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O'Leary DP, O'Leary TJ. Communicating With Patients With Hearing Loss or Deafness-Can You Hear Me? JAMA Intern Med 2024; 184:345-346. [PMID: 38407879 DOI: 10.1001/jamainternmed.2023.8563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
This Viewpoint explores the ideal safeguards to improve communication with patients who are deaf or hearing impaired.
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Affiliation(s)
- Dianne P O'Leary
- Department of Computer Science and Institute for Advanced Computer Studies, University of Maryland, College Park
| | - Timothy J O'Leary
- Office of Research and Development, Veterans Health Administration, Washington, DC
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Benzie C, Newton M, Forster D, McLachlan H. How are women with a disability identified in maternity services in Australia? A cross-sectional survey of maternity managers. Women Birth 2023; 36:e161-e168. [PMID: 35750578 DOI: 10.1016/j.wombi.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Women with a disability have poorer perinatal outcomes, but little is known about the prevalence of women with a disability accessing maternity services, how they are identified and what care and services are available. Estimates suggest that nine percent of women of childbearing age have a disability. AIM To explore how public maternity services in Australia identify pregnant women with a disability, what (if any) routine disability identification questions are used, and to examine availability and adequacy of services for women. METHODS Cross-sectional online survey of maternity managers in Australian public hospitals. FINDINGS Thirty-six percent (70/193) of eligible hospitals responded including all states and territories. Overall, 71 % routinely asked women about disability status (usually as part of routine history taking), however there was wide variation in how this was asked. Most (63 %) did not have standardised documentation processes and two thirds (65 %) were unable to estimate the number of women with a disability seen at their hospital. Most (68 %) did not offer specialised services, with only 13 % having specialised training for staff in disability identification, documentation and referral pathways. Only a quarter of respondents felt that there were adequate services for women with a disability related to maternity care. CONCLUSION This is the first study to explore disability identification in maternity services in Australia. How women were asked was highly varied and documentation not standardised. National guidelines on disability identification for women accessing maternity services should be developed and collection of disability identification data should be routine.
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Affiliation(s)
- Charlie Benzie
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Michelle Newton
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Della Forster
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia
| | - Helen McLachlan
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
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Dillard LK, Nelson-Bakkum ER, Walsh MC, Schultz A. Self-reported hearing loss is associated with poorer perceived health care access, timeliness, satisfaction, and quality: Findings from the Survey of the Health of Wisconsin. Disabil Health J 2023; 16:101394. [PMID: 36335067 DOI: 10.1016/j.dhjo.2022.101394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Hearing loss is a highly prevalent chronic condition impacting communication and may negatively influence patients' health care experiences. OBJECTIVE Determine associations of hearing loss with perceived health care access, timeliness, satisfaction, and quality in a representative sample of the general population. METHODS The Survey of the Health of Wisconsin (SHOW) is a household-based examination survey that collects data from a representative sample of Wisconsin residents. SHOW participants from years 2008-2013 with data on self-reported hearing loss and health care access, timeliness, satisfaction, and quality were included in this study. Age- and sex- and multivariable-adjusted (additionally adjusted for race/ethnicity, education, marital status, public health region, smoking, chronic disease, self-reported health, and insurance coverage) logistic regression models were used to evaluate associations of hearing loss with participants' health care experiences. Results are presented as odds ratios (OR) with corresponding 95% confidence intervals. RESULTS There were 2438 individuals (42.1% men) included in this study with an average age of 48.3 (range 21-74; standard deviation [SD] 14.4) years. The number of participants who self-reported hearing loss was 642 (26.3%). After multivariable adjustment, hearing loss was associated with increased odds of perceived difficulties with health care access (OR 1.47 [1.05, 2.05]), timeliness (OR 1.69 [1.23, 2.32]), quality (OR 2.54 [1.50, 4.32]), and satisfaction (OR 2.50 [1.51, 4.13]). CONCLUSIONS Given the high prevalence of hearing loss and the growing aging population, there is an urgent need to prioritize interventions to improve health care provision for individuals with hearing loss.
