With universal access coming, Dr. Morales sheds light on member diversity at Group Health
As health care reform moves from embattled debate to challenging reality, the nation’s health systems must gear up to serve a massive contingent of previously uninsured patients. The stakes are particularly high for the millions of racial and ethnic minorities who aren’t fluent in English—a population for whom low-quality care and poor health outcomes are well-documented.
Until recent years, Group Health Research Institute (GHRI) had never rigorously explored the racial and ethnic diversity of Group Health’s patient population—nor the disparities in quality or outcomes they may experience. That changed when Leo Morales, MD, PhD, MPH, joined Group Health as a general internist and GHRI associate investigator in 2009. A national leader in cross-cultural survey methodology and health disparities research and policy, Dr. Morales is boldly taking Group Health where the organization has never gone before: to a deeper understanding of the needs of increasingly diverse patients.
Dr. Morales came to Group Health after more than a decade of concurrent service as a health policy analyst at RAND Health and an internal medicine physician and professor at the University of California, Los Angeles (UCLA) School of Medicine. His research included evaluating large-scale language access programs for Latino patients and leading the development of methods at two minority health research centers.
Soon after joining Group Health, Dr. Morales used newly available data to develop its first-ever report on race, ethnicity, and language-preference disparities. Civil rights-era organizational policies aimed at preventing discrimination had previously led Group Health not to collect race or ethnicity data. But as federal regulations and quality-improvement perspectives shifted toward using such data to monitor care quality, the organization followed suit and began collecting the information from patients.
The change let Dr. Morales combine clinical outcomes with measures of patient experience, providing a new and much-needed perspective on minority patients’ experiences.
“Even without health care reform, Group Health and other systems nationwide are seeing a dramatic increase in the numbers of racial and ethnic minorities they serve,” he explains. “As diversity grows, it’s essential to understand these patients’ needs and preferences—especially when it comes to language.”
Today, more than 55 million people in the United States speak a language other than English at home—a 72 percent increase since 1990. Of those, roughly 25 million have limited English proficiency (LEP), meaning they don’t communicate well enough in English to use the health care system effectively. In Washington state, LEP residents tripled from 1990 to 2008—climbing from 165,000 to 460,000. Encounters using skilled language interpreters at Group Health have increased by about 10 percent per year since 2006.
“Clearly, improving care for LEP patients is a priority for Group Health and other health care providers in the region,” Dr. Morales says.
Moving toward this goal, he recently kicked off a four-year, $1.3 million research project examining disparities in chronic illness care for patients with language barriers. Funded by the National Center on Minority Health and Health Disparities, the study will identify factors at the patient, provider, and health system levels that can be changed to improve care for LEP patients with diabetes, high blood pressure, or high blood cholesterol. Key goals are to help them take their medicines correctly—and to help their doctors intensify treatment appropriately.
Dr. Morales assembled a team of experts well-equipped for the work at hand, including UCLA’s Gerardo Moreno, MD, MSPH, who specializes in language-based health disparities among Latinos. Their GHRI co-investigators are Assistant Investigator Rebecca Hubbard, PhD, a nationally known biostatistician, and Affiliate Investigator Elizabeth Lin, MD, MPH, a Group Health family physician with extensive experience in medication adherence research. Other collaborators include consultants Elizabeth Jacobs, MD, MAPP, of the University of Wisconsin-Madison; and Carey Jackson, MD, MPH, MA, of the University of Washington and Harborview Medical Center. Britt Anderson-Sparks, Group Health’s coordinator of interpretive services, will also serve as a consultant.
“How people feel about the interpretive services they receive affects how they feel about their care overall,” she explains. “Understanding their perspectives is an important part of providing high-quality care.”
Dr. Morales is happy to help bring that perspective to Group Health—and to other providers and health systems across the country. He will have ample opportunity.
In June, he became the Group Health principal investigator on the Community Outreach and Research Translation core of the University of Washington’s Institute for Translational Health Sciences, which aims to help diverse communities become more engaged in and informed about research. Recently appointed a Fellow of the American College of Physicians, Dr. Morales also serves on a U.S. Department of Health and Human Services Region 10 council to reduce health disparities and is helping plan an Institute of Medicine workshop on using measures and data to advance value‑ and science-driven health care.
View Dr. Morales' profile.