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Hall S, Ballard M. Deaf patients' preferred communication in clinical settings: implications for healthcare providers. JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2024; 29:170-186. [PMID: 38160399 DOI: 10.1093/deafed/enad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024]
Abstract
Deaf patients who communicate in American Sign Language (ASL) experience communication challenges leading to medical errors, treatment delays, and health disparities. Research on Deaf patient communication preferences is sparse. Researchers conducted focus groups based on the Health Belief Model with culturally Deaf patients and interpreters. The ASL focus groups were interpreted and transcribed into written English, verified by a third-party interpreting agency, and uploaded into NVivo. Deductive coding was used to identify communication methods and inductive coding was used to identify themes within each. Writing back-and-forth introduced challenges related to English proficiency, medical terminology, poor penmanship, and tendencies of providers to abbreviate. Participants had various speechreading abilities and described challenges with mask mandates. Multiple issues were identified with family and friends as proxy interpreters, including a lack of training, confidentiality issues, emotional support, and patient autonomy. Video remote interpreter challenges included technical, environmental, and interpreter qualification concerns. Participants overwhelmingly preferred on-site interpreters for communication clarity. While there was a preference for direct care, many acknowledged this is not always feasible due to lack of providers fluent in ASL. Access to on-site interpreters is vital for many Deaf patients to provide full access to critical medical information. Budget allocation for on-call interpreters is important in emergency settings.
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Affiliation(s)
- Sarah Hall
- Department of Public Health, Utah Valley University, Orem, UT, United States
| | - Michael Ballard
- Department of Languages and Culture, Utah Valley University, Orem, UT, United States
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Buning GE, James TG, Richards B, McKee MM. Self-Reported Accommodation Needs for Patients with Disabilities in Primary Care. Jt Comm J Qual Patient Saf 2024; 50:59-65. [PMID: 38052659 DOI: 10.1016/j.jcjq.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND People with disabilities experience barriers to engaging with health care due to inaccessible social and physical environments at primary care clinics. Despite legal mandates, identification and provision of necessary accommodations for this population at primary care clinics are poor. The objective of this cross-sectional study was to assess patient-reported disability status and accommodation needs among patients at a primary care clinic. METHODS An electronic health record-based Disability and Accommodations Questionnaire assessing disability status, types, and accommodation needs was developed by subject matter experts at Michigan Medicine and the University of Michigan Council for Disability Concerns. The questionnaire underwent multiple rounds of reviews and revisions before its use in clinical settings. A paper-based questionnaire was administered to all patients presenting for a wellness-based visit at an academic health system primary care clinic in southeast Michigan. Data were collected between March 2022 and August 2022. RESULTS Approximately 13% of the 541 patients self-reported a disability, with 54.2% indicating at least one needed accommodation. The most commonly reported disabilities were mental health and hearing-related disabilities, by 4.8% and 4.6% of patients, respectively. The most frequently requested accommodations were communication- or language-based (for example, presence of an American Sign Language interpreter, assistive listening devices), cognitive-based (for example, inclusion of a support person with care decisions), and mobility-based (for example, assistance with transfers). CONCLUSION The Disability and Accommodations Questionnaire helped identify the presence of a disability, its types, and any requested accommodations requested at a primary care health center.
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James TG, Sullivan MK, McKee MM, Rotoli J, Maruca D, Stachowiak R, Cheong J, Varnes JR. Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients. Health Expect 2023; 26:2374-2386. [PMID: 37555478 PMCID: PMC10632638 DOI: 10.1111/hex.13842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/20/2023] [Accepted: 07/30/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Deaf and hard-of-hearing (DHH) patients are a priority population for emergency medicine health services research. DHH patients are at higher risk than non-DHH patients of using the emergency department (ED), have longer lengths of stay in the ED and report poor patient-provider communication. This qualitative study aimed to describe ED care-seeking and patient-centred care perspectives among DHH patients. METHODS This qualitative study is the second phase of a mixed-methods study. The goal of this study was to further explain quantitative findings related to ED outcomes among DHH and non-DHH patients. We conducted semistructured interviews with 4 DHH American Sign Language (ASL)-users and 6 DHH English speakers from North Central Florida. Interviews were transcribed and analysed using a descriptive qualitative approach. RESULTS Two themes were developed: (1) DHH patients engage in a complex decision-making process to determine ED utilization and (2) patient-centred ED care differs between DHH ASL-users and DHH English speakers. The first theme describes the social-behavioural processes through which DHH patients assess their need to use the ED. The second theme focuses on the social environment within the ED: patients feeling stereotyped, involvement in the care process, pain communication, receipt of accommodations and discharge processes. CONCLUSIONS This study underscores the importance of better understanding, and intervening in, DHH patient ED care-seeking and care delivery to improve patient outcomes. Like other studies, this study also finds that DHH patients are not a monolithic group and language status is an equity-relevant indicator. We also discuss recommendations for emergency medicine. PATIENT OR PUBLIC CONTRIBUTION This study convened a community advisory group made up of four DHH people to assist in developing research questions, data collection tools and validation of the analysis and interpretation of data. Community advisory group members who were interested in co-authorship are listed in the byline, with others in the acknowledgements. In addition, several academic-based co-authors are also deaf or hard of hearing.
