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Chandanabhumma PP, Ratakonda S, Panko T, Cuculick J, Hauser P, Paasche-Orlow MK, Fetters MD, McKee MM. Examining the differences of perceptions and experience with online health information accessibility between deaf and hearing individuals: A qualitative study. Patient Educ Couns 2024; 122:108169. [PMID: 38325209 DOI: 10.1016/j.pec.2024.108169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 12/06/2023] [Accepted: 01/21/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Describe and compare the experiences and preferences of Deaf and hearing individuals with different levels of health literacy in accessing, interpreting, and acting upon online health information. METHODS We conducted semi-structured interviews with 17 Deaf and 10 hearing participants with high and low health literacy from three healthcare sites. We conducted thematic analysis of the transcripts to explore information navigation experiences, information sources and dissemination preferences. RESULTS We found thematic differences between Deaf and hearing participants with high and low health literacy in terms of information needs, information search experiences, information search perceptions, and preferred information dissemination approaches. Relative to hearing counterparts, Deaf participants were more likely to encounter challenges in accessing and understanding online information. Deaf participants with low health literacy were more likely to rely on visual graphics to support their understanding of the information than those with high health literacy. Deaf participants advocated for tailored approaches to disseminate health information to Deaf communities. CONCLUSION Our findings suggest that differences in online health information navigation experiences and accessibility may inform disparities in health literacy outcomes between Deaf and hearing individuals. PRACTICE IMPLICATIONS Online health information should be presented in a manner accessible to Deaf community members.
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Affiliation(s)
| | | | - Tiffany Panko
- National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY, USA
| | - Jessica Cuculick
- National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY, USA
| | - Peter Hauser
- National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY, USA
| | | | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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Mussallem A, Panko TL, Contreras JM, Plegue MA, Dannels WA, Roman G, Hauser PC, McKee MM. Making virtual health care accessible to the deaf community: Findings from the telehealth survey. J Telemed Telecare 2024; 30:574-578. [PMID: 35075938 DOI: 10.1177/1357633x221074863] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION To reduce COVID-19 exposure risk, virtual visits became widely adopted as a common form of healthcare delivery for the general population. It is unknown how this affected the deaf population, a sociolinguistic minority group that continues to face communication and healthcare barriers. The survey's objective was to describe the deaf participants' experiences with telehealth visits. METHODS A 28-item online survey, available in American Sign Language and English, was developed and disseminated between November 2020 and January 2021. Ninety-nine deaf participants responded. Descriptive statistics were performed to assess the participant's virtual health care use, experiences, and communication approaches. RESULTS Seventy-five percent of respondents used telehealth at least once in the past 12 months (n = 74; age = 37.6 ± 14.5 years). Of those who used telehealth, nearly two-thirds experienced communication challenges (65.3%; n = 49). Half of the participants reported having to connect via a video relay service that employs interpreters who maintain general certification instead of a remote interpreter with specialized health care interpreting certifications for video visits with their health care providers (n = 37) and a third of participants reported needing to use their residual hearing to communicate with their providers (n = 25). CONCLUSION Standard protocols for health care systems and providers are needed to minimize the burden of access on deaf patients and ensure virtual visits are equitable. It is recommended these visits be offered on Health Insurance Portability and Accountability Act-compliant platforms and include multi-way video to allow for the inclusion of remote medical interpreters and/or real-time captionists to ensure effective communication between the provider and the deaf patient occurs.
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Affiliation(s)
- Ashley Mussallem
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, NY, USA
| | - Tiffany L Panko
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, NY, USA
| | - Jessica M Contreras
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, NY, USA
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Wendy A Dannels
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, NY, USA
| | - Gretchen Roman
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
| | - Peter C Hauser
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, NY, USA
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Mitra M, Akobirshoev I, Valentine A, McKee K, McKee MM. Severe maternal morbidity in deaf or hard of hearing women in the United States. Prev Med 2024; 180:107883. [PMID: 38307211 DOI: 10.1016/j.ypmed.2024.107883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE Prior studies on severe maternal morbidity (SMM) have often excluded women who are deaf or hard of hearing (DHH), even though they are at increased risk of pregnancy complications and adverse birth outcomes. This study compared rates of SMM during delivery and postpartum among DHH and non-DHH women. METHODS This nationally representative retrospective cohort study used hospital discharge data from the 2004-2020 Health Care and Cost Utilization Project Nationwide Inpatient Sample. The risk of SMM with and without blood transfusion during delivery and postpartum among DHH and non-DHH women were compared using modified Poisson regression analysis. The study was conducted in the United States in 2022-2023. RESULTS The cohort included 9351 births to DHH women for the study period, and 13,574,382 age-matched and delivery year-matched births to non-DHH women in a 1:3 case-control ratio. The main outcomes were SMM and non-transfusion SMM during delivery and postpartum. Relative risks were sequentially adjusted for sociodemographic characteristics, hospital-level characteristics, and clinical characteristics. In unadjusted analyses, DHH women were at 80% higher risk for SMM (RR = 1.81, 95% CI 1.63-2.02, p < 0.001) during delivery and postpartum compared to non-DHH women. Adjustment for socio-demographic and hospital characteristics attenuated risk for SMM (RR = 1.54, 95% CI 1.38-1.72, p < 0.001). Adjustment for the Elixhauser comorbidity score further attenuated the risk of SMM among DHH women (RR = 1.13, 95% CI 1.01-1.26, p < 0.05). CONCLUSION The findings of this study demonstrate a critical need for inclusive preconception, prenatal, and postpartum care that address conditions that increase the risk for SMM among DHH people.
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Affiliation(s)
- Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, 415 South St. MS 035, Waltham, MA 02453, USA.
| | - Ilhom Akobirshoev
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, 415 South St. MS 035, Waltham, MA 02453, USA
| | - Anne Valentine
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, 415 South St. MS 035, Waltham, MA 02453, USA
| | - Kimberly McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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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] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Helm KVT, Panko TL, Herschel M, Smith LD, Mitra M, McKee MM. Maternal Health Experiences of Black Deaf and Hard of Hearing Women in the United States. Womens Health Issues 2023; 33:610-617. [PMID: 37648627 PMCID: PMC10843088 DOI: 10.1016/j.whi.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Deaf and hard of hearing (DHH) women are faced with numerous health inequities, including adverse pregnancy and birth outcomes. These outcomes are likely exacerbated for Black DHH women because of the intersection of disability and race. This study aimed to explore the pregnancy and birth experiences of Black DHH women to identify factors that influence their pregnancy outcomes. METHODS Semistructured interviews were conducted between 2018 and 2019 with 67 DHH women who gave birth in the past five years. The present study represents a subgroup analysis of eight of the 67 women who self-identified as Black. Interviews were recorded, transcribed, and analyzed for emerging themes. RESULTS Primary themes centered on unmet needs, barriers, and facilitators. Barriers included limited access to health information owing to communication difficulties and challenges obtaining accommodations. Key facilitators included the availability of sign language interpreters, familial support, and cultural understanding from providers. Participants emphasized these facilitators in their recommendations to providers and DHH women. Findings also underscored the critical role of recognizing cultural identity in perinatal health care delivery. CONCLUSIONS This study outlines themes that affect pregnancy and birthing experiences among Black DHH women in the United States. Study implications include a call to action for providers to prioritize communication accommodations, accessible information, and compassionate care for all Black DHH women. Furthermore, future work should explore the impact of cultural and racial concordance between patients and their health care providers and staff. Understanding how intersectional identities affect perinatal health care access is crucial for reducing disparities among Black DHH women.
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Affiliation(s)
- Kaila V T Helm
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Tiffany L Panko
- Rochester Institute of Technology, NTID Research Center on Culture and Language, Rochester, New York
| | - Melanie Herschel
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Lauren D Smith
- Brandeis University, Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Waltham, Massachusetts
| | - Monika Mitra
- Brandeis University, Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Waltham, Massachusetts
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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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 Educ Couns 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Cerilli C, Katz G, Volandes AE, Davis AD, Paasche-Orlow MK, James TG, McKee MM. "There is No Communication": A Qualitative Examination of Deaf Signers' Experiences With Advance Care Planning. J Palliat Care 2023:8258597231179763. [PMID: 37264781 DOI: 10.1177/08258597231179763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Objective(s): Deaf American Sign Language (ASL) users are subject to health care disparities resulting from communication and language barriers. Currently, few resources on advance care planning and end-of-life care exist in ASL. This study explores Deaf ASL users' perceptions and experiences with end-of-life care and advance care planning. Methods: Semi-structured 1:1 interviews with Deaf signers were translated, and transcribed into English by a bilingual researcher. Investigators inductively coded transcripts and identified themes of barriers, facilitators, knowledge, and sources of information regarding end-of-life care. Participants' knowledge of advance care planning and completion of advance care planning documents were evaluated using a brief assessment. Results: Eleven Deaf ASL users participated in the study with two deaf interviewers. Participants reported barriers to end-of-life care including poor provider communication, inaccessible sources, and inadequate provision of accommodations, leading to patient distrust. Participants' understanding of advance care planning was facilitated by accessible forms of communication and their social networks, such as family, friends, and Deaf peers. Participants primarily gained information on end-of-life care from first-hand familial experience, peers, and media. Participants' mean advance care planning knowledge was 4.6 out of 15 (SD = 2.6). Conclusions: Deaf ASL users face scarce accessible resources around end-of-life care, lowering their ability to understand and proceed with advance care planning. Implementation of ASL accessible advance care planning educational tools in health care settings is needed.
