Abstract
Latinos form the largest U.S. minority and will account for one quarter of the population by 2050. Immigration trends from 1995-2010 challenged health systems in "new destination" regions such as the southeastern U.S., with Latino population increases of 200-400%, and a minimal bilingual health workforce. Academic medical centers and safety net hospitals are challenged to respond beyond the interpreter paradigm of care delivery to provide efficient, cost-effective and compassionate care that complies with the U.S. Title VI mandates. We describe the design and successful implementation of an academic model in the care of Spanish-speaking patients in the pediatric and adult primary care and subspecialty settings in the University of North Carolina Health Care System. This model leverages a limited bilingual workforce to maximize the extent and quality of language-concordant care for this population The innovative features of the UNC Center for Latino Health (CELAH) is based upon five principles: patient navigation, a medical home, a block-scheduling system, a "virtual clinic" model using existing space, and leveraged cost-neutral resources. Patients are scheduled to specific half-day sessions in specialty clinics and matched with bilingual faculty and staff. This facilitates door-to-door care in Spanish for patients, the majority of whom are immigrants from rural Mexico and Central America with limited English and health literacy. CELAH is considered an academic transition model in anticipation of an adequate bilingual health workforce in 1-2 decades. As a hub, this clinical platform supports unique programs in medical education, translational and health equity research, community outreach, and faculty engagement.
Highlights
Latinos have become the largest minority in the U.S (18%, 48 million) based upon Census Bureau data, and by 2050, it is projected that approximately 25% (>100 million) of the U.S population will be of Hispanic origin [1,2]
2) Language and health beliefs are significant barriers to health literacy, as the majority of immigrants are from rural areas of Mesoamerica and live in rural North Carolina
Examples include: 1) bilingual financial counselors are scheduled to the half-day sessions; this improves the efficiency of matching uninsured patients to available charity care services; 2) Pharmacy students and residents provide medication counseling in high complexity clinics; 3) hospital volunteers serve as patient navigators
Summary
Latinos have become the largest minority in the U.S (18%, 48 million) based upon Census Bureau data, and by 2050, it is projected that approximately 25% (>100 million) of the U.S population will be of Hispanic origin [1,2]. The central aim of the UNC Center for Latino Health (CELAH) was to design and implement an innovative clinical care model with language and cultural concordance to maximize quality, efficiency, and patient satisfaction for Spanish-speaking patients in central North Carolina. Important CELAH innovations include block-scheduling of patients to specific half-days and appointment times in specialty clinics, matched with bilingual faculty and staff, as well as the mobile “virtual clinic” staffing model (Figure 2). Examples include: 1) bilingual financial counselors are scheduled to the half-day sessions; this improves the efficiency of matching uninsured patients to available charity care services; 2) Pharmacy students and residents provide medication counseling in high complexity clinics; 3) hospital volunteers (e.g., premedical students) serve as patient navigators. In each half-day clinic, the “virtual clinic” brings together Spanish-speaking patients, bilingual providers, CELAH staff and infrastructure, and leveraged hospital and university resources. This initiative, called Expanding Networks for Latinos through Community Engagement (ENLaCE),
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