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Affiliation(s)
- Tyler G. James
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
- Department of Health Education and BehaviorUniversity of FloridaGainesvilleFloridaUSA
| | | | - Michael M. McKee
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Jason Rotoli
- Department of Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | | | | | - JeeWon Cheong
- Department of Health Education and BehaviorUniversity of FloridaGainesvilleFloridaUSA
| | - Julia R. Varnes
- Department of Health Services Research, Management, and PolicyUniversity of FloridaGainesvilleFloridaUSA
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Liu PL, Yeo TED, Ye JF. Examining the Intervening Roles of Patient-Centered Care and Patient Activation in the Health Impacts of Offline Healthcare Obstacles and Online Health Consultations Among Deaf and Hard-of-Hearing Patients. HEALTH COMMUNICATION 2023:1-10. [PMID: 37853546 DOI: 10.1080/10410236.2023.2268909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Deaf and hard-of-hearing (DHH) patients often encounter difficulties in effective communication with healthcare professionals and are less likely to receive quality medical care. However, DHH populations are understudied in health communication research. This study examined how offline healthcare obstacles and online health consultation impact DHH patients' health, and the mediating roles of patient-centered care (PCC) and patient activation. Data from 323 DHH patients were analyzed using structural equation modeling to test the hypothesized mediation pathway model. Results indicate that offline healthcare obstacles negatively affect DHH patients' perception of patient-centeredness, which reduces their ability and confidence in self-care (conceptualized as patient activation in this study). This reduced patient activation may jeopardize DHH patients' physical and psychological health. Meanwhile, online health consultation is positively associated with PCC, and higher levels of PCC can increase patient activation, contributing to better physical and psychological health. Testing the same model with hearing-abled participants (n = 3542) revealed significant differences in these intervening relationships. Overall, this study provides valuable insights into the relationship between DHH patients' healthcare experience and their health outcomes. The findings support interventions that focus on enhancing PCC and patient activation to improve the physical and psychological health outcomes of DHH patients.
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Rannefeld J, O'Sullivan JL, Kuhlmey A, Zoellick JC. Deaf and hard-of-hearing patients are unsatisfied with and avoid German health care: Results from an online survey in German Sign Language. BMC Public Health 2023; 23:2026. [PMID: 37848898 PMCID: PMC10583338 DOI: 10.1186/s12889-023-16924-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Approximately 235,000 deaf and hard of hearing (DHH) people live in Germany. Due to communication barriers, medical care for this group is difficult in many respects. Especially in the case of acute illnesses, the possibilities of communication, e.g., through sign language interpreters, are limited. This study investigates the satisfaction of DHH patients with medical care in Germany in unplanned medical consultations. The aim of this study is to provide insights into DHH patient's perception of medical care, to identify barriers and avoidance behaviours that stem from fears, miscommunication, and prior experiences. METHODS We obtained data from adult DHH participants between February and April 2022 throughout Germany via an online survey in German Sign Language. The responses of N = 383 participants (65% female, M = 44 years, SD = 12.70 years) were included in statistical analyses. Outcomes were convictions of receiving help, satisfaction with healthcare provision, and avoiding healthcare visits; further variables were concerns during healthcare visits, incidences of miscommunication, and a communication score. We calculated t-tests, ANOVAs, correlations, and linear and logistic regression analyses. RESULTS Our main findings show that (1) DHH patients were unsatisfied with provided healthcare (M = 3.88; SD = 2.34; range 0-10); (2) DHH patients reported many concerns primarily about communication and treatment aspects when visiting a doctor; and (3) 57% of participants deliberately avoided doctor visits even though they experienced symptoms. Factors such as concerns during doctor's visits (B = -0.18; 95%CI: -0.34--0.02; p = .027) or miscommunication with medical staff (B = -0.19; 95%CI: -0.33-0.06; p = .006) were associated with satisfaction with medical care, while we found almost no associations with gender and location, and only few with age and education. CONCLUSIONS Overall, our findings suggest that DHH patients are unsatisfied with provided healthcare, they deliberately avoid doctor visits, and they face various communication barriers. This study revealed several communication-related determinants of satisfaction with healthcare in DHH patients, such as incidences of miscommunication and the communication score. Communication-related barriers have high potential to be addressed in collaboration with the DHH community. To improve the medical care and the satisfaction with healthcare in DHH patients, training healthcare professionals, digital technologies, and other communication-enhancing interventions should be explored in future intervention studies.
