hearing loss or the need for appropriate accommodations under the Americans with Disabilities Act. Not only do health care providers need satisfactory communication skills, they need to know the kinds of accommodations appropriate for the wide range of people who have hearing loss, whether that would be an assistive listening device, speech to text, or a sign language interpreter. Only with those accommodations will people with hearing loss be able to benefit from good communication skills of the health care provider.
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Objective Clarification:
ASHA supports continued inclusion of this objective as it applies to all health care providers, including physicians, nurses, audiologists, speech-language pathologists, other therapists, and social workers.
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Objective Clarification, Objective Text:
HC/HIT HP2020–1(a): Listening is important, but "encouraging open discussion" is a requisite to listening to "meaningful medical/health disclosure".
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Objective Text:
This objective needs to include the responsibility of health care providers to provide patient education/healthy lifestyle promotion.
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Objective Clarification:
This should include language concordance between patients and providers or provisions for assisting populations unable to speak English
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