Do we know the scale of hospital language barriers?

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How many patients at Connecticut’s acute care hospitals have limited English proficiency? And, as the foreign-born and Limited English Proficient (LEP) population grows, how do these hospitals assess and manage care for non-English speakers?

In my job advocating for Asian Pacific Americans, or APAs, we have tried to address this question to understand the scale of language barriers — and improve language access — in the 27 acute-care hospitals in Connecticut.

In my search, I found:

  • There is no public data to count that population.
  • There is no data showing how often interpreter services are used.
  • Asian and Pacific Islander populations are so small and spread out that population data has large margins of error.

According to the Census, APAs accounts for about 4.3 percent of the state’s population — and it’s growing fast. Between 2010 and 2013, Connecticut’s APA population grew by 9 percent, with nearly a third identifying as LEP. In addition, APAs have been identified as the fastest-growing population group in the nation.

However, we don’t know when — or how — each hospital provides interpreter services. Without this data, community members, community organizations, advocates and hospitals have few resources to assess and improve language access. It creates barriers in crafting strong policy to reduce health disparities.

Without language interpreter services, it’s difficult to have effective communication. Patients risk misdiagnoses, missed appointments, confusion with medication and other significant issues.

Data indicates significant language barriers

In 2014, the Asian Pacific American Affairs Commission surveyed Southeast Asians — specifically Cambodian, Laotian and Vietnamese populations. It asked about quality of life, including questions about access to health care.

TrendCT previously looked at the second-most spoken language in each Connecticut neighborhood.

When asked whether they have experienced a language barrier while accessing health care, a significant number of respondents said this occurred “often or always,” including 42 percent of Cambodians, 14 percent of Laotians and 31 percent of Vietnamese. A large portion of respondents said they “sometimes” experience a language barrier during medical visits, including 24 percent of Cambodians, 21 percent of Laotians and 37 percent of Vietnamese.

Although this assessment looks at all health providers, and not just acute-care hospitals, the data indicates the APA community struggles with language barriers while accessing health care.

But in order for communities and advocates to collaborate with area hospitals to find solutions, it’s important to understand the languages each hospital encounters, the frequency with which they encounter each language and the methods by which hospitals enable language access when interpretation is necessary.

The search for meaning in data

We called the switchboards of nearly all acute-care hospitals in Connecticut to ask about language access data. This yielded no information.

Census data gives us a slightly more, albeit convoluted, idea of what kind of language access issues Connecticut hospitals may want to prioritize:

  • Manchester Memorial Hospital lies between regions where Asian and Pacific Island language speakers compose between 5 and 14 percent of the population.
  • Hartford Hospital and St. Francis Hospital serve areas where 3 to 15 percent of the population speaks an Asian or Pacific Islander language. According to a recent TrendCT report analyzing the linguistic demographics of Connecticut Census tracts, the second-languages in areas surrounding these two hospitals include Hindi and other Asian and Indic languages.
  • Yale-New Haven Hospital serves a significant APA population, with up to 17 percent of the population in surrounding areas speaking an Asian or Pacific Island language.
  • Bridgeport Hospital and St. Vincent’s Medical Center serve areas where 3 to 19 percent of the population speaks an Asian or Pacific Island language.
  • Near Windham Hospital — where the Foxwoods and Mohegan Sun resort casinos employ a diverse Asian staff, partly to serve their diverse Asian clientele — about 5 to 10 percent of the population speaks an Asian language.
  • Backus Hospital in Norwich, even nearer to the casinos, serves a significant APA population, with Chinese as a second-language in multiple surrounding areas. Gujarati and Tagalog speakers also reside near Backus Hospital.

Though useful in tracking population trends, Census data provides only a limited perspective on the languages spoken in hospitals.

The APA population is diverse, with myriad distinct cultures, speaking more than 20 different languages. This small population — accounting for about 4.3 percent of the total state population — is spread out throughout the state. We term the APA population a “low-density, high-diversity” group. Furthermore, the U.S. Census does not fully break out languages and ethnicities in its data sets. These issues contribute to high margins of error and diminish the quality of data on the APA community.

Why fill in the gaps?

Good public data on language access would benefit all patients who speak primary languages other than English, as well as improve quality of care.

Nearly a quarter of Connecticut’s population speaks a language other than English at home, according to 2013 Census data. The Limited English Proficient population accounts for about 8 percent — and it grew in Connecticut by 29,000 from 2010 and 2013.

With limited resources and looming budget cuts, hospitals and their communities want to execute best practices and create solutions. In meeting these objectives, hospitals must understand the scope of who needs cultural or language accommodations, and how often.

A lack of public record on services rendered to LEP patients makes tracking the quality of care for non-English speakers virtually impossible. With this crucial information missing from public view, community members, advocates and other stakeholders can provide little input about  how providers meet the needs of the people.

Alok Bhatt is a legislative analyst for the Connecticut Asian Pacific American Affairs Commission.

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