PDF(Pubmed)
Abstract：
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.
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.
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.
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.
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.
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.
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.
摘要：
目的：在急诊医学卫生服务研究中，对聋人和听力困难（DHH）患者的研究不足。理论和有限的证据表明，DHH患者急诊科（ED）利用的风险较高，护理质量较差。这项研究评估了ED的病情敏锐度，停留时间(LOS)DHH患者的急性ED复诊。我们假设DHH患者将经历较差的ED护理结果。
方法：我们使用美国东南部一家大型学术医疗中心的数据，对单一医疗保健系统进行了回顾性图表审查。数据来自医疗中心数据办公室，我们对2011年6月至2020年4月期间的患者和遭遇进行了采样.我们比较了DHH美国手语（ASL）用户（n=108），DHH讲英语的人（n=358），和非DHH英语使用者（n=302）。我们使用多水平建模来评估与ED使用和护理相关的患者细分市场之间的差异。
结果：根据假设，DHHASL用户的EDLOS比非DHH英语使用者长，平均30分钟以上。ED病情敏锐度的差异，通过急诊严重程度指数和分诊疼痛量表测量，没有统计学意义。DHH说英语的人在急性ED重访中占大多数（61％）。
结论：我们的研究发现，DHHASL使用者的EDLOS比非DHH英语使用者长。需要更多的研究来进一步解释DHH状态与ED护理结果（包括EDLOS和急性复诊）之间的关系。可用于确定干预目标，以改善健康公平。
方法：我们使用美国东南部一家大型学术医疗中心的数据，对单一医疗保健系统进行了回顾性图表审查。数据来自医疗中心数据办公室，我们对2011年6月至2020年4月期间的患者和遭遇进行了采样.我们比较了DHH美国手语（ASL）用户（n=108），DHH讲英语的人（n=358），和非DHH英语使用者（n=302）。我们使用多水平建模来评估与ED使用和护理相关的患者细分市场之间的差异。
结果：根据假设，DHHASL用户的EDLOS比非DHH英语使用者长，平均30分钟以上。ED病情敏锐度的差异，通过急诊严重程度指数和分诊疼痛量表测量，没有统计学意义。DHH说英语的人在急性ED重访中占大多数（61％）。
结论：我们的研究发现，DHHASL使用者的EDLOS比非DHH英语使用者长。需要更多的研究来进一步解释DHH状态与ED护理结果（包括EDLOS和急性复诊）之间的关系。可用于确定干预目标，以改善健康公平。
