Race, Ethnicity, and Language Data Standardization for Health Care Quality Improvement (2009) / Chapter Skim
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4 Defining Language Need and Categories for Collection
4 Defining Language Need and Categories for Collection
Pages 93-126
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From page 93... ...
To simplify the collection of language data, most entities should develop a list of common languages used by their service population, accom panied by an open-ended response option for those whose language does not appear on the list. When an entity has the capacity to collect additional information, the language preferred for written materials and the language spoken at home are also valuable.
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From page 94... ...
Issues surrounding the collection of language data include understanding whether there is demand for language services in the health care sector (e.g., among hospitals, physicians) and across states, whether data should be collected for both spoken and written language needs, what languages would make up a national standard set of categories, and how those languages should be coded for sharing of data beyond a single service site.
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Yet while evidence shows that some health care entities col lect language data on their patients, most entities fail to use these data to assess how language barriers impact 2 Children's Health Insurance Program Reauthorization Act of 2009, Public Law 111-3, 111th Cong., 1st sess. (February 4, 2009)
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. On the basis of the findings detailed below, the subcommittee concludes that assessing language needs for each individual is an essential first step toward ensuring effective health care communication, and that provision of language assistance services is an actionable quality improvement option.
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, and in the need for obstetrical interventions. Many studies that do not directly evaluate how language barriers impact health status examine how language incompatibility or LEP leads to different medical management than that received by patients who do not have these limitations or are provided with interpreters (Bard et al., 2004; Bernstein et al., 2004; Sarver and Baker, 2000; Waxman and Levitt, 2000)
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suggest that LEP patients provide more elaborate replies with greater disclosure when interviewed in their primary language and that conducting the assessment in the patient's primary language may be particularly relevant for accurate diagnosis. The absence of language concordance between patient and provider and consequent reliance on ad hoc interpreters may impede disclosure of sensitive information (Marcos, 1979)
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.4 ESTIMATES OF POPULATIONS NEEDING LANGUAGE ASSISTANCE AND APPLICABLE REQUIREMENTS This section examines national estimates of the numbers of people in the United States whose primary lan guage at home is not English and the portion who is not proficient in English who therefore may need language assistance during health care encounters. It also reviews applicable national legislative and regulatory requirements that may guide the collection of language-related data.
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than of those who are older, who live in homes where a non-English language is spoken, speak English "very well" (U.S. Census Bureau, 2003b, 2003c)
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. Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency, requires each federal agency to review its services and develop and implement reasonable steps by which LEP persons can have "meaningful access" to programs or activities without charge for language services (Executive Office of the President, 2000)
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Questions address the individual's English profi ciency, primary or preferred spoken language, language spoken at home, and preferred written language. English Proficiency An advantage of using a question to assess English proficiency, such as that used on the Census (Figure 4-1)
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(Tang, 2009) Categories: • Names of specific languages in use in the United States • Braille Mandated: • Threshold language categories may be required by law and applicable to an entity in different states a Health Care Language Assistance Act of 200, California S.B.
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SOURCE: With kind permission from Springer Science+Business Media: Journal of General Internal Medicine, Identification of limited English proficient patients in clinical care, volume 23, 2008, page 1557, Figure 1.
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Primary or Preferred Spoken Language OCR has used the term "primary language" to mean the language that an LEP individual identifies as the one that he or she uses to communicate effectively and would prefer to use to communicate with service providers (HHS, 2008)
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The Census Bureau does not routinely ask a question about a person's facility with written language. But two TABLE 4-2 Correlations Between Self-Reported English Ability in Speaking, Reading, and Writing English Speak Read Write Speak 1 Read 0.9256 1 Write 0.8974 0.9357 1 Latino Speak Read Write Speak 1 Read 0.6735 1 Write 0.6582 0.8548 1 Asian Speak Read Write Speak 1 Read 0.8112 1 Write 0.7736 0.925 1 SOURCE: Subcommittee analysis based on data from National Latino and Asian American Study (Alegría et al., 2004a, 2004b)
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From page 107... ...
. The subcommittee concludes that a patient's language preference for written materials is useful information, but if a health care entity must limit the number of questions it asks because of either administrative burden or HIT capacity, asking about written language is a lower priority than asking about spoken language since writtenlanguage needs can generally be inferred from responses about spoken language.
