African American, Asian American, and Hispanic patients often experience problems in communicating with their physicians. As findings from the Fund's 2001 Health Care Quality Survey⁽¹⁵⁾ made clear, the difficulties are especially troubling for patients who do not speak English well or who have low levels of health literacy. With support from the Fund, the Institute of Medicine responded this year with a project to gather information on the challenges of caring for patients with low health literacy. In meetings across the country, project staff have heard from consumer and advocacy groups, as well as experts in literacy, communication, and chronic disease.

The Fund also provided partial support for a project by Mara Youdelman of the National Health Law Program to produce an action kit⁽¹⁶⁾ designed to help states finance language services for low-income patients by tapping available federal funding. A project by Dana Mukamel of the University of California, Irvine, is studying whether African American patients are more likely to use high-quality cardiac surgeons if they have access to physician report cards on coronary artery bypass graft (CABG) survival rates. In the coming year, the Fund intends to expand its work in this area with support for several new projects to improve communication for patients with limited English proficiency and low health literacy.

In 1998, the Bureau of Primary Health Care launched health disparities collaboratives⁽¹⁷⁾ in community health centers to address problems in the quality of care provided to minority, poor, and other medically underserved patients. Edward Guadagnoli of Harvard Medical School has recently begun a national evaluation of the impact of the collaboratives on diabetes, cardiovascular disease, and asthma care, with support from the Fund and the Agency for Healthcare Research and Quality (AHRQ). A project led by Mark Chassin, M.D., of Mount Sinai School of Medicine, also cofunded with AHRQ, is investigating underuse of medical services within minority populations and testing clinical interventions to improve care for stroke, hypertension, breast cancer, and premature birth. A project by Glenn Flores, M.D., of the Medical College of Wisconsin and cofunded with the Robert Wood Johnson Foundation, is piloting a program to train minority parents to coach other minority parents in managing their children's asthma.

Cultural competence is increasingly recognized as an important factor in health care quality, in part because of recent Fund-supported work. Last October, the Third National Conference on Quality Health Care for Culturally Diverse Populations, cosponsored by the Fund, featured presentations on innovative practices by several Fund grantees. A new Fund report by former Commonwealth/Harvard Minority Health Policy Fellow Joseph Betancourt, M.D., Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches,⁽¹⁸⁾ was unveiled at the conference. Filmmaker Maren Monsen, M.D., screened Worlds Apart, a documentary video dramatizing minority Americans' experiences with the health care system, which will soon be publicly available. Deborah Danoff, M.D., of the American Association of Medical Colleges, presented a framework for a curriculum on cultural competency to be incorporated into medical student education to fulfill a new accreditation standard. The initial work for the curriculum project was recently published in a series of articles in Academic Medicine.⁽¹⁹⁾