• Michael N Levas, John D Cowden, and M Denise Dowd.
• Division of Emergency Medical Services, Children's Mercy Hospital and Clinics, Kansas City, MO, USA. mnlevas@cmh.edu
• Arch Pediatr Adolesc Med. 2011 Sep 1;165(9):831-6.

ObjectiveTo 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.DesignA retrospective cohort study.SettingRegional urban pediatric hospital.ParticipantsA 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 ExposuresThe cohort of patients were defined by primary caregivers who had to report on their English proficiency.Main Outcome MeasuresNumber of home health care referrals and LOS.ResultsThe 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.ConclusionsAmong 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.

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