San Diego State University, San Diego, CA, USA.
Suffolk University, Boston, MA, USA.
Int J Health Policy Manag. 2014 Oct 3;3(5):259-68. doi: 10.15171/ijhpm.2014.95. eCollection 2014 Oct.
Hispanics comprise 17% of the total U.S. population, surpassing African-Americans as the largest minority group. Linguistically, almost 60 million people speak a language other than English. This language diversity can create barriers and additional burden and risk when seeking health services. Patients with Limited English Proficiency (LEP) for example, have been shown to experience a disproportionate risk of poor health outcomes, making the provision of Language Services (LS) in healthcare facilities critical. Research on the determinants of LS adoption has focused more on overall cultural competence and internal managerial decision-making than on measuring LS adoption as a process outcome influenced by contextual or external factors. The current investigation examines the relationship between state policy, service area factors, and hospital characteristics on hospital LS adoption.
We employ a cross-sectional analysis of survey data from a national sample of hospitals in the American Hospital Association (AHA) database for 2011 (N= 4876) to analyze hospital characteristics and outcomes, augmented with additional population data from the American Community Survey (ACS) to estimate language diversity in the hospital service area. Additional data from the National Health Law Program (NHeLP) facilitated the state level Medicaid reimbursement factor.
Only 64% of hospitals offered LS. Hospitals that adopted LS were more likely to be not-for-profit, in areas with higher than average language diversity, larger, and urban. Hospitals in above average language diverse counties had more than 2-fold greater odds of adopting LS than less language diverse areas [Adjusted Odds Ratio (AOR): 2.26, P< 0.01]. Further, hospitals with a strategic orientation toward diversity had nearly 2-fold greater odds of adopting LS (AOR: 1.90, P< 0.001).
Our findings support the importance of structural and contextual factors as they relate to healthcare delivery. Healthcare organizations must address the needs of the population they serve and align their efforts internally. Current financial incentives do not appear to influence adoption of LS, nor do Medicaid reimbursement funds, thus suggesting that further alignment of incentives. Organizational and system level factors have a place in disparities research and warrant further analysis; additional spatial methods could enhance our understanding of population factors critical to system-level health services research.
西班牙裔占美国总人口的 17%，超过非裔美国人成为最大的少数族裔群体。从语言上看，有近 6000 万人说英语以外的语言。这种语言多样性在寻求医疗服务时会造成障碍和额外的负担和风险。例如，英语水平有限的患者（LEP）被发现面临健康状况不佳的风险不成比例，因此在医疗保健设施中提供语言服务（LS）至关重要。关于 LS 采用的决定因素的研究更多地关注整体文化能力和内部管理决策，而不是将 LS 采用作为受背景或外部因素影响的过程结果进行衡量。本研究考察了州政策、服务区域因素和医院特征对医院 LS 采用的关系。
我们对美国医院协会（AHA）数据库中 2011 年全国医院的调查数据进行了横断面分析（N=4876），以分析医院特征和结果，并利用美国社区调查（ACS）的额外人口数据来估计医院服务区域的语言多样性。国家健康法律项目（NHeLP）的数据使我们能够获得州级医疗补助报销因素。
只有 64%的医院提供 LS。采用 LS 的医院更有可能是非营利性的，位于语言多样性高于平均水平的地区，规模更大，位于城市。语言多样性高于平均水平的县的医院采用 LS 的可能性是语言多样性较低地区的两倍多[调整后的优势比（AOR）：2.26，P<0.01]。此外，具有多元化战略定位的医院采用 LS 的可能性几乎是两倍（AOR：1.90，P<0.001）。
我们的研究结果支持了结构和环境因素在医疗保健服务中的重要性。医疗保健组织必须满足他们所服务的人群的需求，并在内部协调他们的努力。当前的财务激励措施似乎并没有影响 LS 的采用，医疗补助报销资金也没有影响，因此进一步调整激励措施。组织和系统层面的因素在差异研究中占有一席之地，值得进一步分析；更多的空间方法可以提高我们对人口因素的理解，这些因素对系统层面的卫生服务研究至关重要。