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Affiliation(s)
- Lauren K Dillard
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, USA.
| | - Erin R Nelson-Bakkum
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, USA
| | - Matthew C Walsh
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, USA
| | - Amy Schultz
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, USA
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Miyagishima R, Hopper T, Hodgetts B, Soos B, Williamson T, Drummond N. Development of a case definition for hearing loss in community-based older adults: a cross-sectional validation study. CMAJ Open 2021; 9:E796-E801. [PMID: 34404687 PMCID: PMC8373040 DOI: 10.9778/cmajo.20200267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Research based in primary care suggests that hearing loss may be underreported as well as inconsistently recorded in patient histories. In this study, we aimed to develop and validate a case definition for hearing loss among older adults in primary care, using electronic medical records. METHODS We used data from adult patients aged 55 years and older from 13 practices in the Southern Alberta Primary Care Research Network database, part of the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), from Dec. 1, 2014, to Dec. 31, 2016. We developed a hearing loss case definition that was translated into an electronic algorithm. A record review was undertaken as the reference standard, followed by application of the algorithm to the sample. Validation metrics included sensitivity, specificity, positive predictive value and negative predictive value, as well as prevalence. We assessed risk factors using the Fisher exact test and odds ratios. RESULTS The sample included 1000 patients; 496 (49.6%) were female and the mean age was 67.5 (standard deviation 9.6) years. Sensitivity of the case definition algorithm was determined to be 87.3% (95% confidence interval [CI] 76.5%-94.4%) with specificity valued at 94.8% (95% CI 93.1%-96.1%). Positive and negative predictive values were 52.9% (95% CI 42.8%-62.8%) and 99.1% (95% CI 98.2%-99.6%), respectively. The prevalence of hearing loss within the sample was 6.3% (95% CI 4.9%-7.9%). Older age was a significant risk factor for hearing loss (t = 4.98, 95% CI 3.76-8.65). Men had greater odds of hearing loss than women (odds ratio 1.65, 95% CI 0.98-2.79). INTERPRETATION The validated case definition for hearing loss in community-based older adults had high sensitivity and specificity. It may be applied to surveillance and future epidemiologic research within the CPCSSN database.
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Affiliation(s)
- Rebecca Miyagishima
- Department of Family Medicine, Faculty of Medicine and Dentistry (Miyagishima, Drummond); Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine (Hopper, Hodgetts), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Soos, Williamson, Drummond), Cumming School of Medicine; Department of Family Medicine, Cumming School of Medicine (Soos), University of Calgary, Calgary, Alta.; School of Public Health (Drummond), University of Alberta, Edmonton, Alta.
| | - Tammy Hopper
- Department of Family Medicine, Faculty of Medicine and Dentistry (Miyagishima, Drummond); Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine (Hopper, Hodgetts), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Soos, Williamson, Drummond), Cumming School of Medicine; Department of Family Medicine, Cumming School of Medicine (Soos), University of Calgary, Calgary, Alta.; School of Public Health (Drummond), University of Alberta, Edmonton, Alta
| | - Bill Hodgetts
- Department of Family Medicine, Faculty of Medicine and Dentistry (Miyagishima, Drummond); Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine (Hopper, Hodgetts), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Soos, Williamson, Drummond), Cumming School of Medicine; Department of Family Medicine, Cumming School of Medicine (Soos), University of Calgary, Calgary, Alta.; School of Public Health (Drummond), University of Alberta, Edmonton, Alta
| | - Boglarka Soos
- Department of Family Medicine, Faculty of Medicine and Dentistry (Miyagishima, Drummond); Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine (Hopper, Hodgetts), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Soos, Williamson, Drummond), Cumming School of Medicine; Department of Family Medicine, Cumming School of Medicine (Soos), University of Calgary, Calgary, Alta.; School of Public Health (Drummond), University of Alberta, Edmonton, Alta
| | - Tyler Williamson
- Department of Family Medicine, Faculty of Medicine and Dentistry (Miyagishima, Drummond); Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine (Hopper, Hodgetts), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Soos, Williamson, Drummond), Cumming School of Medicine; Department of Family Medicine, Cumming School of Medicine (Soos), University of Calgary, Calgary, Alta.; School of Public Health (Drummond), University of Alberta, Edmonton, Alta
| | - Neil Drummond
- Department of Family Medicine, Faculty of Medicine and Dentistry (Miyagishima, Drummond); Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine (Hopper, Hodgetts), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Soos, Williamson, Drummond), Cumming School of Medicine; Department of Family Medicine, Cumming School of Medicine (Soos), University of Calgary, Calgary, Alta.; School of Public Health (Drummond), University of Alberta, Edmonton, Alta
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Morris MA, Hamer MK, Eberle K, Jensen KM, Wong AA. Implementation of Collection of Patients' Disability Status by Centralized Scheduling. Jt Comm J Qual Patient Saf 2021; 47:627-636. [PMID: 34144917 DOI: 10.1016/j.jcjq.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/16/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Collection of disability status in electronic health records (EHRs) is critical to addressing the significant health care disparities experienced by patients with disabilities. Despite this, little evidence exists to inform implementation. METHODS This pilot trial evaluated the implementation of collection of patients' disability status during primary care new patient registration by centralized call center staff. The study took place over six weeks at an academic hospital system in Colorado. Staff received a 30-minute training on how to ask and document disability status in the EHR. Completion rate of collection, fidelity, and concordance were assessed through chart reviews and recordings of patient registration calls. Focus groups with staff and phone interviews with patients assessed the experience of including disability screeners in patient registration. RESULTS A total of 3,673 new patients were registered at one of the 53 primary care clinics during the study period. Completion of disability status in the EHR increased from 10% at baseline to > 50% by the last week of the trial, which was then maintained for eight weeks. Challenges were identified in the recorded calls with fidelity of if and how the questions were asked. No patient complaints were reported, and patients reported no concerns regarding collection of disability status during interviews. CONCLUSION Documenting disability status during patient registration was effective and was not concerning to patients. To make initial steps to providing equitable care, efforts should be made to implement this type of screening universally across the clinical encounter.
