The Ohio City neighborhood on Cleveland’s Near West Side is home to Cleveland Clinic’s Lutheran Hospital. It’s also home to a diverse inner-city population, 23 percent of which is Hispanic. Although minutes from the hospital — and therefore a top U.S. healthcare system —the large (mostly Puerto Rican) community has remained distant.

That’s not unlike the rest of the United States. In 2008, Hispanics made up nearly 16 percent of U.S. residents but only 9 percent of healthcare costs, reported the National Council of La Raza, America’s largest Latino advocacy organization.

“Many are reluctant to seek healthcare because they speak only Spanish,” says John Rodriguez, MD, a general surgeon in Cleveland Clinic’s Digestive Disease Institute. “And, apart from the language barrier, Hispanics are generally notorious for not prioritizing preventive care or having a primary care physician.”

A Pew Research Center study reports that 27 percent of Hispanics lack a regular healthcare provider.

Mindful of the stats as well as the needs in their own neighborhood, Dr. Rodriguez and two other Cleveland Clinic physicians helped Lutheran Hospital open a Hispanic Clinic in 2014. While likely more common in California, Texas and other regions with large Hispanic populations, Hispanic clinics are rare in areas like Northeast Ohio. The Hispanic influence may not be as prominent here, but healthcare accessibility — for all people groups — is still a major concern.

Hispanic clinics, as well as clinics specialized for other demographics, model how healthcare organizations can become more intentional about providing patient-centered care.

Getting closer

In addition to surgeon Dr. Rodriguez, the Hispanic Clinic currently includes a Hispanic internist and gastroenterologist. Plans are in the works to add a pediatrician. Nurses and office staff also are Spanish-speaking.

“Even though I’ve been at Cleveland Clinic’s main campus for years, it’s difficult for many of these patients to travel to the other side of town,” says gastroenterologist Carlos Romero-Marrero, MD. “We needed to get closer to their community. The Hispanic Clinic improves our accessibility, not just by location but by offering Hispanics an opportunity to see healthcare providers who share their language, culture and background.”

According to Drs. Rodriguez and Romero-Marrero, there are three big reasons why a Hispanic Clinic was necessary to make healthcare more accessible for this underserved population.

1. Remove the language barrier. Navigating the U.S. healthcare system can be challenging for those who aren’t proficient in English. Hispanic clinics can resolve that, beginning with office staff who answer the phone in a caller’s preferred language.“It immediately helps relieve intimidation and is the first step to connecting Hispanic patients with physicians they need — especially those who speak their language,” says Dr. Rodriguez. “The patient-physician relationship is better when you can sit down with each other and have one-on-one interaction, without a translator. Patients are more likely to understand their diagnosis and how to take the next steps in their treatment.”
2. Provide cultural understanding. It’s not just a language thing, say physicians at the Hispanic Clinic. There’s a cultural understanding that also makes the clinic a more comfortable fit for Latino patients. For example:
   • Physicians’ roles. “Many non-Hispanic patients like to participate in their healthcare, but Hispanic patients tend not to,” says Dr. Rodriguez. “While non-Hispanics often will do research, know their options and make treatment decisions with their provider, Hispanic patients tend to need more education about their condition and more guidance about how to address it.”
   • Dietary preferences. Rice, bread and fried foods are big, especially in the Puerto Rican population, says Dr. Romero-Marrero. “Understanding their lifestyle helps us know how to customize care to help them get healthier while still considering their environment,” he says.
   • Religious and family customs. It’s not uncommon for Hispanics to rely on folk medicine or family members’ counsel as their first line of medical care. “We try to be sensitive to their beliefs while advising them on the conventional medical care they need,” says Dr. Romero-Marrero.
3. Address health disparities. Hispanics are not more likely to get colon cancer, but they are more likely to be diagnosed at a later stage, reports an American Cancer Society study. Dr. Rodriguez attributes this disparity to Hispanics’ lower screening rates.“Part of what drove the creation of the Hispanic Clinic was making it easier for patients to get screening colonoscopies, as well as other preventive care,” he says.Diabetes, fatty liver disease and irritable bowel syndrome also are quite common among Hispanic populations, adds Dr. Romero-Marrero. With experts from Cleveland Clinic’s Digestive Disease Institute available at the Hispanic Clinic, patients are more likely to get the care they need rather than delaying or avoiding it because they aren’t confident about finding specialists on their own.In addition, Dr. Rodriguez offers surgical treatments for hernia, gallstones, reflux and other common gastrointestinal conditions. He also performs bariatric surgery, an option for some of the 40 percent of Hispanic Americans who are obese.

Signs of success

In less than one year of operation, Cleveland Clinic’s Hispanic Clinic is growing. Physician referrals are contributing, but patient-to-patient referrals are the biggest factor. And that’s a good indication that the concept is working, notes Dr. Rodriguez. Measurable outcomes will be reported later.

“Every community, not just Latinos, needs healthcare providers who are culturally and linguistically appropriate,” says Dr. Romero-Marrero. “Referring patients to culturally targeted clinics will likely improve a patient’s overall experience and possibly clinical outcome. It’s one step closer to improving health disparities in the U.S.”

For more information, contact Dr. Rodriguez at rodrigj3@ccf.org or Dr. Romero-Marrero at romeroc@ccf.org.