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Affiliation(s)
- Julia Rannefeld
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany.
| | - Julie Lorraine O'Sullivan
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Adelheid Kuhlmey
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Jan Cornelius Zoellick
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
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Conner KR, Jones CM, Wood N, Aldalur A, Paracha M, Powell SJ, Nie Y, Dillon KM, Rotoli J. Use of Routine Emergency Department Care Practices with Deaf American Sign Language Users. J Emerg Med 2023; 65:e163-e171. [PMID: 37640633 PMCID: PMC10653031 DOI: 10.1016/j.jemermed.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 04/20/2023] [Accepted: 05/26/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Deaf individuals who communicate using American Sign Language (ASL) seem to experience a range of disparities in health care, but there are few empirical data. OBJECTIVE To examine the provision of common care practices in the emergency department (ED) to this population. METHODS ED visits in 2018 at a U.S. academic medical center were assessed retrospectively in Deaf adults who primarily use ASL (n = 257) and hearing individuals who primarily use English, selected at random (n = 429). Logistic regression analyses adjusted for confounders compared the groups on the provision or nonprovision of four routine ED care practices (i.e., laboratories ordered, medications ordered, images ordered, placement of peripheral intravenous line [PIV]) and on ED disposition (admitted to hospital or not admitted). RESULTS The ED encounters with Deaf ASL users were less likely to include laboratory tests being ordered: adjusted odds ratio 0.68 and 95% confidence interval 0.47-0.97. ED encounters with Deaf individuals were also less likely to include PIV placement, less likely to result in images being ordered in the ED care of ASL users of high acuity compared with English users of high acuity (but not low acuity), and less likely to result in hospital admission. CONCLUSION Results suggest disparate provision of several types of routine ED care for adult Deaf ASL users. Limitations include the observational study design at a single site and reliance on the medical record, underscoring the need for further research and potential reasons for disparate ED care with Deaf individuals.
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Affiliation(s)
- Kenneth R Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York; Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Courtney M Jones
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Nancy Wood
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York; Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Mariam Paracha
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York; Department of Science and Mathematics, National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, New York
| | - Stephen J Powell
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Yunbo Nie
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Kevin M Dillon
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Jason Rotoli
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
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Nguyen J, Wang YC. A Classification Model Utilizing Facial Landmark Tracking to Determine Sentence Types for American Sign Language Recognition. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083701 DOI: 10.1109/embc40787.2023.10340217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The deaf and hard of hearing community relies on American Sign Language (ASL) as their primary mode of communication, but communication with others who do not know ASL can be difficult, especially during emergencies where no interpreter is available. As an effort to alleviate this problem, research in computer vision based real time ASL interpreting models is ongoing. However, most of these models are hand shape (gesture) based and lack the integration of facial cues, which are crucial in ASL to convey tone and distinguish sentence types. Thus, the integration of facial cues in computer vision based ASL interpreting models has the potential to improve performance and reliability. In this paper, we introduce a simple, computationally efficient facial expression based classification model that can be used to improve ASL interpreting models. This model utilizes the relative angles of facial landmarks with principal component analysis and a Random Forest Classification tree model to classify frames taken from videos of ASL users signing a complete sentence. The model classifies the frames as statements or assertions. The model was able to achieve an accuracy of 86.5%.
