Some 24 million people in the United States have limited proficiency with the English language. When these people seek medical care, they may find it difficult to communicate with doctors and health providers. In urgent situations, lives can be lost or saved depending on whether a hospital has trained staff available to interpret. Hospitals in the United States that receive federal funding are mandated to provide language services to patients. But according to work recently published by San Diego State University health services researcher and epidemiologist Dr. Melody Schiaffino, many regions with an urgent need for language services lack them. Language services can take many forms, including staff and on-call interpreters, as well as online and telephone-based interpretation and translation services. But regardless of how hospitals choose to provide these services, they must provide them to be compliant with rules on language access updated recently as part of the Affordable Care Act by the Department of Health and Human Services Office of Civil Rights and as interpreted by the Civil Rights Act of 1964.
“These language barriers can present a risk factor for your health,” said Schiaffino, an assistant professor in the SDSU Graduate School of Public Health. “It can lead to adverse events, communication errors, readmissions and a plethora of other negative outcomes for patients. It’s a major problem that has been documented substantially.” Schiaffino, along with Dr. Atsushi Nara, an assistant professor of geography at SDSU, and Dr. Liang Mao, an assistant professor of geography at the University of Florida, reviewed data from two major surveys: the American Hospital Association’s Annual Survey of Hospitals for information on language services provided, and the U.S. Census Bureau’s American Community Survey for information on language needs.
The research team parsed these two data sets to create a national gridwork comparing the level of language-service need for around 4,514 hospitals to whether those hospitals offered language services. Analyzing the findings, Schiaffino and colleagues found that across the board, about 31 percent of hospitals did not provide any language services. Not-for-profit hospitals were much more likely than for-profit or government hospitals to offer the services. In low-need areas, about 65 percent of hospitals offered language services, while in moderate- and high-need areas, about 75 percent of hospitals offered these services. Proportionally, though, hospitals in moderate-need areas were more likely to provide language services than those in either low- or high-need areas.
Looking at how different regions were located in proximity to one another, Schiaffino noticed that frequently there were high-need areas with language services directly next to high-need areas without language services. This suggests that hospitals offering language services may be under pressure to care for a larger patient population than would be considered their fair share, Schiaffino said. The work was published in the journal Health Affairs.
“Given that all hospitals depend substantially on federal funding and that all are subject to the same language service mandate, the disparity warrants further investigation,” she said. Based on this work, the U.S. National Institutes of Health in Bethesda, MD, invited Schiaffino to discuss her research during a briefing on health disparities and population health in September. “The opportunity to be invited to speak at NIH was unprecedented,” she said. “To present to senior experts in the field of health disparities at such an early stage in my career was not only inspiring, but also a demonstration of the progress I hope to continue building on to the benefit of vulnerable populations every day. I also believe it is a testament to the quality of the mentorship I have received in my short time at SDSU and look forward to continue growing in this direction.”