Like other policy researchers in academic settings, faculty in the Mongan Institute for Health Policy (MIHP) publish in scholarly journals and contribute to state and federal health policy debates.  In this update on MIHP activities, however, we describe MIHP faculty initiative at the front lines of patient care.  The MIHP benefits from its position within cutting edge health care delivery systems at the Massachusetts General Hospital (MGH) and Partners HealthCare.  In some of our most exciting projects, MIHP faculty members focus on translating high quality policy research into practice in the living laboratories in which we work.  This update outlines several of these translational projects.

Understanding the Effects of Communication Barriers
More than 24 millions American have Limited English Proficiency (LEP). Federal guidelines state that health care systems receiving federal funds must provide “consistent standards of language assistance” for all patients with LEP.  At the MGH, medical interpretation is provided each year either in-person or by telephone in more than 200 languages during more than 60,000 patient encounters.  Karen Donelan, EdM, ScD, is working with pediatric health services researcher Katherine Zuckerman, MD, MPH, to understand the role language barriers play in missed or incomplete referrals from community health centers to pediatric specialists.  They have led a multilingual survey of 400 families to explore barriers to specialty referral and have used the hospital’s electronic medical record system to study scheduling and referral patterns.  Lenny López, MD, MPH, MDiv, is studying how English proficiency affects the frequency, type, and severity of adverse events in the hospital.  Using data from two hospitals within the Partners HealthCare network, Dr. López is comparing adverse events and severity of harm between English speaking patients and LEP patients.  Other language-related projects underway at the MIHP include: development of a multilingual patient guide for women with low health literacy; and research to evaluate the comparative effectiveness of different technologies for making medical interpreters more accessible around-the-clock using combined modalities of in-person, telephone, and video medical interpretation.

Assessing Mental Health Care Outcomes
Each year, many adults and children seek care for psychiatric illnesses and mental health conditions at 67 practice sites affiliated with Partners HealthCare, accounting for more than 200,000 outpatient visits, 12,000 emergency room visits, and over 100,000 inpatient days in 2007.  Determining whether treatments are effective for patients with these varied and complex disorders is challenging.  Christine Vogeli, PhD, is working with Partners mental health care professionals to develop measures of outcomes for patients treated in inpatient, residential, and outpatient sites.  They are creating indicators of best care practices and measures of symptom acuity and patient functioning.  In addition, they are specifying approaches for gathering data prior to and following treatment. The goal of this initiative is to help mental health professionals to measure and improve the care they provide by defining exemplary practice and sharing results.  

Eliminating Racial and Ethnic Disparities in Diabetes Care
The Disparities Solutions Center (DSC) within MIHP, in collaboration with the MGH Chelsea HealthCare Center, the Massachusetts General Physicians Organization, and the MGH Center for Community Health Improvement, has developed the Chelsea Diabetes Management Program aiming to eliminate disparities in diabetes. Based on a culturally competent disease management model involving individual coaching and group education sessions in Spanish and English, the program successfully improved patients’ diabetes control and won an award from the state of Massachusetts. The DSC also partnered with the MGH Revere Health Care Center to develop a similar program specifically tailored to the Cambodian population.  These initiatives are led by MIHP faculty members Joseph R. Betancourt, MD, MPH, and Alexander R. Green, MD, MPH.