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James TG, Panko T, Smith LD, Helm KVT, Katz GR, Caballero ME, Cooley MM, Mitra M, McKee MM. Healthcare communication access among deaf and hard-of-hearing people during pregnancy. PATIENT EDUCATION AND COUNSELING 2023; 112:107743. [PMID: 37060682 PMCID: PMC10167864 DOI: 10.1016/j.pec.2023.107743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Deaf and hard-of-hearing (DHH) people report ineffective healthcare communication. Limited research has been conducted on healthcare communication during pregnancy. This study's aim was to assess communication accommodations and experiences during pregnancy for DHH people. METHODS An accessible web-based survey was administered to a non-probability sample of DHH people through national organizations, social media, and snowball sampling. Eligibility criteria included being 21 years or older; given birth in the U.S. within the past 10 years, report hearing loss prior to the most recent birth. Questions focused on healthcare experiences and information access during their last pregnancy. The sample included 583 respondents for the present analysis. We describe the communication accommodations requested and received during pregnancy, segmented by preferred language. RESULTS Most DHH participants reported communication with prenatal clinicians as "good" or "very good". On-site interpreter services were most commonly requested by American Sign Language (ASL) only and bilingual DHH people. Interpersonal communication modification requests (e.g., speaking louder) were rarely obliged. CONCLUSION This study is the first national examination of requested and received communication accommodations for DHH patients during the perinatal period. PRACTICE IMPLICATIONS Healthcare providers should work closely with patients to ensure effective communication access is provided.
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Affiliation(s)
- Tyler G James
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Tiffany Panko
- Deaf Health Laboratory, Center for Culture and Language, National Technical Institute for the Deaf, Rochester Institute of Technology, USA
| | - Lauren D Smith
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Kaila V T Helm
- Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Gabrielle R Katz
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | | | - Margarita M Cooley
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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Rogers K, Lovell K, Young A. What is the efficacy and effectiveness of telemedicine intervention for deaf signing populations in comparison to face-to-face interventions? A systematic review. BMC Health Serv Res 2023; 23:678. [PMID: 37349811 DOI: 10.1186/s12913-023-09509-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 05/06/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Deaf signing populations face inequality in both access to health services and health outcomes. Telemedicine intervention might offer a potential solution to address these inequalities in mental health and health related services, therefore a systematic review was carried out. The review question was: "What is the efficacy and effectiveness of telemedicine intervention for Deaf signing populations in comparison to face-to-face interventions?". METHODS The PICO framework was applied to identify the components of the review question for this study. The inclusion criteria were: Deaf signing populations; any intervention that includes the delivery of telemedicine therapy and/or the delivery of assessment (e.g. psychological assessments) using telemedicine; and any evidence for the benefits, efficacy and effectiveness of telemedicine intervention with Deaf people whether in health and/or mental health services. The databases PsycINFO, PubMed, Web of Science, CINAHL, and Medline were searched up to August 2021. RESULTS Following the search strategy, and after the duplicates were removed, 247 records were identified. Following screening, 232 were removed as they did not meet the inclusion criteria. The remaining 15 full-text articles were assessed for eligibility. Only two met the criteria to be included in the review (both concerned telemedicine and mental health interventions). However, they did not fully answer the review's research question. Therefore, the evidence gap remains regarding the effectiveness of telemedicine intervention for Deaf people. CONCLUSIONS The review has identified a gap in the knowledge on the efficacy and effectiveness of telemedicine intervention for Deaf people when compared with face-to-face interventions.