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Affiliation(s)
- Caroline Cerilli
- Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, MD, USA
| | - Gabrielle Katz
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Angelo E Volandes
- ACP Decisions Non-Profit Foundation, Waban, MA, USA
- Section of General Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aretha Delight Davis
- ACP Decisions Non-Profit Foundation, Waban, MA, USA
- Section of General Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Tyler G James
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Zazove P, Plegue MA, Mulhem E, Panzer K, Ratakonda S, Sen A, Greenberg J, McEvoy A, Kileny PR, McKee MM. The Association of Hearing Loss with Hospitalization. J Am Board Fam Med 2023:jabfm.2022.220407R1. [PMID: 37169586 DOI: 10.3122/jabfm.2022.220407r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Individuals with hearing loss (HL) are at higher risk for hospitalizations, and may be for readmissions, compared with their hearing peers. The objective of this prospective study was to confirm retrospective studies suggesting that HL increases hospital readmissions, and, if confirmed, possible causes for it. METHODS A prospective cohort study of English-speaking patients >55 years old admitted to general medical and surgical floors at 2 large hospital systems in southeastern Michigan over a 2-year period was conducted. All patients underwent bedside audiometric testing. HL presence and severity were categorized using World Health Organization pure tone assessment parameters. Readmission rates, Charlson comorbidity index, socio-demographic and medical variables were obtained from Epic EMR databases. OUTCOMES There were 1247 hospitalized patients enrolled. Of these, 76.8% had documented HL of which 50.5% (630) was mild HL and 26.3% (328) moderate or worse HL. Patients with any HL were older and more likely to be non-Hispanic, white, male, and had less education, lower health literacy, more comorbidities, and more difficulty communicating with their doctor. Readmission rates at 30 and 90-days were similar between HL and hearing groups, after adjusting for HL severity, Charlston index, and numerous potential confounders. CONCLUSION Patients with HL do not seem to have higher rates of hospital readmissions. We did find high frequency of HL in hospitalized patients along with significant communication difficulties that patients had with their clinicians. These findings have implications for measures to improve patient-physician communication, potentially improving long-term health outcomes.
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Affiliation(s)
- Philip Zazove
- From the Department of Family Medicine, University of Michigan, Ann Arbor, Michigan (PZ, MAP, KP, SR, JG, AM, MMM); Department of Family Medicine and Community Health, Oakland University William Beaumont School of Medicine, Rochester, Michigan (EM); Department of Otorhinolaryngology, University of Michigan, Ann Arbor, Michigan (PRK)
| | - Melissa A Plegue
- From the Department of Family Medicine, University of Michigan, Ann Arbor, Michigan (PZ, MAP, KP, SR, JG, AM, MMM); Department of Family Medicine and Community Health, Oakland University William Beaumont School of Medicine, Rochester, Michigan (EM); Department of Otorhinolaryngology, University of Michigan, Ann Arbor, Michigan (PRK)
| | - Elie Mulhem
- From the Department of Family Medicine, University of Michigan, Ann Arbor, Michigan (PZ, MAP, KP, SR, JG, AM, MMM); Department of Family Medicine and Community Health, Oakland University William Beaumont School of Medicine, Rochester, Michigan (EM); Department of Otorhinolaryngology, University of Michigan, Ann Arbor, Michigan (PRK)
| | - Kate Panzer
- From the Department of Family Medicine, University of Michigan, Ann Arbor, Michigan (PZ, MAP, KP, SR, JG, AM, MMM); Department of Family Medicine and Community Health, Oakland University William Beaumont School of Medicine, Rochester, Michigan (EM); Department of Otorhinolaryngology, University of Michigan, Ann Arbor, Michigan (PRK)
| | - Samantha Ratakonda
- From the Department of Family Medicine, University of Michigan, Ann Arbor, Michigan (PZ, MAP, KP, SR, JG, AM, MMM); Department of Family Medicine and Community Health, Oakland University William Beaumont School of Medicine, Rochester, Michigan (EM); Department of Otorhinolaryngology, University of Michigan, Ann Arbor, Michigan (PRK)
| | - Ananda Sen
- From the Department of Family Medicine, University of Michigan, Ann Arbor, Michigan (PZ, MAP, KP, SR, JG, AM, MMM); Department of Family Medicine and Community Health, Oakland University William Beaumont School of Medicine, Rochester, Michigan (EM); Department of Otorhinolaryngology, University of Michigan, Ann Arbor, Michigan (PRK)
| | - Jenna Greenberg
- From the Department of Family Medicine, University of Michigan, Ann Arbor, Michigan (PZ, MAP, KP, SR, JG, AM, MMM); Department of Family Medicine and Community Health, Oakland University William Beaumont School of Medicine, Rochester, Michigan (EM); Department of Otorhinolaryngology, University of Michigan, Ann Arbor, Michigan (PRK)
| | - Anna McEvoy
- From the Department of Family Medicine, University of Michigan, Ann Arbor, Michigan (PZ, MAP, KP, SR, JG, AM, MMM); Department of Family Medicine and Community Health, Oakland University William Beaumont School of Medicine, Rochester, Michigan (EM); Department of Otorhinolaryngology, University of Michigan, Ann Arbor, Michigan (PRK)
| | - Paul R Kileny
- From the Department of Family Medicine, University of Michigan, Ann Arbor, Michigan (PZ, MAP, KP, SR, JG, AM, MMM); Department of Family Medicine and Community Health, Oakland University William Beaumont School of Medicine, Rochester, Michigan (EM); Department of Otorhinolaryngology, University of Michigan, Ann Arbor, Michigan (PRK)
| | - Michael M McKee
- From the Department of Family Medicine, University of Michigan, Ann Arbor, Michigan (PZ, MAP, KP, SR, JG, AM, MMM); Department of Family Medicine and Community Health, Oakland University William Beaumont School of Medicine, Rochester, Michigan (EM); Department of Otorhinolaryngology, University of Michigan, Ann Arbor, Michigan (PRK)
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McKee MM, Zhang J, Akobirshoev I, McKee KS, Mitra M. Antenatal emergency department and inpatient use among Massachusetts Deaf and Hard of Hearing Women: A Retrospective Cohort Study. Am J Perinatol 2023. [PMID: 36918163 DOI: 10.1055/a-2053-7439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Hearing loss is increasingly prevalent among younger adults, impacting health and health care use. Deaf and hard of hearing (DHH) women have a higher risk of chronic diseases, pregnancy complications and adverse birth outcomes compared to hearing women. Health care utilization patterns during the perinatal period, remains not well understood. The objective was to examine differences in antenatal emergency department and inpatient utilization among DHH and non-DHH women. STUDY DESIGN We conducted a retrospective cohort study design to analyze 2002-2013 Massachusetts Pregnancy to Early Life Longitudinal data to compare antenatal inpatient and emergency department use between DHH (N=925) and hearing (N=2895) women with singleton deliveries. Matching was done based on delivery year, age at delivery and birth parity in 1:3 case-control ratio. Demographic, socioeconomic, clinical and hospital characteristics were first compared for DHH mothers and the matched control group using chi-squared tests and t-tests. Multivariable models were adjusted for socio-demographic and clinical characteristics. RESULTS Among DHH women (N=925), 49% had at least one emergency department visit, 19% had an observational stay, and 14% had a non-delivery hospital stay compared to 26%, 14%, and 6%, respectively among hearing women (N=2895) during the antenatal period (all p<0.001). The risk of non-delivery emergency department visits (RR 1.58; p<0.001) and inpatient stays (RR 1.89; p<0.001) remained higher among DHH women compared to hearing women even after adjustment. Having four or more antenatal emergency department visits (7% vs. 2%) and two or more non-delivery hospital stays (4% vs. 0.4%) were more common among pregnant DHH women compared to their controls (all P<0.001). CONCLUSION(S) The findings demonstrate that DHH women use emergency departments and inpatient services at a significantly higher rate than their hearing controls during the antenatal period. A systematic investigation of the mechanisms for these findings are needed.
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Affiliation(s)
- Michael M McKee
- Family Medicine, University of Michigan Michigan Medicine, Ann Arbor, United States
| | - Jianying Zhang
- Lurie Institute for Disabilty Polciy, Brandeis University Heller School for Social Policy and Management, Waltham, United States
| | - Ilhom Akobirshoev
- Lurie Institute for Disabilty Polciy, Brandeis University Heller School for Social Policy and Management, Waltham, United States
| | | | - Monika Mitra
- Family Medicine, University of Michigan Michigan Medicine, Ann Arbor, United States
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11
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Meeks LM, McKee MM. Disability Training Needed to Increase Deaf and Hard-of-Hearing Representation in Academic Medicine. Acad Med 2023; 98:7. [PMID: 36576757 DOI: 10.1097/acm.0000000000005016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Lisa M Meeks
- Assistant professor of learning health sciences and family medicine, University of Michigan, and director of the DocsWithDisabilities Initiative, Ann Arbor, Michigan; ; Twitter: @meekslisa; ORCID: https://orcid.org/0000-0002-3647-3657
| | - Michael M McKee
- Associate professor of family medicine, and director of the MDisability Program, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-5561-9885
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12
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James TG, McKee MM. Technological Tools to Improve Communication in Patients With Hearing Loss. JAMA 2022; 328:2305-2306. [PMID: 36538323 DOI: 10.1001/jama.2022.22121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Tyler G James
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
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13
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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James TG, Helm KVT, Ratakonda S, Smith LD, Mitra M, McKee MM. Health Literacy and Difficulty Accessing Information About the COVID-19 Pandemic Among Parents Who Are Deaf and Hard-of-Hearing. Health Lit Res Pract 2022; 6:e310-e315. [PMID: 36475981 PMCID: PMC9726226 DOI: 10.3928/24748307-20221116-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
People who are deaf and hard-of-hearing (DHH) struggle with information marginalization and limited health literacy, challenging their ability to access information on preventing coronavirus disease 2019 (COVID-19). This study assessed the relationship between language preference, health literacy, and COVID-19 information barriers among parents who are DHH in the United States. Data were drawn from a larger study focused on individuals who are DHH who had given birth in the past 10 years. Respondents completed a web-based survey between March 2020 and July 2021. We segmented respondents by language preference [i.e., American Sign Language (ASL), English, or bilingual ASL/English] and used logistic regression models to test the hypothesis that language preference and health literacy were both associated with COVID-19 information marginalization. Of the total sample (N = 417), approximately 17% had limited health literacy, and 22% reported experiencing difficulty accessing information about COVID-19. In adjusted analyses, respondents with limited health literacy ([adjusted odds ratio] aOR = 2.245) and Hispanic ethnicity (aOR = 2.149) had higher risk of reporting information access barriers. There was no association between language preference and reporting COVID-19 information barriers. However, individuals who are DHH with limited health literacy were at higher risk of experiencing information marginalization during the ongoing COVID-19 pandemic, highlighting the need for tailored information based on access needs. [HLRP: Health Literacy Research and Practice. 2022;6(4):e310-e315.].
