Effects of the Limited English Proficiency of Parents on Hospital Length of Stay and Home Health Care Referral for Their Home Health Care-Eligible Children With Infections

Objective: To examine the relationship of limited English proficiency of parents to hospital length of stay (LOS) and to home health care referral for their home health care eligible-children with infections. Design: A retrospective cohort study. Setting: Regional urban pediatric hospital. Participants: A total of 1257 children aged 0 to 18 years admitted for infection requiring prolonged antibiotic treatment during the period from January 1, 2000, to December 31, 2008. Main Exposures: The cohort of patients were defined by primary caregivers who had to report on their English proficiency. Main Outcome Measures: Number of home health care referrals and LOS. Results: The median LOS for the study group was 4.1 days (interquartile range, 2.6-7.2 days). Limited English proficiency was associated with longer LOS (adjusted relative LOS, 1.6 [95% confidence interval, 1.1-2.3]), indicating that patients who had caregivers with limited English proficiency stayed 60% longer, on average, than patients with English-proficient primary caregivers. Insurance status (Medicaid), absence of a primary care provider, home health care utilization, and presence of comorbidity were also associated with longer LOS. Limited English proficiency was associated with a significantly decreased number of home health care referrals (odds ratio, 0.2 [95% confidence interval, 0.04-0.8]). Patient insurance (Medicaid) and presence of any comorbidity were also significantly associated with decreased number of home health care referrals. Conclusions: Among pediatric inpatients with infections requiring long-term antibiotics, a primary caregiver with limited English proficiency was identified as an important independent risk factor for both increased LOS and decreased number of home health care referrals.