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Affiliation(s)
| | | | - Alys Young
- The University of Manchester, Manchester, England
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Panko TL, Cuculick J, Albert S, Smith LD, Cooley MM, Herschel M, Mitra M, McKee M. Experiences of pregnancy and perinatal healthcare access of women who are deaf: a qualitative study. BJOG 2023; 130:514-521. [PMID: 36156842 PMCID: PMC9992236 DOI: 10.1111/1471-0528.17300] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/07/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Women who are deaf experience higher rates of reproductive healthcare barriers and adverse birth outcomes compared with their peers who can hear. This study explores the pregnancy experiences of women who are deaf to better understand their barriers to and facilitators of optimal pregnancy-related health care. DESIGN Qualitative study using thematic analysis. SETTING Semi-structured, individual, remote or in-person interviews conducted in the USA. SAMPLE Forty-five women who are deaf and communicate using American Sign Language (ASL) and gave birth in the USA within the past 5 years participated in the interviews. METHODS Semi-structured interviews explored how mothers who are deaf experienced pregnancy and birth, including access to perinatal information and resources, relationships with healthcare providers, communication access and their involvement with the healthcare system throughout pregnancy. A thematic analysis was conducted. MAIN OUTCOME MEASURES Barriers and facilitators related to a positive experience of perinatal care access among women who are deaf. RESULTS Three major themes emerged: (1) communication accessibility; (2) communication satisfaction; and (3) healthcare provider and team support. Common barriers included choosing healthcare providers, inconsistent communication access and difficulty accessing health information. However, when women who are deaf were able to use ASL interpreters, they had more positive pregnancy and birth experiences. Self-advocacy served as a common facilitator for more positive pregnancy and healthcare experiences. CONCLUSIONS Healthcare providers need to be more aware of the communication and support needs of their patients who are deaf, especially how to communicate effectively. Increased cultural awareness and consistent provision of on-site interpreters can improve pregnancy and birth experiences for women who are deaf.
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Affiliation(s)
- Tiffany L Panko
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, New York, USA
| | - Jess Cuculick
- NTID Department of Liberal Studies, Rochester Institute of Technology, Rochester, New York, USA
| | - Sasha Albert
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts, USA
| | - Lauren D Smith
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts, USA
| | - Margarita M Cooley
- Independent Consultant to Brandeis University, Waltham, Massachusetts, USA
| | - Melanie Herschel
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts, USA
| | - Michael McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Heitz C, Challen K, Milne WK. Hot off the press: SGEM#383: Tommy can you hear me-Deaf and hard-of-hearing patients in the ED. Acad Emerg Med 2023; 30:216-218. [PMID: 36587391 DOI: 10.1111/acem.14652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/02/2023]
Abstract
Patients who are deaf and hard of hearing may have difficulty accessing healthcare resources when compared with non-deaf or hard of hearing patients. Little research has been performed investigating in what ways these difficulties manifest. This article summarizes the podcast and blog discussing the manuscript by James et al. in which deaf and hard of hearing patients are compared to non-deaf and hard of hearing patients when it comes to acuity, length of stay, and emergency department revisits. Social media commentary is included.
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Affiliation(s)
- Corey Heitz
- LewisGale Medical Center, Salem, Virginia, USA
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12
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Moreland CJ, Rao SR, Jacobs K, Kushalnagar P. Equitable Access to Telehealth and Other Services for Deaf People During the COVID-19 Pandemic. Health Equity 2023; 7:126-136. [PMID: 36876236 PMCID: PMC9982136 DOI: 10.1089/heq.2022.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 03/05/2023] Open
Abstract
Introduction Deaf people who use American Sign Language (ASL) with low self-perceived ability to understand spoken information face inequitable access to health care due to systemic barriers. Methods We conducted interviews with 266 deaf ASL users at baseline (May-Aug 2020) and 244 deaf ASL users at follow-up (3 months). Questions addressed (1) access to interpretation during in-person visits; (2) whether they visited clinics (3) or emergency departments (EDs); and (4) telehealth use. Analyses involved univariate and multivariable logistic regressions across levels of perceived ability to understand spoken language. Results Less than a third were aged >65 (22.8%); Black, Indigenous, People of Color (28.6%), or LGBTQ+ (31.1%); and had no college degree (30.6%). More respondents reported outpatient visits at follow-up (63.9%) than at baseline (42.3%). Ten more respondents reported going to urgent care or an ED at follow-up than at baseline. At follow-up interviews, 57% of deaf ASL respondents with high perceived ability to understand spoken language reported receiving interpretation at clinic visits compared to 32% of ASL respondents with low perceived ability to understand spoken language (p<0.01). Telehealth and ED visits showed no between-group differences for low versus high perceived ability to understand spoken language. Discussion Our study is the first to explore deaf ASL users' access to telehealth and outpatient encounters over time during the pandemic. The U.S. health care system is designed for people who have high perceived ability to understand spoken information. Systemic access to health care, including telehealth and clinics, must be made consistently equitable for deaf people who require accessible communication.