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Klyn NAM, Letendre C, Shrestha N, Lambert BL, Dhar S. Interpretability of the audiogram by audiologists and physician non-specialists. Int J Audiol 2020; 60:133-139. [PMID: 32815399 DOI: 10.1080/14992027.2020.1805129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The audiogram is frequently used by hearing specialists communicate test results to non-specialists, such as physicians. However, it relies on uncommon terminology and interpreting unusual graphical elements to extract information. In this study, we examine whether the audiogram can be accurately interpreted by specialists and non-specialists. DESIGN We used an online questionnaire to assess the interpretability of an audiogram by audiologists and primary-care physicians. Participants viewed a sample audiogram and submitted their answers via an online survey system. STUDY SAMPLE We recruited actively practicing primary care physicians (n = 100) and actively practicing audiologists (n = 67). We only accepted respondents from the United States. RESULTS The audiogram was not easily interpreted by physicians, with a median score of 4/9. Fewer than 25% could accurately report a threshold correctly. Audiologists were more accurate than physicians (median score 7/9, Wilcoxon two-sample p < 0.001, r = 0.648). CONCLUSIONS The audiogram is difficult for non-specialists to interpret. Clinicians are advised to supplement or supplant the audiogram in interprofessional communication. The development of tools to facilitate interprofessional communication between audiologists and physicians could have positive effects on physician awareness of hearing loss, and even downstream influences on patient behaviour and outcomes.
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Affiliation(s)
- Niall A M Klyn
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA
| | - Claire Letendre
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA
| | - Neeha Shrestha
- Department of Communication Studies and Center for Communication and Health, Northwestern University, Evanston, Illinois, USA
| | - Bruce L Lambert
- Department of Communication Studies and Center for Communication and Health, Northwestern University, Evanston, Illinois, USA
| | - Sumitrajit Dhar
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA.,The Knowles Hearing Center, Northwestern University, Evanston, Illinois, USA
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Morris MA, Lagu T, Maragh-Bass A, Liesinger J, Griffin JM. Development of Patient-Centered Disability Status Questions to Address Equity in Care. Jt Comm J Qual Patient Saf 2019; 43:642-650. [PMID: 29173284 DOI: 10.1016/j.jcjq.2017.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/25/2017] [Accepted: 06/29/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with disabilities experience disparities in accessing and receiving high-quality health care services as compared to patients without disabilities. To address the disparities, health care organizations need to identify which of their patients have disabilities to track quality of care and provide appropriate health care accommodations. To date, no evidence-based sets of disability questions exist that serve these purposes. A study was conducted to identify patient-centered disability questions for health care organizations to determine which patients require health care accommodations and to track the quality of care experienced by patients with disabilities. METHODS In the first of three phases, a focus group with patients and caregivers (N = 54) and interviews with providers (N = 15) were conducted to explore the disability questions that they believed were important. In the second phase, nationally recognized experts (N = 17) participated in a modified Delphi panel to develop a set of disability questions. The third phase entailed cognitive interviews (N = 46) with patients with and without disabilities to refine the wording of the disability questions identified through the previous rounds. RESULTS Through the three phases, six essential questions and three additional recommended questions were identified. Questions addressed hearing, visual, motor, cognitive, communication, and learning disabilities, and the ability to conduct activities of daily living. An overall question for disabilities not included in the previous questions was also identified. CONCLUSION Through a rigorous, three-stage process that engaged multiple stakeholders, patient-centered disability questions were identified for health care organizations to use to identify disparities within their organizations and accommodations that address these disparities.