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The subcommittee concludes that two questions define language need: one that determines whether English-language proficiency is less than "very well" and a second that determines the preferred language needed for a health-related encounter. The subcommittee sets a hierarchy among four possible types of language questions in widespread use and based on the previous discussion, recommends: Recommendation 4-1: To assess patient/consumer language and communication needs, all entities collecting data from individuals for purposes related to health and health care should: • At a minimum, collect data on an individual's assessment of his/her level of English pro ficiency and on the preferred spoken language needed for effective communication with health care providers.
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From page 109... ...
. Thus, focusing on the collection of language data to a top 10 national list would not always be useful even for system-level planning for states and counties, and certainly would not capture the diversity among states or smaller jurisdictions or the specific needs faced by hospitals, health plans, or individual provider practices.
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a,b French French French Creolee French Creole Germana,b German German Greeke Greek Gujarathif Gujarathi Hindi Hindi Hindi Irish Italiana,c Italian Italian Persianf Persian Persian/Farsi Polish Polisha,d Polish Portuguese or Portuguese Portuguese Portuguese Creolee Portuguese Creole Russiana,c Russian Russian Scandinavian languagese Scandinavian languages Scottish Serbo-Croatiand Serbo-Croatian Turkish Urduf Urdu Pushto Yiddishf Yiddish Aramaic West Germanic languagese Other Slavic languagesd Other Indic languagese Other Indo-European languagese Other Asian and Pacific Cantonese Chinesea,b Islander Chinese Chinese Mandarin Japanesed Japanese Japanese Koreana,c Korean Korean Laotiane Laotian Lao Miao Hmongf Miao Hmong Hmong Mon-Khmer Cambodianf Mon-Khmer Cambodian Cambodian/Khmer Mien Tagaloga,c Tagalog Tagalog Thaif Thai Thai Vietnamesea,c Vietnamese Vietnamese Other Asian languagese Hawaiian Ilokano Indonesian Samoan Tahitian Other Pacific Islander languagesf Navajof Native American Navajo Other Native North American Other Native North American American Indian languagesd languages
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From page 111... ...
. In addition, it should be noted that within individually reported languages, such as Chinese, there are various languages/dialects, some of which are sufficiently different that they have been classified as separate languages by the Census Bureau (e.g., Mandarin and Cantonese)
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a. Most spoken languages in North Dakota in 2005 English is spoken by 93.83 percent of people over 5 years old in North Dakota.
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d. Most spoken languages in Maine in 2005 English is spoken by 92.87 percent of people over 5 years old in Maine.
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The Census publishes detailed tables on English-language proficiency by language category for 39 individual languages or groupings nationally and by state (U.S. Census Bureau, 2003a)
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Thresholds for Collection of Spoken or Written Languages The subcommittee considered whether there should be a percentage or numerical threshold requirement for establishing the minimum number of languages on which data should be collected by health care entities or states, given the flexibility recommended for use of locally relevant categories. Such thresholds have been set both for language assistance generally and translation of documents into specific languages.
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From page 116... ...
Accordingly, many entities will have to construct lists of perhaps 10 to 20 language categories that will be manageable within the space constraints of their paper or elec tronic data collection formats. These lists should always have an option to collect languages not listed by including 16 Health Care Language Assistance Act of 200, California S.B.
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From page 117... ...
For example, the California Healthy Family program uses an open-ended format that captures about 30 languages including American Sign Language.17 The main drawback is that it is generally more time-consuming to enter each response manually into a database and to decipher handwriting on paper forms and spelling variations whether paper forms or computer input screens. The Census Bureau has the ability to scan optically or key in individually the free-response answers on language use (Shin and Bruno, 2003)
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The subcommittee did not generate a list of written languages, but illustrates these needs with the experiences of Kaiser Permanente (Appendix G) and Contra Costa Health Plan (Appendix H)
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for spoken language and Braille for written language. SUMMARY The subcommittee has reviewed the frequency of health provider interactions with people needing language assistance and the impact of limited English proficiency on access to care, health outcomes, and patient safety.
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2007. Language services for patients with limited English proficiency: Results of a national survey of internal medicine physicians.
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2005. Limited English proficiency, primary language at home, and disparities in children's health care: How language barriers are measured matters.
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2007. Accessing and using language data from the Census Bureau.
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2007. Providing high-quality care for limited English proficient patients: The importance of language concordance and interpreter use.
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Washington, DC: U.S. Census Bureau.
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2002. Guidance to federal financial assistance recipients regarding Title VI prohibition against national origin dis crimination affecting limited English proficient persons.
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