Assessing the impact of financial incentives on provision of interpretive services in Medicaid

项目摘要/摘要 广泛获得专业口译服务是改善获得护理机会的根本第一步 面临语言障碍的人，包括主要首选语言不是英语的人和 聋哑人或重听人。太长时间以来，美国医疗保健系统已经产生了显著的 具有非英语语言偏好(NELP)的个人在机会、质量和结果方面的差异。 研究表明，患有NELP的个人获得医疗保险的机会和经验都有所减少 住院时间越长，再住院率越高，慢性病管理越差， 不良事件的风险，以及对护理的满意度较低。联邦政策要求获得解释性的 服务，但不强制付款人报销口译费用，导致许多医疗保健系统生病- 配备了为NELP患者提供护理的设备。作为对医疗公平的承诺的一部分，俄勒冈州的医疗补助 该计划最近推出了一项创新的财政激励措施，以增加获得口译服务的机会。 这项研究的长期目标是了解财政激励在多大程度上侧重于健康 公平可以改变制度，并表征这些政策对体验的下游影响 以及人们对医疗保健的看法和质量。我们的具体目标，这是实现这一目标的第一步 长期目标是(1)检查医疗补助中使用解释性服务的频率的变化 俄勒冈州口译服务激励政策实施后有NELP的成员，以及(2)评估 不同环境、护理类型、口译方式、口译员类型、 和人口。 这项研究将使用纵向设计来了解俄勒冈州语言获取激励政策的影响 在患有NELP的医疗补助成员中接受口译服务。我们将使用季度报告 由协调医疗组织(CCOS，俄勒冈州的医疗补助管理医疗实体)提交以评估 有记录的需要口译服务的成员接受这些服务的比例发生变化 提供口译服务的NELP医疗补助成员的访问比例，以及 每个有标记需求的会员每年平均获得口译服务的访问次数。此外，我们还将 使用比较中断时间序列(CITS)方法分析随时间变化的 标记的医疗补助成员在不同的环境、护理类型和 人口。归根结底，更好地了解获得解释性服务是努力实现 消除结构性不平等，提高医疗质量，改善结果。

PROJECT SUMMARY/ABSTRACT Broad access to professional interpretive services is a fundamental first step in improving access to care for people facing language barriers, including individuals whose primary preferred language is not English and those who are deaf or hard of hearing. For too long, the U.S. health care system has produced significant disparities in access, quality, and outcomes for individuals with non-English language preference (NELP). Research demonstrates that individuals with NELP have decreased access to health insurance and experience longer lengths of stay in the hospital, higher readmission rates, poorer management of chronic disease, greater risk of adverse events, and lower satisfaction with their care. Federal policy mandates access to interpretive services but does not mandate that payers reimburse for interpretation, leaving many health care systems ill- equipped to provide care to NELP patients. As part of its commitment to health equity, Oregon’s Medicaid program recently introduced an innovative financial incentive to increase access to interpretive services. The long-term goal of this research is to understand the extent to which financial incentives focused on health equity can change systems, and to characterize the downstream impact of these policies on experiences with and perceptions and quality of health care. Our specific aims, which are the first steps toward attainment of this long-term goal, are to (1) examine changes in the frequency of use of interpretive services among Medicaid members with NELP after implementation of Oregon’s incentive policy for interpretive services, and (2) assess differences in use of interpretive services by setting, type of care, modality of interpretation, interpreter type, and population. This study will use a longitudinal design to understand the impact of Oregon’s language access incentive policy on receipt of interpretive services among Medicaid members with NELP. We will use quarterly reports submitted by Coordinated Care Organizations (CCOs, Oregon’s Medicaid managed care entities) to assess changes in the proportion of members with a documented need for interpretive services who receive these services, the proportion of visits among NELP Medicaid members at which interpretation was provided, and the yearly average number of visits with interpretive services per member with a flagged need. In addition, we will use a comparative interrupted time series (CITS) approach to analyze changes over time in the proportion of flagged Medicaid members receiving interpretive services across different settings, types of care, and populations. Ultimately, better understanding of access to interpretive services is a critical step in efforts to remove structural inequities, enhance quality of health care, and improve outcomes.