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The effect of English language proficiency on length of stay and in-hospital mortality

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Abstract

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.

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

PARTICIPANTS: 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.

MEASUREMENTS: 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.

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Authors and Affiliations

  1. Received from the Division of General Internal Medicine, University Health Network, Canada

    Ava John-Baptiste MHSc, Gary Naglie MD, George Tomlinson PhD, Shabbir M. H. Alibhai MD, MSc, Edward Etchells MD, MSc, Angela Cheung MD, PhD, Moira Kapral MD, MSc, Wayne L. Gold MD, Howard Abrams MD, Maria Bacchus MD, MSc &  Murray Krahn MD, MSc

  2. Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Ava John-Baptiste MHSc, Gary Naglie MD, Shabbir M. H. Alibhai MD, MSc, Edward Etchells MD, MSc, Angela Cheung MD, PhD, Moira Kapral MD, MSc, Wayne L. Gold MD, Howard Abrams MD, Maria Bacchus MD, MSc &  Murray Krahn MD, MSc

  3. Department of Health Policy, University of Toronto, Toronto, Ontario, Canada

    Ava John-Baptiste MHSc, Gary Naglie MD, Shabbir M. H. Alibhai MD, MSc, Edward Etchells MD, MSc, Angela Cheung MD, PhD, Moira Kapral MD, MSc, Howard Abrams MD, Maria Bacchus MD, MSc &  Murray Krahn MD, MSc

  4. Department of Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada

    George Tomlinson PhD

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  1. Ava John-Baptiste MHSc
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  2. Gary Naglie MD
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  11. Murray Krahn MD, MSc
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Corresponding author

Correspondence to Murray Krahn MD, MSc.

Additional information

This research was supported by the University Health Network General Internal Medicine Clinical Research Fund. Ara John-Baptiste is supported by a Canada Graduate Scholarship from the Canadian Institutes of Health Research. Gary Naglie was partially supported by the Mary Trimmer Chair in Geriatric Medicine Research from the University of Toronto.

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John-Baptiste, A., Naglie, G., Tomlinson, G. et al. The effect of English language proficiency on length of stay and in-hospital mortality. J GEN INTERN MED 19, 221–228 (2004). https://doi.org/10.1111/j.1525-1497.2004.21205.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2004.21205.x

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