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

Costs of Care for Hospitalized Children Associated With Preferred Language and Insurance Type

“…lack of transportation and/or access to follow-up care for publicly-insured patients may lead to keeping a child in the hospital longer than might be strictly medically necessary. Previous studies have found longer LOS among children with Medicaid, in populations hospitalized for spinal fusion, 27 infections, 7 and asthma. 28 For example, Glick reports longer LOS and similar costs (adjusted for LOS) among Medicaid-insured children with asthma, but found low-income patients to have longer LOS but lower LOS-adjusted costs, similar to our findings.…”

“…Prior studies examining language and hospital utilization have demonstrated mixed results, with some finding increased LOS 5,7 or resource utilization 6,35 , generally within more narrowly defined diagnosis groups, and some finding none. 36 Public insurance and/or other markers for socioeconomic status have also been linked to increased LOS and, in some cases, increased resource utilization (including costs).…”

“…As seen in previous studies, parental LEP may result in providers performing more tests, trying more treatments, or observing patients for longer periods to compensate for incomplete information and poor communication. 4,5,7,34 These more expensive stays may also reflect poorer access to outpatient care or delayed presentation, 10 although controlling for distance from home to hospital likely attenuated those associations. As we found among privately-insured Spanish-speakers, these cost differences were driven by children with medical complexity and prolonged LOS, suggesting that language barriers, cultural factors, and provider biases are most likely to impact care in visible ways when that care is more complicated or less evidence-based and standardized.…”

“…In 2011, 15% of US children lived with at least one parent who had limited English proficiency (LEP), defined as speaking English less than “very well.” 1 Language barriers in health care have been associated with decreased adherence, comprehension, and satisfaction with care, 2,3 along with increased resource utilization in some settings 4–7 , worse condition-specific outcomes, 8–11 and increased risk for serious adverse events. 12–15 Language barriers often co-occur with other potential barriers to high quality care, including poverty, low health literacy, and public insurance.…”

In-Person Interpreter Use and Hospital Length of Stay among Infants with Low Birth Weight

“…Parents with NEPL report poor communication with healthcare providers [4,5,6] and lower satisfaction with their children’s healthcare [4]. Children of parents with NEPL experience fewer outpatient referrals [4,7] and delayed hospital discharge [7]. While US law and national guidelines mandate the use of interpreter services in all healthcare organizations [8], interpreters are underused by healthcare providers even when they are readily available [9,10,11,12,13,14,15].…”