Fourth National Conference on
Quality Health Care for Culturally Diverse Populations:
Integrating Community Needs into the National Health Agenda

September 28-October 1, 2004, Washington, DC
Hilton Washington, Washington DC

Workshop A-8: Cultural competence for new public health priorities: emergency preparedness for diverse populations

The emergence of threats to the nation’s health through bioterrorism and other means raises fundamental questions of how to effectively educate and integrate diverse communities into emergency preparedness. This session will introduce participants to the activities being undertaken by the Joint Commission on the Accreditation of Health Care Organizations as well as discuss a completed first phase project in New York to assess the level of preparedness of primary care sites in one of the most diverse cities in the world.

Discussant
Dennis P. Andrulis is a research professor at Downstate Medical Center Brooklyn where he oversees projects, prepares major reports and publishes on issues affecting urban communities, the uninsured and other vulnerable populations. Recent work includes a book entitled Managed Care in the Inner City, creation of a cultural competence self-assessment tool for health care organizations, and a National Cultural competence conference series. He has also developed a compendium and analysis of national data sources on the nation’s 100 largest cities and their surrounding areas, entitled The Social and Health Landscape of Urban and Suburban America.

Dennis P. Andrulis, PhD
SUNY Downstate Medical Center
Dept of Preventive Medicine & Community Health
450 Clarkson Avenue
Box #1240
Brooklyn, NY 11203
Office: 718-270-7726
Fax: 718-270-7565
dennis.andrulis@downstate.edu

Improving Primary Care Emergency Preparedness & Integrating Community Needs to Strengthen Response Capabilities

Primary care centers are indispensable providers of health care and community support to New Yorkers. In order to effectively meet community needs in the event of a disaster, it is critical to ensure that these clinics have developed and implemented comprehensive emergency management plans. Recognizing the essential role that primary care settings will play in the immediate and long-term response to an emergency, the Primary Care Development Corporation (PCDC) was contracted by the New York City Department of Health and Mental Hygiene (NYCDOHMH) to implement an 18-month, HRSA-sponsored demonstration project to establish a core level of competency among primary care centers in emergency preparedness, with a focus on bioterrorism preparedness. Through the Primary Care Emergency Management Demonstration Project (PCEMDP), PCDC will develop the tools and resources necessary to allow primary care settings to more effectively participate in overall city planning with surrounding hospitals, neighborhood community service organizations, and city state public health and emergency management agencies.

A fundamental component of primary care emergency preparedness—and a particular focus of this effort—is the need to ensure that response plans address the unique and substantial cultural requirements confronted by these sites. While primary care providers are familiar with many of the day-to-day needs of the diverse communities they serve, it is important to ensure that services such as translation capabilities, educational documents, health alerts, sinage, and risk communication are all provided effectively in an emergency event.

To ensure these objectives are met, the PCEMDP has woven into this effort a number of cultural competency elements. Recently, the PCEMDP completed an assessment of the preparedness levels of 12 primary care sites across New York City. These sites were representative of the many different types of primary care settings—from hospital-based outpatient departments to private group practices—and all serve diverse communities. Complementing the assessment, a comprehensive set of primary care emergency management criteria were also developed and serve as the guide for the project.

Notwithstanding the urgency that surrounds all emergency preparedness efforts in New York, there are particular challenges that this project must thoughtfully address. The sheer depth of cultural diversity is astounding—one site, for example, has a language bank of over 150 different languages and dialects, and uses it frequently. Since many of these sites have limited resources in terms of staff and funding, it will be a challenge to develop a template plan that accommodates the needs of all the communities they serve. In addition, New York City—like other large municipalities—is working to develop and refine its regional emergency response strategy, including the role that primary care centers can play in providing community support in the event of a disaster. These and other issues will continue to be addressed through the project’s completion in March 2005.