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Affiliation(s)
| | | | | | | | | | - Michael M. McKee
- Address correspondence to Michael M. McKee, MD, 1018 Fuller Street, Department of Family Medicine, University of Michigan, Ann Arbor, MI 48104;
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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Marzolf BA, McKee MM, Okanlami OO, Zazove P. Call to Action: Eliminate Barriers Faced by Medical Students With Disabilities. Ann Fam Med 2022; 20:376-378. [PMID: 35879081 PMCID: PMC9328715 DOI: 10.1370/afm.2824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 12/01/2021] [Accepted: 01/03/2022] [Indexed: 11/09/2022] Open
Abstract
When physicians have a disability or chronic condition, they can offer deeper insight and ability into managing the needs of patients with similar conditions. Yet an alarming 2021 survey found that only 40.7% of physicians feel confident that they provide the same level of care to people with disabilities (PWD) as those without. This may contribute to troubling health care disparities for the over 61 million Americans living with disabilities. In a recent report, The American Medical Association (AMA) recognized that increased concordance between patients and physicians with disabilities is key to resolving health care inequities for PWD, yet although 1 in 5 patients reports a disability, only 1 in 33 physicians identifies as such. This is because prospective medical students with disabilities face many barriers in medical education and practice. We call for specific changes to medical school admission processes and curricula to promote a more just and diverse workforce which includes more physicians with disabilities.
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Affiliation(s)
- Brianna A Marzolf
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Oluwaferanmi O Okanlami
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan.,Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Philip Zazove
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
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19
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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] [What about the content of this article? (0)] [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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20
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Bernard A, Weiss S, Rahman M, Ulin SS, D'Souza C, Salgat A, Panzer K, Stein JD, Meade MA, McKee MM, Ehrlich JR. The Impact of COVID-19 and Pandemic Mitigation Measures on Persons With Sensory Impairment. Am J Ophthalmol 2022; 234:49-58. [PMID: 34197781 PMCID: PMC8238639 DOI: 10.1016/j.ajo.2021.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To assess the impact of the COVID-19 pandemic and associated mitigation measures on persons with sensory impairments (SI), including visual impairments (VI) and hearing impairments (HI). DESIGN Cross-sectional survey. METHODS Adults with VI (best-corrected visual acuity <20/60 in the better-seeing eye), HI (International Classification of Diseases, Tenth Revision, codes), and age- and sex-matched controls (n = 375) were recruited from the University of Michigan. The 34-item Coronavirus Disability Survey was administered. Both χ2 tests and logistic regression were used to compare survey responses between groups. RESULTS All groups reported high levels of disruption of daily life, with 80% reporting "a fair amount" or "a lot" of disruption (VI: 76%, HI: 83%, CT: 82%, P = .33). Participants with VI had greater difficulty with day-to-day activities and were more likely to cite the following reasons: caregiver was worried about COVID-19 (odds ratio [OR]VI = 7.2, 95% CI = 3.5-14.4, P < .001) and decreased availability of public transportation (ORVI = 5.0, 95% CI = 1.5-15.6, P = .006). Participants with VI, but not HI, showed a trend toward increased difficulty accessing medical care (ORVI = 2.0, 95% CI = 0.99-4.0, P = .052) and began relying more on others for day-to-day assistance (ORVI = 3.1, 95% CI = 1.6-5.7, P < .001). Overall, 30% reported difficulty obtaining trusted information about the pandemic. Those with VI reported more difficulty seeing or hearing trusted information (ORVI = 6.1, 95% CI = 1.6-22.1, P = .006). Employed participants with HI were more likely to report a reduction in wages (ORHI = 2.5, 95% CI = 1.2-5.3, P = .02). CONCLUSIONS Individuals with VI have experienced increased disruption and challenges in daily activities related to the pandemic. People with SI may benefit from targeted policy approaches to the current pandemic and future stressors. Minimal differences in some survey measures may be due to the large impact of the pandemic on the population as a whole. The SARS-CoV-2 (COVID-19) pandemic and public health mitigation measures have had an exceedingly large impact around the globe. As of the time of writing, more than 114 million global cases (28 million US) had been diagnosed, and there had been more than 2.5 million fatalities attributed to COVID-19 (517,000 US).1,2.
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Affiliation(s)
- Alec Bernard
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sara Weiss
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Moshiur Rahman
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Sheryl S Ulin
- Center for Ergonomics, Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Clive D'Souza
- Center for Ergonomics, Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Anah Salgat
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kate Panzer
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Joshua D Stein
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA; Department Health Policy and Management, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle A Meade
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA; Center for Disability Health and Wellness, University of Michigan, Ann Arbor, Michigan, USA; Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA; Center for Disability Health and Wellness, University of Michigan, Ann Arbor, Michigan, USA
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA; Center for Disability Health and Wellness, University of Michigan, Ann Arbor, Michigan, USA; Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA; Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.
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21
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Akobirshoev I, McKee MM, Reif S, Adams RS, Li FS, Mitra M. Opioid Use Disorder-Related Emergency Department Visits Among Deaf or Hard of Hearing Adults in the United States. Disabil Health J 2022; 15:101291. [DOI: 10.1016/j.dhjo.2022.101291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 11/03/2022]
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22
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James TG, Coady KA, Stacciarini JMR, McKee MM, Phillips DG, Maruca D, Cheong J. "They're Not Willing To Accommodate Deaf patients": Communication Experiences of Deaf American Sign Language Users in the Emergency Department. Qual Health Res 2022; 32:48-63. [PMID: 34823402 DOI: 10.1177/10497323211046238] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Deaf people who use American Sign Language (ASL) are more likely to use the emergency department (ED) than their hearing English-speaking counterparts and are also at higher risk of receiving inaccessible communication. The purpose of this study is to explore the ED communication experience of Deaf patients. A descriptive qualitative study was performed by interviewing 11 Deaf people who had used the ED in the past 2 years. Applying a descriptive thematic analysis, we developed five themes: (1) requesting communication access can be stressful, frustrating, and time-consuming; (2) perspectives and experiences with Video Remote Interpreting (VRI); (3) expectations, benefits, and drawbacks of using on-site ASL interpreters; (4) written and oral communication provides insufficient information to Deaf patients; and (5) ED staff and providers lack cultural sensitivity and awareness towards Deaf patients. Findings are discussed with respect to medical and interpreting ethics to improve ED communication for Deaf patients.
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Affiliation(s)
- Tyler G James
- Department of Health Education and Behavior, 3463University of Florida, Gainesville, FL, USA
| | - Kyle A Coady
- Department of Health Education and Behavior, 3463University of Florida, Gainesville, FL, USA
| | - Jeanne-Marie R Stacciarini
- Department of Family, Community and Health System Science, College of Nursing, 3463University of Florida, Gainesville, FL, USA
| | - Michael M McKee
- Department of Family Medicine, 12266University of Michigan, Ann Arbor, MI, USA
| | | | | | - JeeWon Cheong
- Department of Health Education and Behavior, 3463University of Florida, Gainesville, FL, USA
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23
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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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24
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James TG, Sullivan MK, Butler JD, McKee MM. Promoting health equity for deaf patients through the electronic health record. J Am Med Inform Assoc 2021; 29:213-216. [PMID: 34741507 DOI: 10.1093/jamia/ocab239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 11/14/2022] Open
Abstract
Language status can be conceptualized as an equity-relevant variable, particularly for non-English-speaking populations. Deaf and hard-of-hearing (DHH) individuals who use American Sign Language (ASL) to communicate comprise one such group and are understudied in health services research. DHH individuals are at high-risk of receiving lower-quality care due to ineffective patient-provider communication. This perspective outlines barriers to health equity research serving DHH ASL-users due to systems developed by large-scale informatics networks (eg, the Patient-Centered Clinical Outcomes Research Network), and institutional policies on self-serve cohort discovery tools. We list potential to help adequate capture of language status of DHH ASL-users to promote health equity for this population.
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Affiliation(s)
- Tyler G James
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Health Education and Behavior, University of Florida, Gainesville, Florida, USA
| | | | - Joshua D Butler
- Clinical and Translational Sciences Institute, University of Rochester Medical Center, Rochester, New York, USA
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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25
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Eysenbach G, Cuculick J, Hauser PC, Wyse K, McKee MM. Using Gaze Tracking as a Research Tool in the Deaf Health Literacy and Access to Health Information Project: Protocol for a Multisite Mixed Methods Study and Preliminary Results. JMIR Res Protoc 2021; 10:e26708. [PMID: 34491211 PMCID: PMC8456339 DOI: 10.2196/26708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Previous studies have identified the internet as a major source of health information. Reliable and accessible sources of web-based health information are critical for cultivating patient-centered care. However, the accessibility and use of web-based health information remains largely unknown for deaf individuals. We used gaze-tracking technology to understand the navigation and use of web-based health information by deaf adults who communicate with sign language and by hearing adults. OBJECTIVE This paper discusses our protocol for implementing gaze-tracking technology in a study that included both deaf and hearing participants. We report the preliminary results and lessons learned from the implementation of the protocol. METHODS We conducted gaze-tracking sessions with 450 deaf signers and 450 hearing participants as a part of a larger, multisite mixed methods research study. Then, we conducted qualitative elicitation interviews with a subsample of 21 deaf and 13 hearing participants, who engaged in a search task and reviewed their gaze recordings. To our knowledge, no study has implemented a similar research protocol to better understand the experiences of deaf adults. As such, we also examined research staff notes and observations from team meetings regarding the conduct of gaze-tracking data to delineate lessons learned and best practices for research protocols in this area. RESULTS Findings from the implementation of this study protocol highlight the use of gaze technology with deaf participants. We developed additional protocol steps to minimize gaze disruption from either lipreading or communicating in sign language. For example, research assistants were often unable to maintain eye contact with participants while signing because of the need to simultaneously point at the computer monitor to provide instructions related to gaze study components, such as the calibration process. In addition to developing ways to effectively provide instructions in American Sign Language, a practice exercise was included in the gaze tracker session to familiarize participants with the computer and technology. The use of the playback feature permitted a deeper dialogue between researchers and participants, which we found vital for understanding the experiences of deaf participants. CONCLUSIONS On the basis of our experience using the study protocol through a large research project, incorporating gaze-tracking technology offers beneficial avenues for better understanding how individuals interact with health information. Gaze tracking can determine the type and placement of visual content that attracts attention from the viewers of diverse backgrounds, including deaf individuals. The lessons learned through this study will help future researchers in determining ideal study designs, such as suitable protocols and participant characteristics (eg, deaf signers), while including gaze trackers in their projects. This approach explored how different ways of presenting health information can affect or enable visual learners to engage and use health information effectively. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/26708.
