Reframing Our Health Care System for Patients With Hearing Loss

McKee, Michael; James, Tyler G.; Helm, Kaila V. T.; Marzolf, Brianna; Chung, Dana H.; Williams, John F.; Zazove, Philip

doi:10.1044/2022_jslhr-22-00052

Cited by 20 publications

(11 citation statements)

References 82 publications

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“…I will focus on persons with speech, language, and voice disabilities, which I will define collectively as communication disabilities. Another article in this Special Forum will focus independently on hearing disabilities (see McKee et al, 2022 ). The most comprehensive data we have on communication disabilities and health and health care disparities come from the National Health Interview Survey (NHIS).…”

Section: Health and Health Care Disparities Experienced By Persons Wi...mentioning

confidence: 99%

Striving Toward Equity in Health Care for People With Communication Disabilities

Morris

2022

J Speech Lang Hear Res

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Purpose: Approximately 10% of the U.S. adult population has a speech, language, and/or voice disability, collectively referred to as communication disabilities. An increasing number of studies demonstrate that persons with communication disabilities have worse health and health care outcomes as compared to those without communication disabilities. Understanding the state of the science, including potential contributing factors is critical to begin to address the disparities. Method: Applying a historical lens and integrating multiple models of disability provide a comprehensive perspective of the health and health care outcomes of persons with communication disabilities. Results: Three phases for addressing health care disparities exist: detecting, understanding, and reducing. Results from a 2012 National Health Interview Survey provide compelling population-level results of the health and health care disparities experienced by persons with communication disabilities. To understand the disparities, factors within the health care system, such as availability of communication aids and services, as well as provider and staff biases, assumptions, and lack of knowledge need to be considered. To date, few interventions exist to address disparities in care for persons with communication disabilities. Consequently, researchers need to engage with stakeholders in innovative study designs and methods to facilitate the rapid development, implementation, and dissemination of interventions that address the disparities. Conclusion: To ensure equity for the large and growing population of persons with communication disabilities, researchers, policy makers, patients, and health care systems need to collaborate in identifying and addressing the factors contributing to health and health care disparities.

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Section: Health and Health Care Disparities Experienced By Persons Wi...mentioning

confidence: 99%

Striving Toward Equity in Health Care for People With Communication Disabilities

Morris

2022

J Speech Lang Hear Res

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“…16 As ASL is a distinct language and not known by most health care providers, providers require the use of an ASL interpreter to facilitate patient-provider communication. 17 Preliminary descriptive studies, however, suggest that DHH patients who use ASL to communicate use the ED for less acute conditions than non-DHH English-speaking patients and also have higher risk of revisiting within a 36-month time frame. 8 This large time frame of ED revisits, however, does not provide information about acute ED revisits, which is of more interest to health services researchers.…”

Section: Introductionmentioning

confidence: 99%

“…ASL is a natural language distinct from English 15 and is used by at least 500,000 individuals in the United States 16 . As ASL is a distinct language and not known by most health care providers, providers require the use of an ASL interpreter to facilitate patient–provider communication 17 …”

Section: Introductionmentioning

confidence: 99%

Emergency department condition acuity, length of stay, and revisits among deaf and hard‐of‐hearing patients: A retrospective chart review

James

Miller

McKee

et al. 2022

Academic Emergency Medicine

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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.

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“…Less than 20% of those aged 70 years or older with hearing loss reported hearing aid use . Due to infrequent use of hearing aids, many older adults with hearing loss struggle with understanding clinicians . A potential tool is the use of personal sound amplification products (PSAPs); these devices, not much larger than a smartphone, amplify sounds close to the user while reducing noises farther away.…”

mentioning

confidence: 99%

Technological Tools to Improve Communication in Patients With Hearing Loss

James

McKee

2022

JAMA

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The risk of hearing loss increases as the population ages, with approximately 23 million adults aged 70 years or older (63%) in the US having diminished speech perception. 1 Although hearing loss is common in elderly people, management is largely ineffective due to several factors: poor screening, high cost of hearing aids, vanity, hearing loss stigma, and inadequate training of health care practitioners. As a result, hearing loss results in adverse consequences both in health care settings and in everyday life. 2 Studies have demonstrated that those with untreated hearing loss use hospitals and emergency departments more often than those without hearing loss and generate, on average, an additional $22 000 in health care expenses over 10 years. 3 Chang et al 4 analyzed Medicare recipients with hearing loss and selfreported communication difficulties and found that they were 32% more likely to be readmitted to the hospital within 30 days of discharge compared with those who did not report hearing loss or communication difficulties.Hearing loss is a major source of social isolation among older adults and causes health care communication breakdowns between clinicians and patients, 5 reducing patients' health care satisfaction and adherence. 6 Despite the considerable adverse effects of age-related hearing loss, hearing aid use remains low even though these aids provide communication benefits, reduce social isolation, and improve quality of life. Less than 20% of those aged 70 years or older with hearing loss reported hearing aid use. 7 Due to infrequent use of hearing aids, many older adults with hearing loss struggle with understanding clinicians. 6 A potential tool is the use of personal sound amplification products (PSAPs); these devices, not much larger than a smartphone, amplify sounds close to the user while reducing noises farther away. In previous small studies, PSAPs have shown benefits in improving the quality of hearing and communication. 8,9 In this issue of JAMA, Nieman et al 10 report a randomized trial of a community health worker-delivered PSAP intervention among 151 older adults with hearing loss. Participants in the intervention group received 1 of 2 PSAPs and were encouraged to use the device in their daily routines. The community health worker-led device instruction took place in 1 to 2 individual sessions in less than 2 hours of total time. The primary outcome was self-perceived communication at 3 months; secondary outcomes included physical health, depression, social isolation, loneliness, and self-efficacy in

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Reframing Our Health Care System for Patients With Hearing Loss

Cited by 20 publications

References 82 publications

Striving Toward Equity in Health Care for People With Communication Disabilities

Striving Toward Equity in Health Care for People With Communication Disabilities

Emergency department condition acuity, length of stay, and revisits among deaf and hard‐of‐hearing patients: A retrospective chart review

Technological Tools to Improve Communication in Patients With Hearing Loss

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