Patricia Simino Boyce currently serves as the Director of Emerging Initiatives and Information Management at Primary Care Development Corporation and Adjunct Assistant Professor at New York University. Previously, she served as Director of CQI Initiatives, HIV Quality of Care Program at the New York State Department of Health AIDS Institute; Manager of the Northeast Health Care Consulting for Ernst & Young; and Principle in an independent health care consulting practice. Dr. Boyce has more than 20 years experience in health care, specializing in quality improvement; program design and project management; and education and training. Dr. Boyce is a Registered Nurse with a MA in Community Health, a MA in Education, and a PhD in Medical Sociology.

Melissa Corrado is the Program Manager for the Primary Care Emergency Management Demonstration Project. Prior to joining PCDC, Ms. Corrado was involved in a number of efforts targeted at including traditionally underrepresented populations in biomedical research, primarily through targeted public education and recruitment campaigns in communities across New York City. Ms. Corrado oversaw the recruitment and enrollment process for studies such as the New York Cancer Project, which sought to encourage scientists and researchers to examine issues that lead to health disparities in cancer, heart disease, and diabetes.

Patricia Simino Boyce, RN, Ph.D.
Director of Emerging Initiatives and Information Management
Primary Care Development Corporation
22 Cortlandt Street, 12th Floor, New York, NY 10007
Phone: 212.437.3927
Fax: 212.693.1860
psboyce@pcdcny.org
www.pcdcny.org

Melissa Corrado
Program Manager
Primary Care Development Corporation
22 Cortlandt Street, 12th Floor, New York, NY 10007
Phone: 212.437.3925
Fax: 212.693.1860
mcorrado@pcdcny.org
www.pcdcny.org

Addressing Cultural and Linguistic Diversity in Community-Wide Emergency Preparedness Planning: Joint Commission Initiatives

Disparities that are known to exist in the provision of routine, regular clinical care are only amplified in the event of a disaster or an emergency. Organizations undertaking disaster and emergency preparedness planning should consider the concepts of cultural competency when developing their preparedness plans so as to minimize the risk of increased disparities in care during a response.

Strong linkages to the community infrastructure are critical to the overall preparedness of health care organizations for an emergency situation or disaster. As such, well-prepared health care organizations are necessary but insufficient for the totality of an effective response. A successful response to a potentially calamitous event dictates that both organizations and the community be fully prepared. The Joint Commission’s emphasis on important recognized emergency management practices can provide a foundation that will help to reduce the risk of disparities in care during an emergency and improve the level of preparedness for communities with diverse populations. These practices include collaborative planning involving all key players in the community as early in the process as possible; communication of planning and response activities in a manner and language concordant with the community being served; and the importance of how a community defines itself and what its unique cultural and linguistic needs are.

The use of trusted, credible sources to communicate planning strategies and response requirements; educating the community and keeping it informed throughout the emergency through multiple mechanisms that are appropriate for the intended audience; and planning for the unique informational needs of a diverse community are just some of the critical components of emergency preparedness and planning activities that must consider the concepts of cultural competency for an effective community-wide response to a disaster.

This workshop will address the importance of cultural competency in the context of community-wide emergency preparedness and planning. Audience members will learn about relevant accreditation standards and public policy and research initiatives currently being undertaken at the Joint Commission.

Chandrika Divi, MPH is an Associate Project Director in the Center for Patient Safety at the Joint Commission on Accreditation of healthcare Organizations. She is the project manager for the study Understanding Adverse Events in Minority Patients with Limited English Proficiency funded by the Commonwealth Fund. Ms. Divi has developed proposals and worked on projects related to patient safety, health care quality and emergency preparedness. She earned an MPH from Boston University in International Health and Health Services, and a BSc in biology from the University of Ottawa, Canada.

Chandrika Divi, MPH
Associate Project Director
JCAHO
1 Renaissance Blvd
Oakbrook Terrace, IL 60181
Phone: 630-792-5918
cdivi@jcaho.org

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