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Affiliation(s)
| | - Jessica Cuculick
- Department of Liberal Studies, National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY, United States.,Research Center on Culture and Language, National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY, United States
| | - Peter C Hauser
- Research Center on Culture and Language, National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY, United States
| | - Kelley Wyse
- Family Medicine Department, The University of Michigan, Ann Arbor, MI, United States
| | - Michael M McKee
- Family Medicine Department, The University of Michigan, Ann Arbor, MI, United States
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26
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Assi L, Ehrlich JR, Zhou Y, Huang A, Kasper J, Lin FR, McKee MM, Reed NS, Swenor BK, Deal JA. Self-reported dual sensory impairment, dementia, and functional limitations in Medicare beneficiaries. J Am Geriatr Soc 2021; 69:3557-3567. [PMID: 34478566 PMCID: PMC8648982 DOI: 10.1111/jgs.17448] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Vision and hearing impairments often co-exist with dementia, and all are independently associated with limitations in daily activities. Our aim was to examine the association of dual sensory impairment with functional limitations, and further examine the combined estimated association of sensory impairment and dementia with these functional limitations. METHODS Cross-sectional analysis of the National Health and Aging Trends Study (NHATS), a population-based cohort of Medicare beneficiaries, was performed. Participants were selected from the 2015 round. Survey weighted Poisson regression models adjusted for dementia, demographics, and health status variables examined the association of self-reported dual sensory impairment (no sensory impairment, single sensory impairment, dual sensory impairment) with scores of limitations in mobility, self-care, and household activities. Models were repeated to take into account the combined effects of dual sensory impairment and dementia. RESULTS Overall, 7124 participants representative of Medicare beneficiaries 65 years or older were included. Of them, 43.9% were 75 years or older and 55.3% were female. Older adults with dual sensory impairment had greater limitations with mobility (prevalence rate ratio [PRR] = 1.45, 95% CI = 1.28-1.63), self-care (PRR = 1.41, 95% CI = 1.25-1.59), and household activities (PRR = 1.54, 95% CI = 1.37-1.72) compared with those without sensory impairment. They also had greater limitations than those with a single sensory impairment across the different activity categories. In models taking into account the combined estimated effect of both sensory impairment and dementia, those with dual sensory impairment and dementia had greater limitations than those without sensory impairment or dementia in each category (mobility: PRR = 1.85, 95% CI = 1.59-2.14, self-care: PRR = 1.86, 95% CI = 1.59-2.18, household: PRR = 2.41, 95% CI = 2.09-2.77). CONCLUSIONS Older adults with dual sensory impairment had greater functional limitations compared with those without sensory impairment and those with a single sensory impairment. Strategies to improve visual and/or hearing function (e.g., sensory aids, rehabilitation) could potentially help prevent or minimize disability, even among those with dementia.
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Affiliation(s)
- Lama Assi
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Department of Ophthalmology, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Joshua R. Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI,Institute for Social Research, University of Michigan Medical School, Ann Arbor, MI
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Alison Huang
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Judith Kasper
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Frank R. Lin
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michael M. McKee
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI,Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Nicholas S. Reed
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,The Disability Health Research Center, Johns Hopkins Bloomberg University, Baltimore, MD
| | - Bonnielin K Swenor
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,The Disability Health Research Center, Johns Hopkins Bloomberg University, Baltimore, MD,The Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD
| | - Jennifer A. Deal
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,The Disability Health Research Center, Johns Hopkins Bloomberg University, Baltimore, MD
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27
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DeJonckheere M, McKee MM, Guetterman TC, Schleicher LS, Mulhem E, Panzer K, Bradley K, Plegue MA, Rapai ME, Green LA, Zazove P. Implementation of a Hearing Loss Screening Intervention in Primary Care. Ann Fam Med 2021; 19:388-395. [PMID: 34546945 PMCID: PMC8437567 DOI: 10.1370/afm.2695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/16/2020] [Accepted: 12/03/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Hearing loss (HL) is underdiagnosed and often unaddressed. A recent study of screening for HL using an electronic prompt showed efficacy in increasing appropriate referrals for subsequent testing. We build on the results of this study using a qualitative lens to explore implementation processes through the perspectives of family medicine clinicians. METHODS We collected clinic observations and semistructured interviews of family medicine clinicians and residents who interacted with the HL prompt. All data were analyzed using thematic, framework, and mixed methods integration strategies. RESULTS We interviewed 27 clinicians and conducted 10 observations. Thematic analysis resulted in 6 themes: (1) the prompt was overwhelmingly viewed as easy, simple to use, accurate; (2) clinicians considered prompt as an effective way to increase awareness and conversations with patients about HL; (3) clinician and staff buy-in played a vital role in implementation; (4) clinicians prioritized prompt during annual visits; (5) medical assistant involvement in prompt workflow varied by health system, clinic, and clinician; (6) prompt resulted in more conversations about HL, but uncertain impact on patient outcomes. Themes are presented alongside constructs of normalization process theory and intervention outcomes. CONCLUSION Integration of a HL screening prompt into clinical practice varied by clinician buy-in and beliefs about the impact on patient outcomes, involvement of medical assistants, and prioritization during clinical visits. Further research is needed to understand how to leverage clinician and staff buy-in and whether implementation of a new clinical prompt has sustained impact on HL screening and patient outcomes.
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Affiliation(s)
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | | | | | - Elie Mulhem
- Department of Family Medicine and Community Health, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | | | - Kathleen Bradley
- Department of Family Medicine and Community Health, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Mary E Rapai
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lee A Green
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Philip Zazove
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
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28
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James TG, McKee MM, Sullivan MK, Ashton G, Hardy SJ, Santiago Y, Phillips DG, Cheong J. Community-Engaged Needs Assessment of Deaf American Sign Language Users in Florida, 2018. Public Health Rep 2021; 137:730-738. [PMID: 34161191 DOI: 10.1177/00333549211026782] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Deaf American Sign Language (ASL) users comprise a linguistic and cultural minority group that is understudied and underserved in health education and health care research. We examined differences in health risk behaviors, concerns, and access to health care among Deaf ASL users and hearing English speakers living in Florida. METHODS We applied community-engaged research methods to develop and administer the first linguistically accessible and contextually tailored community health needs assessment to Deaf ASL users living in Florida. Deaf ASL users (n = 92) were recruited during a 3-month period in summer 2018 and compared with a subset of data on hearing English speakers from the 2018 Florida Behavioral Risk Factor Surveillance System (n = 12 589). We explored prevalence and adjusted odds of health behavior, including substance use and health care use. RESULTS Mental health was the top health concern among Deaf participants; 15.5% of participants screened as likely having a depressive disorder. Deaf people were 1.8 times more likely than hearing people to engage in binge drinking during the past month. In addition, 37.2% of participants reported being denied an interpreter in a medical facility in the past 12 months. CONCLUSION This study highlights the need to work with Deaf ASL users to develop context-specific health education and health promotion activities tailored to their linguistic and cultural needs and ensure that they receive accessible health care and health education.
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Affiliation(s)
- Tyler G James
- 3463 Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Michael M McKee
- 21614 Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Meagan K Sullivan
- 12234 Florida Disability and Health Program, Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, FL, USA
| | - Glenna Ashton
- Deaf Community Advisory Workgroup, Gainesville, FL, USA
| | - Stephen J Hardy
- Deaf Community Advisory Workgroup, Gainesville, FL, USA.,Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | - Yary Santiago
- Deaf Community Advisory Workgroup, Gainesville, FL, USA.,Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | | | - JeeWon Cheong
- 3463 Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
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29
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Affiliation(s)
- Megan H Pesch
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Katie Kuboushek
- Department of Otolaryngology and Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Michigan, Ann Arbor, MI, USA
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Marc C Thorne
- Department of Otolaryngology and Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Michigan, Ann Arbor, MI, USA
| | - Jason B Weinberg
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Michigan, Ann Arbor, MI, USA
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30
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Mitra M, McKee MM, Akobirshoev I, Ritter GA, Valentine AM. Pregnancy and Neonatal Outcomes Among Deaf or Hard of Hearing Women: Results From Nationally Representative Data. Womens Health Issues 2021; 31:470-477. [PMID: 33888398 DOI: 10.1016/j.whi.2021.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 01/05/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although the literature suggests that women with disabilities are at increased risk for pregnancy complications and adverse birth outcomes, there are few population-based studies of the pregnancy outcomes among deaf and hard of hearing (DHH) women in the United States. OBJECTIVE To compare pregnancy complications and neonatal outcomes between deliveries to DHH and non-DHH women using national hospitalization discharge record data. STUDY DESIGN We used the 2007-2016 Healthcare Cost and Utilization Project National Inpatient Sample to compare pregnancy complications and outcomes among deliveries to DHH women with deliveries to non-DHH women using bivariate and Poisson regressions, controlling for sociodemographic, hospital, and clinical characteristics. RESULTS DHH women had an increased risk of adverse pregnancy outcomes and chronic medical conditions, including preexisting diabetes (relative risk [RR], 2.01; 95% confidence interval, 1.68-2.42; p < .001), gestational diabetes (RR, 1.31; 95% CI, 1.19-1.44; p < .001), chronic hypertension (RR, 1.51; 95% CI, 1.33-1.72; p < .001), preeclampsia and eclampsia (RR, 1.35; 95% CI, 1.21-1.51; p < .01), placenta previa (RR, 1.62; 95% CI, 1.22-2.16; p < .01), placental abruption (RR, 1.43; 95% confidence interval, 1.15-1.78; p < .01), labor induction (RR, 1.16; 95% CI, 1.05-1.27; p < .01), chorioamnionitis (RR, 1.43; 95% CI, 1.22-1.69; p < .001), cesarean delivery (RR, 1.09; 95% CI, 1.04-1.14; p < .001), premature rupture of membranes (RR, 1.34; 95% CI, 1.20-1.50; p < .001), antepartum hemorrhage (RR, 1.36; 95% CI, 1.13-1.64; p < .001), and postpartum hemorrhage (RR, 1.30; 95% CI, 1.13-1.49; p < .001). After adjustment for socioeconomic and hospital characteristics, the risk for gestational diabetes, preeclampsia and eclampsia, placenta previa, and chorioamnionitis remained unexplained. CONCLUSIONS DHH women are at an increased risk for adverse pregnancy, fetal, and neonatal outcomes, illuminating the need for awareness among obstetric and primary care providers as well as the need for systematic investigation of outcomes and evidence-based guidelines.
