Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Department of Health Education and Behavior, University of Florida, Gainesville, Florida, USA.
Acad Emerg Med. 2022 Nov;29(11):1290-1300. doi: 10.1111/acem.14573. Epub 2022 Aug 5.
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.
在急诊医学卫生服务研究中，聋哑和重听（DHH）患者的研究较少。理论和有限的证据表明，DHH 患者急诊就诊和护理质量较差的风险更高。本研究评估了 DHH 患者的急诊状况严重程度、住院时间（LOS）和急诊再就诊情况。我们假设 DHH 患者的急诊护理结果较差。
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。数据来自医疗中心的数据办公室，我们对 2011 年 6 月至 2020 年 4 月之间的患者和就诊进行了抽样。我们比较了使用美国手语（ASL）的 DHH 患者（n=108）、使用英语的 DHH 患者（n=358）和非 DHH 英语患者（n=302）。我们使用多水平模型评估了与急诊就诊和护理相关的不同患者群体的结果差异。
正如假设的那样，与非 DHH 英语患者相比，DHH ASL 用户的急诊 LOS 平均长 30 分钟。通过紧急严重程度指数和分诊疼痛量表衡量的急诊状况严重程度差异没有统计学意义。DHH 英语患者占急性急诊再就诊的大多数（61%）。
我们的研究发现，与非 DHH 英语患者相比，DHH ASL 用户的急诊 LOS 更长。需要进一步研究来进一步解释 DHH 状态与急诊护理结果（包括急诊 LOS 和急性再就诊）之间的关联，这可能有助于确定改善健康公平的干预目标。
