Hospital and ICU LOS.

ObjectivesTo conduct comparative cost analysis of hospital care for critically ill patients with Limited English Proficiency (LEP) versus patients with English proficiency (controls).Patients and methodsWe conducted a historical cohort study using propensity matching at Mayo Clinic Rochester, a quaternary care academic center. We included hospitalized patients who had at least one admission to ICU during a 10-year period between 1/1/2008-12/31/2017.ResultsDue to substantial differences in baseline characteristics of the groups, propensity matching for the covariates age, sex, race, ethnicity, APACHE 3 score, and Charlson Comorbidity score was used, and we achieved the intended balance. The final cohort included 80,404 patients, 4,246 with LEP and 76,158 controls. Patients with LEP had higher costs during hospital admission to discharge, with a mean cost difference of $3861 (95% CI $822 to $6900, p = 0.013) and also higher costs during index ICU admission to hospital discharge, with a mean cost difference of $3166 (95% CI $231 to $6101, p = 0.035). A propensity matched cohort including only those that survived showed those with LEP had significantly greater mean costs for all outcomes. Sensitivity analysis revealed that international patients with LEP had significantly greater overall hospital costs of $9,240 than patients with LEP who resided in the US (95% CI $3341 to $15,140, p = 0.002).ConclusionThis is the first study to demonstrate significantly higher costs for patients with LEP experiencing a critical illness. The causes for this may be increased healthcare utilization secondary to communication deficiencies that impede timely decision making about care.研究目的：对比英语熟练度受限（Limited English Proficiency，LEP）重症患者与英语流利患者（对照组）的住院医疗成本差异。 研究对象与方法：本研究于四级学术医疗中心罗切斯特梅奥诊所（Mayo Clinic Rochester）开展，采用倾向得分匹配的历史性队列研究设计。纳入2008年1月1日至2017年12月31日这10年间，至少有1次重症监护病房（Intensive Care Unit，ICU）住院经历的住院患者。 研究结果：鉴于两组基线特征存在显著差异，本研究针对年龄、性别、种族、民族、急性生理学与慢性健康状况评分系统Ⅲ（APACHE 3）、查尔森合并症评分（Charlson Comorbidity score）等协变量进行倾向得分匹配，最终实现了组间均衡性。最终队列共纳入80404例患者，其中LEP患者4246例，对照组患者76158例。LEP患者从住院至出院的医疗成本更高，平均成本差异为3861美元（95%置信区间[CI]：822~6900，P=0.013）；其从首次ICU住院至出院的医疗成本亦更高，平均成本差异为3166美元（95%CI：231~6101，P=0.035）。对仅纳入存活患者的倾向得分匹配队列进行分析，结果显示LEP患者的各项结局指标平均成本均显著更高。敏感性分析结果表明，境外LEP患者的总住院医疗成本较美国境内LEP患者高出9240美元（95%CI：3341~15140，P=0.002），差异具有统计学意义。 研究结论：本研究为首项证实重症LEP患者医疗成本显著更高的研究。其潜在原因可能为沟通障碍导致医疗服务利用增加，进而延误诊疗决策的制定。