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Affiliation(s)
- Monika Mitra
- The Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, 02453.
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ilhom Akobirshoev
- The Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, 02453
| | - Grant A Ritter
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Anne M Valentine
- The Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, 02453
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31
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Abstract
Hearing loss (HL) is common among individuals aged 50 and older and is associated with increased healthcare costs. Whether HL is associated with less access to healthcare is unclear. In this study, we examined the association between HL and access to medical care and prescription drugs among individuals 50+ with and without HL. We used nationally representative 2013-2014 Medical Expenditure Panel Survey data, consisting of 1,977 adults with HL and 17,399 without. We applied an inverse propensity score weighting and regression modeling to adjust for any potential differences in health and socioeconomic conditions between the two groups. Adults with HL were more likely to be white, less educated, poorer, and with public insurance ( p < 0.001). They were also likely to have hypertension, heart disease, stroke, emphysema, high cholesterol, diabetes, joint pain, and arthritis ( p < 0.001). The odds of reporting unmet medical needs (odds ratio [OR] = 1.85; 95% confidence interval [CI] = 1.29-2.66), delay in getting medical needs met (OR = 1.37; 95% CI = 1.00-1.87), and having unfilled prescriptions (OR = 1.81; 95% CI = 1.27-2.59) were higher among individuals with HL compared with their counterparts without HL. Individuals with HL have less access to care and prescription drugs. To ensure equitability in access, public health policies should address specific needs of people with HL.
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Affiliation(s)
- Elham Mahmoudi
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Philip Zazove
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Terrence Pleasant
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Lisa Meeks
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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32
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Kuo PL, Huang AR, Ehrlich JR, Kasper J, Lin FR, McKee MM, Reed NS, Swenor BK, Deal JA. Prevalence of Concurrent Functional Vision and Hearing Impairment and Association With Dementia in Community-Dwelling Medicare Beneficiaries. JAMA Netw Open 2021; 4:e211558. [PMID: 33739429 PMCID: PMC8601132 DOI: 10.1001/jamanetworkopen.2021.1558] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Impairments in vision or hearing are common and have been independently linked to higher risk of dementia in older adults. There is a limited understanding of the prevalence of concurrent functional vision and hearing impairment (dual sensory impairment) and its contribution to dementia risk. OBJECTIVE To examine the age-specific prevalence of functional dual sensory impairment among older adults, and to investigate the cross-sectional and 7-year longitudinal associations between functional dual sensory impairment and dementia. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 7562 older adults used data from the US National Health and Aging Trends Study (NHATS), a nationally representative cohort study of community-dwelling, Medicare beneficiaries aged 65 years and older in the US. Participants in the study with complete data on hearing, vision, and dementia were included in analysis. Data were collected between 2011 and 2018, and between March 2018 and May 2020. EXPOSURES Self-reported functional sensory impairments (ie, no sensory impairment, functional vision impairment only, functional hearing impairment only, and functional dual sensory impairment). MAIN OUTCOMES AND MEASURES Age-specific prevalence of functional sensory impairments was calculated. Generalized linear regression with a complementary log-log link and a discrete time proportional hazards model with a complementary log-log link were used to assess the cross-sectional and 7-year longitudinal hazard of dementia. RESULTS Of 7562 participants, 3073 (40.7%) were ages 80 years or older and 4411 (58.3%) were women. Overall, 5.4% (95% CI, 4.7%-6.1%) of participants reported functional vision impairment only, 18.9% (95% CI, 18.9%-17.8%) reported functional hearing impairment only, and 3.1% (95% CI, 2.7%-3.5%) reported functional dual sensory impairment (prevalence estimates are weighted). Participants reporting sensory impairments were older (no impairment: age ≥90 years, 2.12% [95% CI, 1.79%-2.46%] vs functional dual sensory impairment: age ≥90 years, 20.06% [95% CI, 16.02%-24.10%]), had lower education (no impairment: <high school, 19.05% [95% CI, 17.27%-20.83%] vs functional dual sensory impairment: <high school, 46.15% [95% CI, 38.38%-53.92%]), and greater disease burden (eg, heart disease: no impairment, 15.30% [95% CI, 14.04%-16.55%] vs functional dual sensory impairment, 25.49% [95% CI, 19.96%-31.02%]). Compared with no impairment, functional vision impairment (adjusted hazard ratio [aHR], 1.89; 95% CI, 1.57-2.28), functional hearing impairment (aHR, 1.14; 95% CI, 1.00-1.31), and functional dual sensory impairment (aHR, 2.00; 95% CI, 1.57-2.53) were associated with a higher cross-sectional hazard of dementia. Over 7 years, functional vision impairment (aHR, 1.40; 95% CI, 1.12-1.74), functional hearing impairment (aHR, 1.09; 95% CI, 0.95-1.24), and functional dual sensory impairment (aHR, 1.50; 95% CI, 1.12-2.02) were associated with a higher hazard of incident dementia compared with no impairment. CONCLUSIONS AND RELEVANCE In this cohort study of US Medicare beneficiaries, dual sensory impairment was prevalent in older adults and associated with increased risk of dementia. These findings suggest that sensory rehabilitative interventions for multiple impairments may be an additional resource in efforts to reduce dementia risk.
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Affiliation(s)
- Pei-Lun Kuo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alison R. Huang
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joshua R. Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Judith Kasper
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Frank R. Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael M. McKee
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | - Nicholas S. Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Disability Health Research Center, Johns Hopkins Bloomberg University, Baltimore, Maryland
| | - Bonnielin K. Swenor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Disability Health Research Center, Johns Hopkins Bloomberg University, Baltimore, Maryland
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Disability Health Research Center, Johns Hopkins Bloomberg University, Baltimore, Maryland
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33
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Zazove P, Plegue MA, McKee MM, DeJonckheere M, Kileny PR, Schleicher LS, Green LA, Sen A, Rapai ME, Mulhem E. Effective Hearing Loss Screening in Primary Care: The Early Auditory Referral-Primary Care Study. Ann Fam Med 2020; 18:520-527. [PMID: 33168680 PMCID: PMC7708285 DOI: 10.1370/afm.2590] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Hearing loss, the second most common disability in the United States, is under-diagnosed and under-treated. Identifying it in early stages could prevent its known substantial adverse outcomes. METHODS A multiple baseline design was implemented to assess a screening paradigm for identifying and referring patients aged ≥55 years with hearing loss at 10 family medicine clinics in 2 health systems. Patients completed a consent form and the Hearing Handicap Inventory for the Elderly (HHI). An electronic alert prompted clinicians to screen for hearing loss during visits. RESULTS The 14,877 eligible patients during the study period had 36,701 encounters. Referral rates in the family medicine clinics increased from a baseline rate of 3.2% to 14.4% in 1 health system and from a baseline rate of 0.7% to 4.7% in the other. A general medicine comparison group showed referral rate increase from the 3.0% baseline rate to 3.3%. Of the 5,883 study patients who completed the HHI 25.2% (n=1,484) had HHI scores suggestive of hearing loss; those patients had higher referral rates, 28% vs 9.2% (P <.001). Of 1,660 patients referred for hearing testing, 717 had audiology data available for analysis: 669 (93.3%) were rated appropriately referred and 421 (58.7%) were considered hearing aid candidates. Overall, 71.5% of patients contacted felt their referral was appropriate. CONCLUSION An electronic alert used to remind clinicians to ask patients aged ≥55 years about hearing loss significantly increased audiology referrals for at-risk patients. Audiologic and audiogram data support the effectiveness of the prompt. Clinicians should consider adopting this method to identify patients with hearing loss to reduce its known and adverse sequelae.
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Affiliation(s)
- Philip Zazove
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Paul R Kileny
- Otorhinolaryngology Department, University of Michigan, Ann Arbor, Michigan
| | | | - Lee A Green
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ananda Sen
- Department of Family Medicine and Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Mary E Rapai
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Elie Mulhem
- Department of Family Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan
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McKee MM, Choi H, Wilson S, DeJonckheere MJ, Zazove P, Levy H. Determinants of Hearing Aid Use Among Older Americans With Hearing Loss. Gerontologist 2020; 59:1171-1181. [PMID: 29788270 DOI: 10.1093/geront/gny051] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Hearing loss (HL) is common among older adults and is associated with significant psychosocial, cognitive, and physical sequelae. Hearing aids (HA) can help, but not all individuals with HL use them. This study examines how social determinants may impact HA use. RESEARCH DESIGN AND METHODS We conducted an explanatory sequential mixed methods study involving a secondary analysis of a nationally representative data set, the Health and Retirement Study (HRS; n = 35,572). This was followed up with 1:1 qualitative interviews (n = 21) with community participants to clarify our findings. Both samples included individuals aged 55 and older with a self-reported HL, with or without HA. The main outcome measure was the proportion of participants with a self-reported HL who use HA. RESULTS AND DISCUSSION Analysis of HRS data indicated that younger, nonwhite, non-Hispanic, lower income, and less-educated individuals were significantly less likely to use HA than their referent groups (all p values < .001). Area of residence (e.g., urban) were not significantly associated with HA use. Qualitative findings revealed barriers to HA included cost, stigma, vanity, and a general low priority placed on addressing HL by health care providers. Facilitators to obtaining and using HA included family/friend support, knowledge, and adequate insurance coverage for HA. IMPLICATIONS Many socioeconomic factors hinder individuals' ability to obtain and use HA, but these obstacles appeared to be mitigated in part when insurance plans provided adequate HA coverage, or when their family/friends provided encouragement to use HA.