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Chang JE, Weinstein BE, Chodosh J, Greene J, Blustein J. Difficulty Hearing Is Associated With Low Levels of Patient Activation. J Am Geriatr Soc 2019; 67:1423-1429. [PMID: 30941740 DOI: 10.1111/jgs.15833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/22/2019] [Accepted: 01/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Patient activation encompasses the knowledge, skills, and confidence that equip adults to participate actively in their healthcare. Patients with hearing loss may be less able to participate due to poor aural communication. We examined whether difficulty hearing is associated with lower patient activation. DESIGN Cross-sectional study. SETTING/PARTICIPANTS A nationally representative sample of Americans aged 65 years and older (n = 13 940) who participated in the Medicare Current Beneficiary Survey (MCBS) during the years 2011 to 2013. MEASUREMENT Self-reported degree of difficulty hearing ("no trouble," "a little trouble," and "a lot of trouble") and overall activation based on aggregated scored responses to 16 questions from the MCBS Patient Activation Supplement: low activation (below the mean minus 0.5 SDs), high activation (above the mean plus 0.5 SDs), and medium activation (the remainder). Sociodemographic and self-reported clinical measures were also included. RESULTS "A little trouble" hearing was reported by 5655 (40.6%) of respondents, and "a lot of trouble" hearing was reported by 893 (6.4%) of respondents. Difficulty hearing was significantly associated with low patient activation: in analyses using multivariable multinomial logistic regression, respondents with "a little trouble" hearing had 1.42 times the risk of low vs high activation (95% confidence interval [CI] = 1.27-1.58), and those with "a lot of trouble" hearing had 1.70 times the risk of low vs high activation (95% CI = 1.29-2.11), compared with those with "no trouble" hearing. CONCLUSIONS Nearly half of people aged 65 years and older reported difficulty hearing, and those reporting difficulty were at risk of low patient activation. That risk rose with increased difficulty hearing. Given the established link between activation and outcomes of care, and in view of the association between hearing loss and poor healthcare quality and outcomes, clinicians may be able to improve care for people with hearing loss by attending to aural communication barriers.
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Affiliation(s)
- Ji Eun Chang
- Department of Public Health Policy and Management, New York University College of Global Public Health, New York, New York
| | - Barbara E Weinstein
- Graduate Center, Au.D. Program, City University of New York, New York, New York.,Division of Geriatrics and Palliative Care, New York University School of Medicine, New York, New York
| | - Joshua Chodosh
- Division of Geriatrics and Palliative Care, New York University School of Medicine, New York, New York.,Department of Population Health, New York University School of Medicine, New York, New York.,Veterans Affairs New York Harbor Healthcare System, New York, New York
| | - Jessica Greene
- Baruch College, Marxe School of Public and International Affairs, City University of New York, New York, New York
| | - Jan Blustein
- Department of Population Health, New York University School of Medicine, New York, New York.,New York University Robert F. Wagner Graduate School of Public Service, New York, New York
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Screening, Education, and Rehabilitation Services for Hearing Loss Provided to Clients with Low Vision: Measured and Perceived Value Among Participants of the Vision-Hearing Project. Ear Hear 2018; 38:57-64. [PMID: 27556525 DOI: 10.1097/aud.0000000000000351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Combined vision and hearing impairment, termed dual sensory impairment (DSI), is associated with poorer health outcomes compared with a single sensory loss alone. Separate systems of care exist for visual and hearing impairment which potentially limit the effectiveness of managing DSI. To address this, a Hearing Screening Education Model (HSEM) was offered to older adults attending a low-vision clinic in Australia within this pilot study. The present study aimed to evaluate the benefits of seeking help on hearing handicap, self-perceived health, and use of community services among those identified with unmet hearing needs after participation in the HSEM. DESIGN Of 210 older adults (>55 years of age) who completed the HSEM and were referred for follow-up, 169 returned for a follow-up interview at least 12 months later. Of these, 68 (40.2%) sought help, and the majority were seen by a hearing healthcare provider (89.7%). Changes in hearing handicap, quality of life, and reliance on community services between the baseline and 12-month follow-up were compared between those who sought help and those who did not. In addition, the perceived value of the HSEM was assessed. RESULTS Results showed that there was no significant difference in hearing handicap between those who sought help (mean change -1.02 SD = 7.97, p = 0.3) and those who did not (mean change 0.94 SD = 7.68, p = 0.3), p = 0.18. The mental component of the SF-36 worsened significantly between baseline and follow-up measures across the whole group (mean change -2.49 SD = 9.98, p = 0.002). This was largely driven by those not seeking help, rather than those seeking help, but was not significantly different between the two groups. Those who sought help showed a significant reduction in the use of community services compared with those who did not. Further, all participants positively viewed the HSEM's underlying principle of greater integration between vision and hearing services. CONCLUSIONS These findings suggest a need to further develop and evaluate integrated models of healthcare for older adults with DSI. It also highlights the importance of using broader measures of benefit, other than use of hearing aids to evaluate outcomes of hearing healthcare programs.
