In another Fund-supported study, researchers led by LeRoi S. Hicks, M.D., M.P.H., of Brigham and Women's Hospital and Harvard Medical School, found significant differences in the degree to which white and minority hospital patients reported problems with their care.⁽⁸⁾ Notably, a much lower proportion of black and Latino patients than of white patients said that hospital staff demonstrated respect for their preferences. In addition to uncovering disparities in hospital patients' experiences, the study demonstrated that data from generic patient surveys can be stratified by race and ethnicity to identify areas that might benefit from culturally competent care practices.

Approximately 45 million U.S. residents—about 18 percent of the population—speak a language other than English at home. Working under a grant from the Fund, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) found that hospitalized patients whose first language is not English are more likely to be subject to medical errors caused by communication problems with their providers.⁽⁹⁾ Just recently, JCAHO adopted a new Information Management Standard (6.20) that requires documentation of patients' primary language in their medical record.

Fund-supported research has also found that use of medical interpreters can significantly improve patients' health care experiences. In a study of enrollees in California's State Children's Health Insurance Program, Leo S. Morales, M.D., Ph.D., of the University of California, Los Angeles, found that less than half (47%) of patients who required an interpreter during a medical visit said they were always provided with one.⁽¹⁰⁾ When interpreters were available, patients were more satisfied with their care. In fact, non-English-speaking patients who always had an interpreter during medical visits reported greater satisfaction than English speakers who did not need interpreters.

This and other Fund work has demonstrated that culturally competent care, including the use of medical interpreters, can improve health care quality and satisfaction among minority patients. Still, there is little agreement about how to measure cultural competency or incorporate it into quality improvement efforts. Going forward, the Fund will turn to supporting efforts that set standards for culturally competent practice and develop measures of culturally competent processes and outcomes. These standards and measures can then be used to evaluate health care organizations and monitor their progress in delivering higher-quality, patient-centered, culturally competent health care.