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Affiliation(s)
- Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | - HwaJung Choi
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Shelby Wilson
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | | | - Philip Zazove
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | - Helen Levy
- Institute for Social Research, School of Public Health, University of Michigan, Ann Arbor.,Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor
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35
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Mitra M, McKee MM, Akobirshoev I, Valentine A, Ritter G, Zhang J, McKee K, Iezzoni LI. Pregnancy, Birth, and Infant Outcomes Among Women Who Are Deaf or Hard of Hearing. Am J Prev Med 2020; 58:418-426. [PMID: 31952943 PMCID: PMC7039738 DOI: 10.1016/j.amepre.2019.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Being deaf or hard of hearing can be marginalizing and associated with inequitable health outcomes. Until recently, there were no U.S. population-based studies of pregnancy outcomes among deaf or hard of hearing women. In light of inconsistent findings in the limited available literature, this study sought to conduct a more rigorous study using population-based, longitudinal linked data to compare pregnancy complications, birth characteristics, and neonatal outcomes between deaf or hard of hearing and non-deaf or hard of hearing women. METHODS Researchers conducted a retrospective cohort study in 2019 using the Massachusetts Pregnancy to Early Life Longitudinal data system. This system links all Massachusetts birth certificates, fetal death reports, and delivery- and nondelivery-related hospital discharge records for all infants and their mothers. The study included women with singleton deliveries who gave birth in Massachusetts between January 1998 and December 2013. RESULTS The deaf or hard of hearing women had an increased risk of chronic medical conditions and pregnancy complications including pre-existing diabetes, gestational diabetes, pre-eclampsia and eclampsia, and placental abruption. Deliveries to deaf or hard of hearing women were significantly associated with adverse birth outcomes, including preterm birth, low birth weight or very low weight, and low 1-minute Apgar score or low 5-minute Apgar score. No significant differences were found in size for gestational age, fetal distress, or stillbirth among deaf or hard of hearing women. CONCLUSIONS Findings from this 2019 study indicate that deaf or hard of hearing women are at a heightened risk for chronic conditions, pregnancy-related complications, and adverse birth outcomes and underscore the need for systematic investigation of the pregnancy- and neonatal-related risks, complications, costs, mechanisms, and outcomes of deaf or hard of hearing women.
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Affiliation(s)
- Monika Mitra
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts.
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ilhom Akobirshoev
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts
| | - Anne Valentine
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts
| | - Grant Ritter
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Jianying Zhang
- Statistician Consultant to the Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts
| | - Kimberly McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Lisa I Iezzoni
- The Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
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McKee MM, Hauser PC, Champlin S, Paasche-Orlow M, Wyse K, Cuculick J, Buis LR, Plegue M, Sen A, Fetters MD. Deaf Adults' Health Literacy and Access to Health Information: Protocol for a Multicenter Mixed Methods Study. JMIR Res Protoc 2019; 8:e14889. [PMID: 31599730 PMCID: PMC6812478 DOI: 10.2196/14889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 01/26/2023] Open
Abstract
Background Deaf American Sign Language (ASL) users often struggle with limited health literacy compared with their hearing peers. However, the mechanisms driving limited health literacy and how this may impact access to and understanding of health information for Deaf individuals have not been determined. Deaf individuals are more likely than hearing individuals to use the internet, yet they continue to report significant barriers to health information. This study presents an opportunity to identify key targets that impact information access for a largely marginalized population. Objective This study aims to elucidate the role of information marginalization on health literacy in Deaf ASL users and to better understand the mechanisms of health literacy in this population for the purpose of identifying viable targets for future health literacy interventions. Methods This is an exploratory mixed methods study to identify predictors and moderators of health literacy in the Deaf population. These predictors of health literacy will be used to inform the second step that qualitatively explains the findings, including how Deaf individuals access and understand Web-based health information. Multiple interviewer- and computer-based instruments underwent translation and adaptation, from English to ASL, to make them accessible for the Deaf participants in our study. A planned sample of 450 Deaf ASL users and 450 hearing native English speakers, aged 18 to 70 years, will be recruited from 3 partnering sites: Rochester, NY; Flint, MI; and Chicago, IL. These individuals will participate in a single data collection visit. A subset of participants (approximately 30) with key characteristics of interest will be invited for a second data collection visit to observe and inquire more about their ability to directly access, navigate, and comprehend Web-based health information. The study will help assess how the ways health literacy and information are visualized may differ between Deaf individuals and hearing individuals. The study will also survey participants’ ownership and use of computer and mobile devices and their level of Web-based information use, including health information. Results Adaptation and translation of protocols and instruments have been completed and are now in use for the study. Recruitment is underway and will continue until late 2020. Results from this study will be used to provide a guide on how to structure Web-based health information in a way that maximizes accessibility and improves health literacy for Deaf individuals. Conclusions The results from this mixed methods proposal will advance what is known about health literacy and health information accessibility for Deaf individuals. This innovative study will generate rich data on how to formulate health information and health literacy interventions more accurately to take advantage of visual learning skills. International Registered Report Identifier (IRRID) PRR1-10.2196/14889
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Affiliation(s)
- Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Peter C Hauser
- Department of American Sign Language and Interpreter Education, Rochester Institute of Technology, Rochester, NY, United States
| | - Sara Champlin
- Mayborn School of Journalism, University of North Texas, Denton, TX, United States
| | | | - Kelley Wyse
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Jessica Cuculick
- Center on Cognition and Language, National Technical Institute for Deaf, Rochester Institute of Technology, Rochester, NY, United States
| | - Lorraine R Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Melissa Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
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Mahmoudi E, Zazove P, Meade M, McKee MM. Association Between Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss. JAMA Otolaryngol Head Neck Surg 2019; 144:498-505. [PMID: 29710214 DOI: 10.1001/jamaoto.2018.0273] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Hearing loss (HL) is common among older adults and is associated with poorer health and impeded communication. Hearing aids (HAs), while helpful in addressing some of the outcomes of HL, are not covered by Medicare. Objective To determine whether HA use is associated with health care costs and utilization in older adults. Design, Setting, and Participants This retrospective cohort study used nationally representative 2013-2014 Medical Expenditure Panel Survey data to evaluate the use of HAs among 1336 adults aged 65 years or older with HL. An inverse propensity score weighting was applied to adjust for potential selection bias between older adults with and without HAs, all of whom reported having HL. The mean treatment outcomes of HA use on health care utilization and costs were estimated. Exposures Encounter with the US health care system. Main Outcomes and Measures (1) Total health care, Medicare, and out-of-pocket spending; (2) any emergency department (ED), inpatient, and office visit; and (3) number of ED visits, nights in hospital, and office visits. Results Of the 1336 individuals included in the study, 574 (43.0%) were women; mean (SD) age was 77 (7) years. Adults without HAs (n = 734) were less educated, had lower income, and were more likely to be from minority subpopulations. The mean treatment outcomes of using HAs per participant were (1) higher total annual health care spending by $1125 (95% CI, $1114 to $1137) and higher out-of-pocket spending by $325 (95% CI, $322 to $326) but lower Medicare spending by $71 (95% CI, -$81 to -$62); (2) lower probability of any ED visit by 2 percentage points (PPs) (24% vs 26%; 95% CI, -2% to -2%) and lower probability of any hospitalization by 2 PPs (20% vs 22%; 95% CI, -3% to -1%) but higher probability of any office visit by 4 PPs (96% vs 92%; 95% CI, 4% to 4%); and (3) 1.40 more office visits (95% CI, 1.39 to 1.41) but 0.46 (5%) fewer number of hospital nights (95% CI, -0.47 to -0.44), with no association with the number of ED visits, if any (95% CI, 0.01 to 0). Conclusions and Relevance This study demonstrates the beneficial outcomes of use of HAs in reducing the probability of any ED visits and any hospitalizations and in reducing the number of nights in the hospital. Although use of HAs reduced total Medicare costs, it significantly increased total and out-of-pocket health care spending. This information may have implications for Medicare regarding covering HAs for patients with HL.