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Affiliation(s)
- Christopher J Moreland
- Center for Deaf Health Equity, Gallaudet University, Washington, District of Columbia, USA.,Dell Medical School at the University of Texas, Austin, Texas, USA
| | - Sowmya R Rao
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Katja Jacobs
- Center for Deaf Health Equity, Gallaudet University, Washington, District of Columbia, USA
| | - Poorna Kushalnagar
- Center for Deaf Health Equity, Gallaudet University, Washington, District of Columbia, USA
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Accommodating hearing loss in outpatient physician offices in the U.S. Disabil Health J 2023; 16:101397. [PMID: 36376146 DOI: 10.1016/j.dhjo.2022.101397] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Approximately 16.2 million Americans ages 18 and older (5.7%) report being deaf or having serious difficulty hearing. Hearing loss impedes effective communication during clinical encounters putting patients' safety at risk. A large fraction of Americans with Disabilities Act lawsuits addresses whether providers offered auxiliary aids and services required to ensure effective communication. OBJECTIVE Examine use of different hearing accommodations for deaf or hard of hearing patients by U.S. physicians. METHODS We surveyed randomly selected physicians nationwide representing 7 specialties about their reported use of 8 types of accommodations when communicating with adult outpatients who are deaf or have significant difficulty hearing, even with hearing aids (overall weighted response rate = 61.0%). We performed a descriptive analysis of responses, using survey sampling weights. RESULTS Among the 526 physicians in this analysis, most were male, white, urban, and practiced in community-based practices. Overall, 81.5% (SE = 1.9) reported that patients with significant hearing limitations get worse quality health care than others. Among participants, 49.8% (2.4) reported never using an in-person sign language interpreter hired by the practice, and 63.2% (2.4) never use video remote interpreting. In contrast, 30.7% (2.1) always and 29.8% (2.2) usually speak louder and slower to patients with significant hearing limitations. None of the 8 accommodations were always or usually used by 8.9% (1.3) of participants. CONCLUSIONS More than 32 years after the Americans with Disabilities Act, most physicians do not offer accommodations sufficient to ensure effective communication with adult outpatients with significant hearing limitations.
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Ratakonda S, Argersinger DP, Auchus GC, McGowan C, Ship H, Wang DR, McKee MM. A call for disability health curricula in medical schools. Trends Mol Med 2022; 28:1012-1015. [PMID: 36109318 DOI: 10.1016/j.molmed.2022.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/11/2022] [Indexed: 01/21/2023]
Abstract
People with disabilities encounter significant health and health-care inequities yet disability health training in medical education remains inadequate. This Scientific Life article examines the need to integrate disability health education into medical school curricula and shares successful training examples that can serve as a framework for how to accomplish this.
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Affiliation(s)
- Sanjana Ratakonda
- University of Michigan, Department of Family Medicine, Ann Arbor, MI, USA
| | | | | | | | - Hannah Ship
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - David R Wang
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael M McKee
- University of Michigan, Department of Family Medicine, Ann Arbor, MI, USA.
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James TG, Miller MD, McKee MM, Sullivan MK, Rotoli J, Pearson TA, Mahmoudi E, Varnes JR, Cheong JW. Emergency department condition acuity, length of stay, and revisits among deaf and hard-of-hearing patients: A retrospective chart review. Acad Emerg Med 2022; 29:1290-1300. [PMID: 35904003 PMCID: PMC9671827 DOI: 10.1111/acem.14573] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/12/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Deaf and hard-of-hearing (DHH) patients are understudied in emergency medicine health services research. Theory and limited evidence suggest that DHH patients are at higher risk of emergency department (ED) utilization and poorer quality of care. This study assessed ED condition acuity, length of stay (LOS), and acute ED revisits among DHH patients. We hypothesized that DHH patients would experience poorer ED care outcomes. METHODS We conducted a retrospective chart review of a single health care system using data from a large academic medical center in the southeast United States. Data were received from the medical center's data office, and we sampled patients and encounters from between June 2011 and April 2020. We compared DHH American Sign Language (ASL) users (n = 108), DHH English speakers (n = 358), and non-DHH English speakers (n = 302). We used multilevel modeling to assess the differences among patient segments in outcomes related to ED use and care. RESULTS As hypothesized, DHH ASL users had longer ED LOS than non-DHH English speakers, on average 30 min longer. Differences in ED condition acuity, measured through Emergency Severity Index and triage pain scale, were not statistically significant. DHH English speakers represented a majority (61%) of acute ED revisit encounters. CONCLUSIONS Our study identified that DHH ASL users have longer ED LOS than non-DHH English speakers. Additional research is needed to further explain the association between DHH status and ED care outcomes (including ED LOS and acute revisit), which may be used to identify intervention targets to improve health equity.
