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Community tries to keep up with diverse patient base: Hospital's new system improves cultural understanding

July 21, 2008

It takes years of research for an anthropologist to understand another culture, but doctors and nurses don't have that much time.

With the growing diversity of people receiving health care in the United States, a patient's cultural background is often ignored or misunderstood by care givers. That can make for a less-than-positive hospital stay or doctor visit or, in rare cases, a catastrophic medical mistake.

To avoid any such pitfalls, Community Health Network has implemented Culture Vision, an Internet-based program that allows providers quick access to health care guidelines with respect to different cultural, racial or religious backgrounds.

The Culture Vision database, compiled and marketed by Maryland-based Cook Ross Inc., has been up and running for two

months at Community Health's five area

hospitals, as well as its network of physi cians offices, urgent care centers and nursing homes.

Increasing diversity of the patient base drove the decision to use Culture Vision, said Deborah Whitfield, director of network diversity at Community Health.

"When we deal with that mix of patients coming through our door, we need to be able to communicate with them and we want to make sure we can provide good health outcomes," she said.

The need will only increase. The U.S. Census Bureau estimates that ethnic groups and people of color will make up half the country's population by 2050.

"We're seeing demographic change and preparing for the future," Whitfield said.

Cook Ross launched Culture Vision in 2005 after more than a decade of planning and research. The company sells the product on an annual subscription basis to 46 hospitals in 13 states.

Culture Vision provides guidance in understanding how and what patients believe will make them well, a list of potential questions to ask, and information about the prevalence of diseases within certain populations.

The site can be helpful in the diagnosis stage of care. Latino women, for example, are more prone to diabetes, cervical cancer and osteoporosis, according to a Culture Vision demonstration provided on Cook Ross' Web page.

Peer-reviewed journals and government reports provide the bulk of the information Cook Ross posts on Culture Vision, Executive Vice President Amri Johnson said. Content is updated continually.

"Culture Vision is a tool for health care providers to rapidly access information," Johnson said. "Our motto is 'three clicks in five minutes' to find what you need as far as cultural competency is concerned."

Lack of knowledge regarding a certain culture's medical beliefs can lead to misunderstandings and even misdiagnoses, according to Johnson.

For example, Vietnamese women refuse to consume any cold fluids or food after giving birth. The belief goes that blood, which is hot, is lost in delivery and adding cold substances to the body could upset the hot/cold balance.

A reticent patient may not willingly share this information and drink ice water, anyway, making her feel uncomfortable or anxious. Being able to do some quick research on Culture Vision can prevent that negative experience, according to Johnson.

"It allows you to ask the right questions," he said.

Beliefs that won't affect a patient's medical outcome can still heavily detract from his comfort level. In the Japanese language, the word for the number 'four' is pronounced the same as the word for 'death,' making a Japanese patient uneasy about being placed in a room with the number four.

One negative experience can develop into a lifelong problem for a patient with a diverse cultural background, noted Nancy Jewell, president and CEO of the Indiana Minority Health Care Coalition.

"Not understanding or stereotyping can really compromise the delivery of care. It creates distrust in that culture toward the health care system and they stop going in," she said.

Even if a better cultural understanding doesn't change the fundamental service a doctor or nurse provides-such as performing necessary surgery or setting a broken bone-it starts a dialogue that can improve a patient's state of mind and eventual outcome. If it's possible to incorporate a particular custom into the regimen of care, Whitfield said, Culture Vision helps pave the way.

"We have to take into consideration that some cultures do nontraditional things and be able to have a conversation with them," she said.

In the two months Culture Vision has been available to Community Health, the database has received 1,800 hits, Whitfield said. Common topics looked up include beliefs about death, labor and delivery, nutrition and use of blood products and transplants.

And while the site provides vital facts about different cultures and religions, Community Health employees are reminded not to develop stereotypes about any one group.

"It could be tempting to take this cultural information and apply it uniformly, but that would be an error in judgment," Whitfield said. "It's a cultural assessment tool for the individual."
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