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Affiliation(s)
- Elham Mahmoudi
- Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Philip Zazove
- Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Michelle Meade
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.,Department of Physical Medicine & Rehabilitation, School of Medicine, University of Michigan, Ann Arbor
| | - Michael M McKee
- Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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Mahmoudi E, Basu T, Langa K, McKee MM, Zazove P, Alexander N, Kamdar N. Can Hearing Aids Delay Time to Diagnosis of Dementia, Depression, or Falls in Older Adults? J Am Geriatr Soc 2019; 67:2362-2369. [PMID: 31486068 DOI: 10.1111/jgs.16109] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To examine the association between hearing aids (HAs) and time to diagnosis of Alzheimer disease (AD) or dementia, anxiety or depression, and injurious falls among adults, aged 66 years and older, within 3 years of hearing loss (HL) diagnosis. DESIGN Retrospective cohort study. SETTING We used 2008 to 2016 national longitudinal claims data (based on office visit, inpatient, or outpatient healthcare encounters) from a large private payer. We used Kaplan-Meier curves to examine unadjusted disease-free survival and crude and adjusted Cox regression models to examine associations between HAs and time to diagnosis of three age-related/HL-associated conditions within 3 years of HL diagnosis. All models were adjusted for age, sex, race/ethnicity, census divisions, and prior diagnosis of cardiovascular conditions, hypertension, hypercholesterolemia, obesity, and diabetes. PARTICIPANTS The participants included 114 862 adults, aged 66 years and older, diagnosed with HL. MEASUREMENT Diagnosis of (1) AD or dementia; (2) depression or anxiety; and (3) injurious falls. INTERVENTION Use of HAs. RESULTS Large sex and racial/ethnic differences exist in HA use. Approximately 11.3% of women vs 13.3% of men used HAs (95% confidence interval [CI] difference = -0.024 to -0.016). Approximately 13.6% of whites (95% CI = 0.13-0.14) vs 9.8% of blacks (95% CI = 0.09-0.11) and 6.5% of Hispanics (95% CI = 0.06-0.07) used HAs. The risk-adjusted hazard ratios of being diagnosed with AD/dementia, anxiety/depression, and injurious falls within 3 years after HL diagnosis, for those who used HAs vs those who did not, were 0.82 (95% CI = 0.76-0.89), 0.89 (95% CI = 0.86-0.93), and 0.87 (95% CI = 0.80-0.95), respectively. CONCLUSIONS Use of HAs is associated with delayed diagnosis of AD, dementia, depression, anxiety, and injurious falls among older adults with HL. Although we have shown an association between use of HAs and reduced risk of physical and mental decline, randomized trials are needed to determine whether, and to what extent, the relationship is causal. J Am Geriatr Soc 67:2362-2369, 2019.
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Affiliation(s)
- Elham Mahmoudi
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Tanima Basu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Kenneth Langa
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Institute for Social Research, University of Michigan, Ann Arbor, Michigan.,Veteran Affairs (VA) Center for Clinical Management Policy Research, Ann Arbor, Michigan
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Philip Zazove
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Neil Alexander
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan.,Institute of Gerontology, University of Michigan, Ann Arbor, Michigan
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.,Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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McKee MM, Meade MA, Zazove P, Stewart HJ, Jannausch ML, Ilgen MA. The Relationship Between Hearing Loss and Substance Use Disorders Among Adults in the U.S. Am J Prev Med 2019; 56:586-590. [PMID: 30772153 DOI: 10.1016/j.amepre.2018.10.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hearing loss is common and associated with poorer health and impeded communication. Little is known about the association between hearing loss and substance use disorders in the general population. The objective of this study was to assess substance use disorder prevalence among individuals with hearing loss, versus those without hearing loss, in a nationally representative sample of adults. METHODS Two years (2015 and 2016) of National Survey on Drug Use and Health (unweighted N=86,186) were combined to compare substance use disorders among adults with and without self-reported hearing loss. Statistical analysis included descriptive frequencies, chi-square tests, and multiple logistic regressions. Analyses were performed in 2018. RESULTS Hearing loss prevalence across all age groups was 5.2%. Among younger age groups, after adjusting for sociodemographics, hearing loss was independently associated with an increased likelihood of experiencing a substance use disorder (ages 18-34 years, AOR=1.34, 95% CI=1.10, 1.64 vs 35-49 years, AOR=1.87, 95% CI=1.39, 2.53). Hearing loss was also associated with a greater likelihood of a prescription opioid use disorder (AOR=2.85, 95% CI=1.86, 4.39) in the group aged 18-34 years and, for the group aged 35-49 years, hearing loss increased the likelihood of both an alcohol use disorder (AOR=1.87, 95% CI=1.39, 2.53) and a prescription opioid use disorder (AOR=1.99, 95% CI=1.01, 3.91). CONCLUSIONS Hearing loss is independently associated with substance use disorders among those aged 49 years and younger; these associations are particularly pronounced for prescription opioid use disorders in the group aged 18-34 years. Given the concern of inappropriate use of prescription opioids, this information may have implications for healthcare providers' pain management for patients with hearing loss.
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Affiliation(s)
- Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Michelle A Meade
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Philip Zazove
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Haylie J Stewart
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Mary L Jannausch
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Mark A Ilgen
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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Affiliation(s)
- Michael M. McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
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McKee MM, Lin FR, Zazove P. State of research and program development for adults with hearing loss. Disabil Health J 2018; 11:519-524. [DOI: 10.1016/j.dhjo.2018.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 07/26/2018] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
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Zazove P, Plegue MA, Kileny PR, McKee MM, Schleicher LS, Green LA, Sen A, Rapai ME, Guetterman TC, Mulhem E. Initial Results of the Early Auditory Referral-Primary Care (EAR-PC) Study. Am J Prev Med 2017; 53:e139-e146. [PMID: 28826949 DOI: 10.1016/j.amepre.2017.06.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 05/22/2017] [Accepted: 06/23/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hearing loss (HL) is the second most common disability in the U.S., yet is clinically underdiagnosed. To manage its common adverse psychosocial and cognitive outcomes, early identification of HL must be improved. METHODS A feasibility study conducted to increase screening for HL and referral of patients aged ≥55 years arriving at two family medicine clinics. Eligible patients were asked to complete a self-administered consent form and the Hearing Handicap Inventory (HHI). Independently, clinicians received a brief educational program after which an electronic clinical prompt (intervention) alerted them (blinded to HHI results) to screen for HL during applicable patient visits. Pre- and post-intervention differences were analyzed to assess the proportion of patients referred to audiology and those diagnosed with HL (primary outcomes) and the audiology referral appropriateness (secondary outcome). Referral rates for those who screened positive for HL on the HHI were compared with those who scored negatively. RESULTS There were 5,520 eligible patients during the study period, of which 1,236 (22.4%) consented. After the intervention's implementation, audiology referral rates increased from 1.2% to 7.1% (p<0.001). Overall, 293 consented patients (24%) completed the HHI and scored >10, indicating probable HL. Of these 293 patients, 28.0% were referred to audiology versus only 7.4% with scores <10 (p<0.001). Forty-two of the 54 referred patients seen by audiology were diagnosed with HL (78%). Overall, the diagnosis of HL on problem lists increased from 90 of 4,815 patients (1.9%) at baseline to 163 of 5,520 patients (3.0%, p<0.001) over only 8 months. CONCLUSIONS The electronic clinical prompt significantly increased audiology referrals for at-risk patients for HL in two family medicine clinics. Larger-scale studies are needed to address the U.S. Preventive Services Task Force call to assess the long-term impact of HL screening in community populations.
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Affiliation(s)
- Philip Zazove
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Paul R Kileny
- Otorhinolaryngology Department, University of Michigan, Ann Arbor, Michigan
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Lee A Green
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ananda Sen
- Department of Family Medicine and Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Mary E Rapai
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Elie Mulhem
- Department of Family Medicine, Beaumont Health System, Troy, Michigan
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Wu JP, McKee KS, McKee MM, Meade MA, Plegue MA, Sen A. Use of Reversible Contraceptive Methods Among U.S. Women with Physical or Sensory Disabilities. Perspect Sex Reprod Health 2017; 49:141-147. [PMID: 28514522 DOI: 10.1363/psrh.12031] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT Women with disabilities experience a higher rate of adverse pregnancy outcomes than women without disabilities. Preventing or delaying pregnancy when that is the best choice for a woman is a critical strategy to reducing pregnancy-related disparities, yet little is known about current contraceptive use among women with disabilities. METHODS A cohort of 545 reproductive-age women with physical disabilities (i.e., difficulty walking, climbing, dressing or bathing) or sensory disabilities (i.e., difficulty with vision or hearing) was identified from among participants in the 2011-2013 National Survey of Family Growth. Those at risk for unplanned pregnancy were categorized by whether they were using highly effective reversible contraceptive methods (IUD, implant), moderately effective ones (pill, patch, ring, injectable), less effective ones (condoms, withdrawal, spermicides, diaphragm, natural family planning) or no method. Multinomial regression was conducted to examine the association between disability and type of contraceptive used. RESULTS Some 39% of women with disabilities were at risk of unplanned pregnancy, and 27% of those at risk were not using contraceptives. The presence of disability was associated with decreased odds of using highly effective methods or moderately effective methods, rather than less effective ones (odds ratio, 0.6 for each), but had no association with using no method. CONCLUSION There is a significant need to reduce contraceptive disparities related to physical or sensory disabilities. Future research should explore the extent to which contraceptive use differs by type and severity of disability, as well as identify contextual factors that contribute to any identified differences.
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Affiliation(s)
- Justine P Wu
- Assistant professor, Departments of Family Medicine and Obstetrics and Gynecology, The University of Michigan, Ann Arbor
| | - Kimberly S McKee
- Research fellow, Department of Family Medicine, The University of Michigan, Ann Arbor
| | - Michael M McKee
- Assistant professor, Department of Family Medicine, The University of Michigan, Ann Arbor
| | - Michelle A Meade
- Associate professor, Department of Physical Medicine and Rehabilitation, The University of Michigan, Ann Arbor
| | - Melissa A Plegue
- Lead statistician Department of Family Medicine, The University of Michigan, Ann Arbor
| | - Ananda Sen
- Professor, Department of Family Medicine, The University of Michigan, Ann Arbor
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McKee MM, Stransky ML, Reichard A. Hearing loss and associated medical conditions among individuals 65 years and older. Disabil Health J 2017; 11:122-125. [PMID: 28596096 DOI: 10.1016/j.dhjo.2017.05.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/25/2017] [Accepted: 05/29/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hearing loss is prevalent, but few studies have investigated its associations with common medical conditions. OBJECTIVE The objective was to assess the prevalence of medical conditions among individuals with hearing loss, compared to those without hearing loss, in people aged 65 years and older. METHODS The National Health Interview Survey (NHIS) collects data on a variety of health-related topics, including disability. Three years of NHIS data (2011-2013; unweighted n = 53,111) were pooled to examine subpopulations of individuals with hearing loss. Comparisons were made between adults aged 65 and older with, and without, self-reported hearing loss. Statistical analysis included descriptive frequencies, Chi-square tests, and multiple logistic regressions. The outcomes of interest included self-reported diagnosis of arthritis, cardiovascular disease, diabetes, high blood pressure, emphysema, stroke, cancer, asthma, multiple chronic conditions, health status, and obesity. RESULTS Hearing loss prevalence was nearly 37%. After adjusting for sociodemographics, smoking status, and disability, hearing loss was independently associated with the following conditions: arthritis (OR 1.41; 1.27-1.57), cancer (OR 1.35; 1.21-1.5), cardiovascular disease (OR 1.48; 1.33-1.66), diabetes (OR 1.16; 1.03-1.31), emphysema (OR 1.41; 1.14-1.74), high blood pressure (OR 1.29; 1.17-1.43), and stroke (OR 1.39; 1.12-1.66). There was an association with worse health status over the past year (OR 1.5 (1.3-1.73). CONCLUSIONS Hearing loss among older individuals is independently associated with increased disease burden and poorer self-reported health. Future studies are needed to investigate the mechanistic nature of these associations, and whether improved access to hearing healthcare surveillance can reduce the overall health burden among these individuals.