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Affiliation(s)
- Tyler G. James
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
- Department of Health Education and BehaviorUniversity of FloridaGainesvilleFloridaUSA
| | - M. David Miller
- School of Human Development and Organizational Studies in EducationUniversity of FloridaGainesvilleFloridaUSA
| | - Michael M. McKee
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
| | | | - Jason Rotoli
- Department of Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Thomas A. Pearson
- Department of EpidemiologyUniversity of FloridaGainesvilleFloridaUSA
| | - Elham Mahmoudi
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Julia R. Varnes
- Department of Health Services Research Management and PolicyUniversity of FloridaGainesvilleFloridaUSA
| | - Jee Won Cheong
- Department of Health Education and BehaviorUniversity of FloridaGainesvilleFloridaUSA
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McKee M, James TG, Helm KVT, Marzolf B, Chung DH, Williams J, Zazove P. Reframing Our Health Care System for Patients With Hearing Loss. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3633-3645. [PMID: 35969852 PMCID: PMC9802570 DOI: 10.1044/2022_jslhr-22-00052] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 06/04/2023]
Abstract
PURPOSE Nearly 20% of U.S. Americans report a hearing loss, yet our current health care system is poorly designed and equipped to effectively care for these individuals. Individuals with hearing loss report communication breakdowns, inaccessible health information, reduced awareness and training by health care providers, and decreased satisfaction while struggling with inadequate health literacy. These all contribute to health inequities and increased health care expenditures and inefficiencies. It is time to reframe the health care system for these individuals using existing models of best practices and accessibility to mitigate inequities and improve quality of care. METHOD A review of system-, clinic-, provider-, and patient-level barriers, along with existing and suggested efforts to improve care for individuals with hearing loss, are presented. RESULTS These strategies include improving screening and identification of hearing loss, adopting universal design and inclusion principles, implementing effective communication approaches, leveraging assistive technologies and training, and diversifying a team to better care for patients with hearing loss. Patients should also be encouraged to seek social support and resources from hearing loss organizations while leveraging technologies to help facilitate communication. CONCLUSIONS The strategies described introduce actionable steps that can be made at the system, clinic, provider, and patient levels. With implementation of these steps, significant progress can be made to more proactively meet the needs of patients with hearing loss. Presentation Video: https://doi.org/10.23641/asha.21215843.
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Affiliation(s)
- Michael McKee
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Tyler G. James
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Kaila V. T. Helm
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Brianna Marzolf
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Dana H. Chung
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - John Williams
- Department of Population Health Science, University of Mississippi Medical Center, Jackson
| | - Philip Zazove
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
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Iezzoni LI, McKee MM, Meade MA, Morris MA, Pendo E. Have Almost Fifty Years Of Disability Civil Rights Laws Achieved Equitable Care? Health Aff (Millwood) 2022; 41:1371-1378. [PMID: 36190880 PMCID: PMC10359967 DOI: 10.1377/hlthaff.2022.00413] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
For almost fifty years, federal civil rights laws such as Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act (ADA) of 1990 and the ADA Amendments Act of 2008, and Section 1557 and other provisions of the 2010 Patient Protection and Affordable Care Act have prohibited discrimination against Americans with disabilities, including in health care. Despite these laws, disabled Americans continue to experience disparities in health and health care, from preventive care to home and community-based services. In its 2022 Health Equity Framework for People with Disabilities, the National Council on Disability highlighted some of these disparities and recommended remedies. To explore these concerns, this article examines disability inequities and potential solutions within six areas. It concludes by recommending the ratification of the 2006 United Nations Convention on the Rights of Persons with Disabilities to reinvigorate US efforts to maximize the health and dignity of disabled Americans and support their full participation in the community.