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Exploring an educational assessment tool to measure registered nurses' knowledge of hearing impairment and effective communication strategies: A USA study. Nurse Educ Pract 2018; 28:144-149. [DOI: 10.1016/j.nepr.2017.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 01/15/2017] [Accepted: 10/16/2017] [Indexed: 11/19/2022]
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Morris MA, Inselman J, Rogers JMG, Halverson C, Branda M, Griffin JM. How do patients describe their disabilities? A coding system for categorizing patients' descriptions. Disabil Health J 2017; 11:310-314. [PMID: 29110969 DOI: 10.1016/j.dhjo.2017.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 09/29/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND To provide care that meets the values and preferences of patients with disabilities, health care providers need to understand patients' perceptions and understanding of their disability. No studies have explored patients' definitions of disability within the healthcare setting. OBJECTIVE The aim of the study was to understand how patients' define their disability in the healthcare setting and to develop a coding system for categorizing how they describe their disability. METHODS In 2000 all new outpatients at Mayo Clinic, Rochester, MN completed a form that inquired if they had a disability and if so, to write in the disability. The research team categorized the responses by disability type (e.g.: visual or physical) and how the patient described his disability or "disability narrative" (e.g.: diagnosis or activity). RESULTS Within 128,636 patients, 14,908 reported a disability. For adults, lower limb (26%) and chronic conditions (24%) were the most frequent disability type and activity limitations (56%) were the most frequent disability narrative category. For pediatric patients, developmental disabilities (43%) were the most frequently reported disability type and diagnoses (83%) were the most frequent disability narrative category. Patients used different disability narrative categories to describe different disability types. For example, most adults reporting a mental health listed a diagnosis (97%), compared to only 13% of those with lower limb disabilities. CONCLUSIONS Patients had diverse descriptions of their disabilities. In order for providers and healthcare organizations to provide high-quality care, they should engage patients in developing a consistent, patient-centered language around disability.
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Affiliation(s)
- Megan A Morris
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 1st Street SW, Rochester, MN 55905, USA.
| | - Jonathan Inselman
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 1st Street SW, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Julie M G Rogers
- Mayo Clinic, Department of Anesthesiology, 200 1st Street SW, Rochester, MN 55905, USA
| | - Colin Halverson
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 1st Street SW, Rochester, MN 55905, USA; Center for Biomedical Ethics and Society, Vanderbilt University, 2525 West End Ave., Suite 400, Nashville, TN 37203, USA
| | - Megan Branda
- Department of Health Sciences Research, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Joan M Griffin
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 1st Street SW, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
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Collection of Patients' Disability Status by Healthcare Organizations: Patients' Perceptions and Attitudes. J Healthc Qual 2017; 39:219-229. [DOI: 10.1097/jhq.0000000000000036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Birth Outcomes Among U.S. Women With Hearing Loss. Am J Prev Med 2016; 51:865-873. [PMID: 27687529 PMCID: PMC9397576 DOI: 10.1016/j.amepre.2016.08.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 06/09/2016] [Accepted: 08/02/2016] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The purpose of this study is to estimate the national occurrence of deliveries in women with hearing loss and to compare their birth outcomes to women without hearing loss. METHODS This study examined the 2008-2011 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project in 2015 to compare birth outcomes in women with hearing loss and without. Birth outcomes included preterm birth and low birth weight. Multivariate regression analyses compared birth outcomes between women with and without hearing loss, controlling for maternal age, racial and ethnic identity, type of health insurance, comorbidity, region of hospital, location and teaching status of the hospital, ownership of the hospital, and median household income for mother's ZIP code. RESULTS Of an estimated 17.9 million deliveries, 10,462 occurred in women with hearing loss. In adjusted regression analyses controlling for demographic characteristics, women with hearing loss were significantly more likely than those without hearing loss to have preterm birth (OR=1.28, 95% CI=1.08, 1.52, p<0.001) and low birth weight (OR=1.43, 95% CI=1.09, 1.90, p<0.05). CONCLUSIONS This study provides a first examination of the pregnancy outcomes among women with hearing loss in the U.S. This analysis demonstrates significant disparities in birth outcomes between women with and without hearing loss. Understanding and addressing the causes of these disparities is critical to improving pregnancy outcomes among women with hearing loss.
