The effect of English language proficiency on length of stay and in-hospital mortality.
BACKGROUND
In ambulatory care settings, patients with limited English proficiency receive lower quality of care. Limited information is available describing outcomes for inpatients.


OBJECTIVE
To investigate the effect of English proficiency on length of stay (LOS) and in-hospital mortality.


METHODS
Retrospective analysis of administrative data at 3 tertiary care teaching hospitals (University Health Network) in Toronto, Canada.


METHODS
Consecutive inpatient admissions from April 1993 to December 1999 were analyzed for LOS differences first by looking at 23 medical and surgical conditions (59,547 records) and then by a meta-analysis of 220 case mix groups (189,119 records). We performed a similar analysis for in-hospital mortality.


METHODS
LOS and odds of in-hospital death for limited English-proficient (LEP) patients relative to English-proficient (EP) patients.


RESULTS
LEP patients stayed in hospital longer for 7 of 23 conditions (unstable coronary syndromes and chest pain, coronary artery bypass grafting, stroke, craniotomy procedures, diabetes mellitus, major intestinal and rectal procedures, and elective hip replacement), with LOS differences ranging from approximately 0.7 to 4.3 days. A meta-analysis using all admission data demonstrated that LEP patients stayed 6% (approximately 0.5 days) longer overall than EP patients (95% confidence interval, 0.04 to 0.07). LEP patients were not at increased risk of in-hospital death (relative odds, 1.0; 95% confidence interval, 0.9 to 1.1).


CONCLUSIONS
Patients with limited English proficiency have longer hospital stays for some medical and surgical conditions. Limited English proficiency does not affect in-hospital mortality. The effect of communication barriers on outcomes of care in the inpatient setting requires further exploration, particularly for selected conditions in which length of stay is significantly prolonged.
Division of General Internal Medicine, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Ava
A
John-Baptiste
Gary
G
Naglie
George
G
Tomlinson
Shabbir M H
SM
Alibhai
Edward
E
Etchells
Angela
A
Cheung
Moira
M
Kapral
Wayne L
WL
Gold
Howard
H
Abrams
Maria
M
Bacchus
Murray
M
Krahn
D000368:Aged; D002170:Canada; D003142:Communication; D003144:Communication Barriers; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007802:Language; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies