LEP was associated with increased discharge to a skilled care facility (adjusted OR 1.41) after total joint arthroplasty

Description #

In this retrospective cohort of 4721 total joint arthroplasty (TJA) patients, those with limited English proficiency (LEP) were more likely than English-proficient patients to be discharged to a skilled care facility (rather than home) on univariate analysis (161 of 378 [42.6%] vs 889 of 4343 [20.5%]; P < .001). The association persisted in the adjusted logistic model: LEP was independently associated with increased discharge to skilled care with an odds ratio of 1.41 (95% CI, 1.03-1.93; P = .03) (Table 2).

"were more likely to be discharged to a skilled care facility (161 patients [42.6%] vs 889 patients [20.5%]) compared with patients with English proficiency." (Manuel, 2022, p. 3)

"LEP was associated with ... increased discharge to skilled care (odds ratio, 1.41; 95% CI, 1.03-1.93)" (Manuel, 2022, p. 3)

Methods Context #

What? #ⓘ

The observable: discharge disposition — specifically discharge to a skilled care facility versus home.

"we examine the association of LEP with ... discharge destination, hospitalization cost, and rate of 30-day readmission after TJA." (Manuel, 2022, p. 1)

How? #ⓘ

Binomial logistic regression adjusting for a pre-specified covariate set (demographics, insurance, ASA status, case class, case length, blood loss); reference group is English-proficient patients.

"Binomial logistic regressions were used to understand the association of LEP with discharge disposition and 30-day readmission rates." (Manuel, 2022, p. 1)

Who? #ⓘ

Patients aged 18 years or older who underwent TJA from 2015 to 2019 at a single urban academic medical center (N = 4721; 4343 English proficient, 378 LEP).

"This study used electronic health data of patients aged 18 years or older who underwent TJA from 2015 to 2019 at an urban academic medical center" (Manuel, 2022, p. 1)

Other Notes #

Unlike the LOS and cost models, the disposition model was not adjusted for discharge disposition (which is the outcome here); the LOS and cost rate ratios were additionally adjusted for disposition location per the Table 2 footnote.

Caveats #

• Observational single-center EHR-derived cohort with LEP defined by interpreter request; residual confounding precludes causal inference The findings are from a retrospective observational cohort at a single urban academic medical center, using variables derived from the electronic health record, and can establish association but not causation. The authors explicitly acknowledge the limitations inherent to observational EHR-based analysis (with further detail deferred to an unavailable eAppendix). Residual and unmeasured confounding is possible despite multivariable adjustment; the exposure (LEP) was operationalized as a non-English language preference plus a recorded request for interpreter services, which may misclassify patients who are LEP but did not request an interpreter, and single-center results may not generalize to other settings or payer/case mixes.