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Silence in the EHR: infrequent documentation of aphonia in the electronic health record. BMC Health Serv Res 2014; 14:425. [PMID: 25248751 PMCID: PMC4181429 DOI: 10.1186/1472-6963-14-425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 09/16/2014] [Indexed: 11/22/2022] Open
Abstract
Background To begin to deliver patient-centered care, providers need to be aware of when a patient has a communication disability and what communication methods to use with the patient. The aim of the study was to describe if and how patients’ communication disabilities are documented within electronic health records (EHR). Methods A retrospective manual chart review of all inpatient and outpatient clinical encounter notes within the EHR for patients who had undergone a laryngectomy at Northwestern Memorial Hospital (Chicago, IL) between 2000–2013. We selected patients who had undergone a laryngectomy as the patient population as we were able to easily identify the patients through Common Procedural Terminology (CPT) codes. Results We identified 81 patient charts with 7484 encounter notes. Of the 81 patient charts, 58 (72%) had at least one encounter note with a communication notation. Excluding speech-language pathology notes, 1164 (16%) of all encounter notes included some notation of the patients’ communication abilities. We coded the communication notations into four categories. 1) Descriptions of communication abilities appeared in 663 (9%) of all encounter notes, 2) descriptions of communication methods appeared in 590 (8%) of all encounter notes, and the last two categories 3) medical management and 4) referrals to speech-language pathology services each appeared in 148 (2%) of all encounter notes. While all patients had the same type of communication disability, aphonia, providers used 39 different terms and phrases to describe aphonia. Conclusions Patients’ communication abilities were infrequently documented in the EHR. When providers did document a patient’s communication disability or method, they used inconsistent descriptions, suggesting a lack of standardized language. Further work is needed to determine how to consistently and accurately document patients’ communication abilities so staff and providers can quickly recognize how best to communicate with patients with communication disabilities.
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Dullard B, Saunders GH. Documentation of Dual Sensory Impairment in Electronic Medical Records. THE GERONTOLOGIST 2014; 56:313-7. [PMID: 24846883 PMCID: PMC7289325 DOI: 10.1093/geront/gnu032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/18/2014] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY To examine the documentation of sensory impairment in the electronic medical records (EMRs) of Veterans with both hearing and vision losses (dual sensory impairment [DSI]). DESIGN AND METHODS A retrospective chart review of the EMRs of 20 patients with DSI was conducted. Providers' documentation of the presence of sensory impairment, the use of assistive technology during clinical appointments, and the content of notes mentioning communication issues were extracted from each chart note in the EMR for the prior 6 years. RESULTS Primary care providers documented DSI in 50% of EMRs, vision loss alone in 40%, and hearing loss alone in 10% of EMRs. Audiologists documented vision loss in 50% of cases, whereas ophthalmologists/optometrists documented hearing loss in 15% of cases. Examination of two selected cases illustrates that care can be compromised when providers do not take note of sensory impairments during planning and provision of clinical care. IMPLICATIONS Sensory impairment is poorly documented by most providers in EMRs. This is alarming because vision and hearing affect patient-physician communication and the use of medical interventions. The results of this study raise awareness about the need to document the presence of sensory impairments and use the information when planning treatment for individuals with DSI.
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Affiliation(s)
- Brittney Dullard
- Speech, Language, and Hearing Sciences, University of Connecticut, Mansfield.
| | - Gabrielle H Saunders
- National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, Oregon
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Barnett S, McKee M, Smith SR, Pearson TA. Deaf sign language users, health inequities, and public health: opportunity for social justice. Prev Chronic Dis 2011; 8:A45. [PMID: 21324259 PMCID: PMC3073438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Steven Barnett
- Rochester Prevention Research Center, National Center for Deaf Health Research, Rochester, New York, USA.
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