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Affiliation(s)
- Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.
| | - Michelle L Stransky
- Institute on Disability, University of New Hampshire, Durham, NH, 03824, United States
| | - Amanda Reichard
- Institute on Disability, University of New Hampshire, Durham, NH, 03824, United States
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McKee MM, Moreland C, Atcherson SR, Zazove P. Hearing Loss: Communicating With the Patient Who Is Deaf or Hard of Hearing. FP Essent 2015; 434:24-28. [PMID: 26161525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hearing loss impairs health care communication and adversely affects patient satisfaction, treatment adherence, and use of health services. Hearing loss is the third most common chronic health condition among older patients after hypertension and arthritis, but only 15% to 18% of older adults are screened for hearing loss during health maintenance examinations. Patients with hearing loss may be reluctant to disclose it because of fear of ageism, perceptions of disability, and vanity. Lipreading and note writing often are ineffective ways to communicate with deaf and hard of hearing (DHH) patients who use American Sign Language; use of medical sign language interpreters is preferred. A variety of strategies can improve the quality of health care communication for DHH patients, such as the physician facing the patient, listening attentively, and using visual tools. Physicians should learn what hearing loss means to the DHH patient. Deaf American Sign Language users may not perceive hearing loss as a disability but as a cultural identity. Patients' preferred communication strategies will vary. Relay services, electronic communication, and other telecommunications methods can be helpful, but family physicians and medical staff should learn from each DHH patient about which communication strategies will work best.
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Affiliation(s)
- Michael M McKee
- University of Michigan Department of Family Medicine, 1018 Fuller St, Ann Arbor, MI 48104-1213,
| | - Christopher Moreland
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229
| | - Samuel R Atcherson
- University of Arkansas Department of Audiology & Speech Pathology, 5820 Asher Avenue University Plaza Suite 600, Little Rock, AR 72204,
| | - Philip Zazove
- University of Michigan Department of Family Medicine, 1150 W. Medical Center Dr M7300 Med Sci I SPC 5625, Ann Arbor, MI 48109-5625
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Atcherson SR, Moreland C, Zazove P, McKee MM. Hearing Loss: Hearing Augmentation. FP Essent 2015; 434:18-23. [PMID: 26161524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Etiologies of hearing loss vary. When hearing loss is diagnosed, referral to an otology subspecialist, audiology subspecialist, or hearing aid dispenser to discuss treatment options is appropriate. Conventional hearing aids provide increased sound pressure in the ear canal for detection of sounds that might otherwise be soft or inaudible. Hearing aids can be used for sensorineural, conductive, or mixed hearing loss by patients with a wide range of hearing loss severity. The most common type of hearing loss is high-frequency, which affects audibility and perception of speech consonants, but not vowels. As the severity of hearing loss increases, the benefit of hearing aids for speech perception decreases. Implantable devices such as cochlear implants, middle ear implants, and bone-anchored implants can benefit specific patient groups. Hearing assistive technology devices provide auditory, visual, or tactile information to augment hearing and increase environmental awareness of sounds. Hearing assistive devices include wireless assistive listening device systems, closed captioning, hearing aid-compatible telephones, and other devices. For some patients, financial barriers and health insurance issues limit acquisition of hearing aids, implantable devices, and hearing assistive devices. Physicians should be aware that for some patients and families, hearing augmentation may not be desired for cultural reasons.
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Affiliation(s)
- Samuel R Atcherson
- University of Arkansas Department of Audiology & Speech Pathology, 5820 Asher Avenue University Plaza Suite 600, Little Rock, AR 72204,
| | - Christopher Moreland
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229
| | - Philip Zazove
- University of Michigan Department of Family Medicine, 1150 W. Medical Center Dr M7300 Med Sci I SPC 5625, Ann Arbor, MI 48109-5625
| | - Michael M McKee
- University of Michigan Department of Family Medicine, 1018 Fuller St, Ann Arbor, MI 48104-1213,
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McKee MM, Moreland C, Atcherson SR, Zazove P. Hearing Loss: Foreword. FP Essent 2015; 434:1. [PMID: 26161522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Zazove P, Atcherson SR, Moreland C, McKee MM. Hearing Loss: Diagnosis and Evaluation. FP Essent 2015; 434:11-17. [PMID: 26161523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hearing loss is a common disability in the United States, most frequent among men, elderly individuals, and veterans but is increasingly affecting other younger adults. Types of hearing loss include sensorineural, conductive, and mixed. Hearing loss in children often is related to infections, time spent in a neonatal intensive care unit, and genetic etiologies. Presbycusis (ie, age-related hearing loss) is the most common etiology in adults. Adverse effects of untreated hearing loss include isolation, depression, lower income, and higher unemployment. Hearing aid use reduces levels of disability, cognitive impairment, and psychosocial distress while improving quality of life. At least 75% of individuals with hearing loss are not receiving treatment for it. All infants should be screened for hearing loss, as should children and adults with risk factors. The Joint Commission on Infant Hearing Screening has a 1-3-6 goal for screening: identification by age 1 month, confirmation by age 3 months, and intervention by age 6 months. The presence of an ongoing physician-patient relationship increases the likelihood that a patient will admit to having a hearing loss. Adults can be screened using single-question or standardized instrument screens. All patients with suspected hearing loss should undergo audiometry by an audiology subspecialist.
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Affiliation(s)
- Philip Zazove
- University of Michigan Department of Family Medicine, 1150 W. Medical Center Dr M7300 Med Sci I SPC 5625, Ann Arbor, MI 48109-5625
| | - Samuel R Atcherson
- University of Arkansas Department of Audiology & Speech Pathology, 5820 Asher Avenue University Plaza Suite 600, Little Rock, AR 72204,
| | - Christopher Moreland
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229
| | - Michael M McKee
- University of Michigan Department of Family Medicine, 1018 Fuller St, Ann Arbor, MI 48104-1213,
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Moreland C, Atcherson SR, Zazove P, McKee MM. Hearing Loss: Issues in the Deaf and Hard of Hearing Communities. FP Essent 2015; 434:29-40. [PMID: 26161526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hearing loss can lead to impairments in language and speech acquisition, educational attainment, social development, and reading achievement. More than 90% of deaf and hard of hearing (DHH) children are born to hearing parents who may lack the knowledge or experience to effectively care for a child with hearing loss. Family involvement is crucial for teaching self-advocacy and global communication skills, optimizing social development, and helping DHH individuals understand and manage external attitudes about deafness and hearing loss. American Sign Language is a naturally developed language with an always-expanding lexicon and grammatical structures different from those of English. Teaching spoken English and American Sign Language equally, often called bilingual bimodal education, can enhance academic and reading achievement as well as language and psychosocial development. Formal schooling options for a DHH child include enrollment in a public or private school system (often called inclusion, integration, or mainstreaming), a school for the deaf, or a bilingual school. Individuals with hearing loss experience stereotypes and biases that create disparities in health insurance coverage, health care access, and outcomes of mental and physical conditions. Family physicians should recognize and minimize biases to improve health care in the DHH community.
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Affiliation(s)
- Christopher Moreland
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229
| | - Samuel R Atcherson
- University of Arkansas Department of Audiology & Speech Pathology, 5820 Asher Avenue University Plaza Suite 600, Little Rock, AR 72204,
| | - Philip Zazove
- University of Michigan Department of Family Medicine, 1150 W. Medical Center Dr M7300 Med Sci I SPC 5625, Ann Arbor, MI 48109-5625
| | - Michael M McKee
- University of Michigan Department of Family Medicine, 1018 Fuller St, Ann Arbor, MI 48104-1213,
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McKee MM, Winters PC, Sen A, Zazove P, Fiscella K. Emergency Department utilization among Deaf American Sign Language users. Disabil Health J 2015; 8:573-8. [PMID: 26166160 DOI: 10.1016/j.dhjo.2015.05.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/30/2015] [Accepted: 05/09/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Deaf American Sign Language (ASL) users comprise a linguistic minority population with poor health care access due to communication barriers and low health literacy. Potentially, these health care barriers could increase Emergency Department (ED) use. OBJECTIVE To compare ED use between deaf and non-deaf patients. METHOD A retrospective cohort from medical records. The sample was derived from 400 randomly selected charts (200 deaf ASL users and 200 hearing English speakers) from an outpatient primary care health center with a high volume of deaf patients. Abstracted data included patient demographics, insurance, health behavior, and ED use in the past 36 months. RESULTS Deaf patients were more likely to be never smokers and be insured through Medicaid. In an adjusted analysis, deaf individuals were significantly more likely to use the ED (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.11-3.51) over the prior 36 months. CONCLUSION Deaf American Sign Language users appear to be at greater odds for elevated ED utilization when compared to the general hearing population. Efforts to further understand the drivers for increased ED utilization among deaf ASL users are much needed.
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Affiliation(s)
| | - Paul C Winters
- Family Medicine Research Programs, Department of Family Medicine, School of Medicine and Dentistry, University of Rochester, USA
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, USA
| | - Philip Zazove
- Department of Family Medicine, University of Michigan, USA
| | - Kevin Fiscella
- Family Medicine Research Programs, Department of Family Medicine, School of Medicine and Dentistry, University of Rochester, USA
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