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Affiliation(s)
- Lisa I. Iezzoni
- Lisa I. Iezzoni , Harvard University and Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - Elizabeth Pendo
- Elizabeth Pendo, Saint Louis University, St. Louis, Missouri
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James TG, Argenyi MS, Guardino DL, McKee MM, Wilson JAB, Sullivan MK, Griest Schwartzman E, Anderson ML. Communication Access In Mental Health And Substance Use Treatment Facilities For Deaf American Sign Language Users. Health Aff (Millwood) 2022; 41:1413-1422. [DOI: 10.1377/hlthaff.2022.00408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Tyler G. James
- Tyler G. James , University of Michigan, Ann Arbor, Michigan
| | - Michael S. Argenyi
- Michael S. Argenyi, Wake Forest University, Winston-Salem, North Carolina
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Emergency Department Utilization Among Deaf and Hard-of-Hearing Patients: A Retrospective Chart Review. Disabil Health J 2022; 15:101327. [DOI: 10.1016/j.dhjo.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/23/2022]
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Halkides H, James TG, McKee MM, Meade MA, Moran C, Park S. Spotlighting Disability in a Major Electronic Health Record: Michigan Medicine’s Disability and Accommodations Tab (Preprint). JMIR Form Res 2022; 6:e38003. [DOI: 10.2196/38003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 10/12/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
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James TG, Varnes JR, Sullivan MK, Cheong J, Pearson TA, Yurasek AM, Miller MD, McKee MM. Conceptual Model of Emergency Department Utilization among Deaf and Hard-of-Hearing Patients: A Critical Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412901. [PMID: 34948509 PMCID: PMC8701061 DOI: 10.3390/ijerph182412901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022]
Abstract
Deaf and hard-of-hearing (DHH) populations are understudied in health services research and underserved in healthcare systems. Existing data indicate that adult DHH patients are more likely to use the emergency department (ED) for less emergent conditions than non-DHH patients. However, the lack of research focused on this population’s ED utilization impedes the development of health promotion and quality improvement interventions to improve patient health and quality outcomes. The purpose of this study was to develop a conceptual model describing patient and non-patient (e.g., community, health system, provider) factors influencing ED utilization and ED care processes among DHH people. We conducted a critical review and used Andersen’s Behavioral Model of Health Services Use and the PRECEDE-PROCEED Model to classify factors based on their theoretical and/or empirically described role. The resulting Conceptual Model of Emergency Department Utilization Among Deaf and Hard-of-Hearing Patients provides predisposing, enabling, and reinforcing factors influencing DHH patient ED care seeking and ED care processes. The model highlights the abundance of DHH patient and non-DHH patient enabling factors. This model may be used in quality improvement interventions, health services research, or in organizational planning and policymaking to improve health outcomes for DHH patients.
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Affiliation(s)
- Tyler G. James
- Department of Family Medicine, School of Medicine, University of Michigan, 1018 Fuller St., Ann Arbor, MI 48104, USA;
- Department of Health Education and Behavior, University of Florida, Florida Gym Room 5, P.O. Box 118210, Gainesville, FL 32611, USA; (J.C.); (A.M.Y.)
- Correspondence:
| | - Julia R. Varnes
- Department of Health Services Research, Management, and Policy, University of Florida, P.O. Box 100185, Gainesville, FL 32610, USA;
| | | | - JeeWon Cheong
- Department of Health Education and Behavior, University of Florida, Florida Gym Room 5, P.O. Box 118210, Gainesville, FL 32611, USA; (J.C.); (A.M.Y.)
| | - Thomas A. Pearson
- Department of Epidemiology, University of Florida, P.O. Box 100231, Gainesville, FL 32610, USA;
| | - Ali M. Yurasek
- Department of Health Education and Behavior, University of Florida, Florida Gym Room 5, P.O. Box 118210, Gainesville, FL 32611, USA; (J.C.); (A.M.Y.)
| | - M. David Miller
- School of Human Development and Organizational Studies in Education, University of Florida, P.O. Box 117047, Gainesville, FL 32611, USA;
| | - Michael M. McKee
- Department of Family Medicine, School of Medicine, University of Michigan, 1018 Fuller St., Ann Arbor, MI 48104, USA;
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