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Field Testing

Communicating with diverse patient populations is a growing challenge for American health care organizations. It is important that organizations meet this challenge and always strive for effective communication to maintain safety, respect for patients and informed consent in health care.

In phase I of field testing, The Ethical Force Program® (led by the Institute for Ethics at the American Medical Association) selected sixteen hospitals and health centers to help develop and field test a self-assessment toolkit on the topic of patient-centered communication. In phase II, testing continues in nine sites, which used the assessment results to inform quality improvement interventions.

Based on the results of field testing, The Ethical Force Program and AMA created the Communication Climate Assessment Toolkit (C-CAT), which helps hospitals and physician practices perform an organizational assessment to determine how well they communicate with diverse patient populations. The C-CAT focuses on those populations that are at risk of poor health outcomes because of vulnerability to ineffective communication during encounters with the health care system. Patients who may be most at risk of ineffective communication are those who speak limited or no English, those from minority cultural groups who may not share "mainstream" health beliefs and values, and those with low health literacy.

Participating hospitals included:

  • Children's Hospital and Research Center, Oakland, Calif. (Phase I, II)
  • George Washington University Hospital, Washington, D.C. (Phase I)
  • North Broward Hospital District, Fort Lauderdale, Fla. (Phase I)
  • Sierra Kings District Hospital, Reedley, Calif. (Phase I, II)
  • The University of Chicago Hospitals, Chicago, Ill. (Phase I, II)
  • University of Kansas Hospital, Kansas City, Kans. (Phase I)
  • University of Mississippi Medical Center, Jackson, Miss. (Phase I, II)
  • Windham Hospital, Willimantic, Conn. (Phase I, II)

Participating health centers included:

  • Community Health Center, Inc., Middletown, Conn. (Phase I, II)
  • Family HealthCare Network, Visalia, Calif. (Phase I)
  • Geisinger Medical Group, Mount Pocono, Pa. (Phase I, II)
  • Golden Valley Health Centers, Merced, Calif. (Phase I, II)
  • Hennepin Faculty Associates at Hennepin County Medical Center, Minneapolis, Minn. (Phase I)
  • Louisville Oncology, Louisville, Ky. (Phase I)
  • Open Door Family Medical Center, Ossining, N.Y. (Phase I)
  • Rainbow Babies and Children's Hospital, Cleveland, Ohio (Phase I, II)

The sites were selected based on organization size and type, patient population diversity and region served. The selection committee tried to include small and large organizations, that are for-profit and not-for-profit, teaching and non-teaching, and located in urban, suburban, and rural locations. The diversity of selected organizations is important because the field testing process will develop and refine the patient-centered communication self-assessment toolkit so that it will become a valuable resource for a wide range of health care organizations.

The Ethical Force Program® is conducting this initiative in collaboration with the Health Research and Educational Trust, the American Hospital Association's research and education affiliate, with funding from The California Endowment, the Connecticut Health Foundation and the American Medical Association Foundation.

Further detailed information about the field-testing and validation of the C-CAT can be found in a recently published, peer-reviewed journal article.