P3.O291: Differences in Healthcare Utilization after Pediatric Cardiology Hospital Discharge between Non-English-Speaking Families and English-Speaking Families.

Background: Over the past decades, advances in pediatric healthcare have led to improved clinical outcomes. Despite medical and social advances, the distribution of these improved outcomes has not been equal across varying racial, ethnic, and socioeconomic populations. A lack of appropriate language services can be associated with miscommunication among medical providers and patients, more frequent readmissions, and emergency room (ER) visits, and poorer health outcomes. We reviewed hospital discharges from our pediatric cardiology unit over three years prior to the pandemic to better understand the healthcare utilization patterns among non-English- and English-speaking families after discharge.

Methods: This is a single center, Institutional Review Board approved (Study 00003001; approved 01/16/2023), retrospective chart review of patients diagnosed with cardiac disease and discharged between 2017-2019 from the cardiology service. The data collected included demographics (including families’ preferred language), cardiac diagnosis, type of discharge (medical, post-operative, post-cardiac catheterization, post-electrophysiology (EP) catheterization, procedural), discharge teaching documentation and follow up plan. Charts were then reviewed for documentation of telephone encounters, urgent care visits, ER visits, and re-admissions within 30 days of discharge. Propensity scoring was used to match non-English- and English-speaking patients based on age, diagnosis, and discharge type. A Mann-Whitney U test was performed to determine differences in length of stay between groups. Chi-squared test was employed to assess differences in readmission rates.

Results: 3479 discharges from the cardiology service were identified between January 2017 and December 2019. From this cohort, 180 non-English-speaking patients and 357 case-matched English-speaking patients for comparison were identified. Preferred patient languages were primarily Spanish (27%), Somali (23%), Nepali (12%) and Arabic (11%). 43% of the discharges were medical, 29.2% were post-operative, 26% were post-catheterization, and 1.7% were for other procedures. There was no statistically significant difference between English- and non-English-speaking patients in terms of median hospital length of stay [English-speaking 3 (range 0-161) days vs non-English-speaking 3 (range 0-122) days; p=0.25]. Hospital readmissions within 30 days of discharge were significantly higher among the non-English-speaking patients (12.8% vs 6.4%; p=0.02).

Conclusion: Non-English-speaking patients experience a significantly increased number of hospital readmissions after discharge. This is attributable to the complexity of care these patients require. Parents are expected to learn multiple medications with differing schedules and intricate feeding instructions to optimize nutrition. Close monitoring of signs and symptoms needs to be communicated to families by their cardiology team for the child to receive proper care and evaluation. Hospital services need to consider the importance of providing language concordant discharge instructions to mitigate some of the disparities seen. Patients and providers may benefit from increased availability of language-specific discharge instructions to facilitate communication of the often-intricate plans of care these patients require.