医疗保险年度健康访视：改善健康系统识别听力损失的机会？
The Medicare annual wellness visit: An opportunity to improve health system identification of hearing loss?
机构信息
Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland, USA.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
出版信息
J Am Geriatr Soc. 2024 Oct;72(10):3089-3097. doi: 10.1111/jgs.19111. Epub 2024 Jul 26.
BACKGROUND
Hearing loss is prevalent and consequential but under-diagnosed and managed. The Medicare Annual Wellness Visit (AWV) health risk assessment elicits patient-reported hearing concerns but whether such information affects documentation, diagnosis, or referral is unknown.
METHODS
We use 5 years of electronic medical record (EMR) data (2017-2022) for a sample of 13,776 older primary care patients. We identify the first (index) AWV indication of hearing concerns and existing and subsequent hearing loss EMR diagnoses (visit diagnoses or problem list diagnoses) and audiology referrals. For a 20% random sample of AWV notes (n = 474) we compared hearing loss EMR diagnoses to documentation of (1) hearing concerns, (2) hearing loss/aid use, and (3) referrals for hearing care.
RESULTS
Of 3845 (27.9%) older adults who identified hearing concerns (mean age 79.1 years, 57% female, 75% white) 24% had an existing hearing diagnosis recorded. Among 474 patients with AWV clinical notes reviewed, 90 (19%) had an existing hearing loss diagnosis. Clinicians were more likely to document hearing concerns or hearing loss/aid use for those with (vs. without) an existing EMR diagnosis (50.6% vs. 35.9%, p = 0.01; 68.9% vs. 37.5%, p < 0.001, respectively). EMR diagnoses of hearing loss were recorded for no more than 40% of those with indicated hearing concerns. Among those without prior diagnosis 38 (9.9%) received a hearing care referral within 1 month. Subgroup analysis suggest greater likelihood of documenting hearing concerns for patients age 80+ (OR:1.51, 95% confidence interval [CI]: 1.03, 2.19) and decreased likelihood of documenting known hearing loss among patients with more chronic conditions (OR: 0.49, 95% CI: 0.27, 0.9), with no differences observed by race.
CONCLUSION
Documentation of hearing loss in EMR and AWV clinical notes is limited among older adults with subjective hearing concerns. Systematic support and incorporation of hearing into EMR and clinical notes may increase hearing loss visibility by care teams.
背景
听力损失普遍存在且后果严重，但却未得到充分诊断和管理。医疗保险年度健康访视（AWV）健康风险评估会引出患者报告的听力问题，但这些信息是否会影响记录、诊断或转介尚不清楚。
方法
我们使用了 5 年的电子病历（EMR）数据（2017-2022 年），对 13776 名老年初级保健患者进行了抽样分析。我们确定了首次（索引）AWV 听力问题的指征，以及现有的和随后的听力损失 EMR 诊断（就诊诊断或问题列表诊断）和听力转介。对于 AWV 记录的 20%随机样本（n=474），我们将听力损失 EMR 诊断与听力问题的记录进行了比较，包括（1）听力问题，（2）听力损失/助听设备使用情况，以及（3）听力保健转介。
结果
在 3845 名（27.9%）确定听力问题的老年人中（平均年龄 79.1 岁，57%为女性，75%为白人），有 24%的人有现有的听力诊断记录。在 474 名接受 AWV 临床记录审查的患者中，有 90 名（19%）有现有的听力损失诊断。对于有（vs. 无）现有的 EMR 诊断的患者，临床医生更有可能记录听力问题或听力损失/助听设备使用情况（50.6% vs. 35.9%，p=0.01；68.9% vs. 37.5%，p<0.001）。对于有指示性听力问题的患者，只有不到 40%的人记录了听力损失 EMR 诊断。在那些没有先前诊断的患者中，有 38 人（9.9%）在 1 个月内接受了听力保健转介。亚组分析表明，对于 80 岁以上的患者，更有可能记录听力问题（OR：1.51，95%置信区间[CI]：1.03，2.19），而对于有更多慢性疾病的患者，更不可能记录已知的听力损失（OR：0.49，95%CI：0.27，0.9），但种族之间没有差异。
结论
在有主观听力问题的老年人中，听力损失在 EMR 和 AWV 临床记录中的记录是有限的。系统的支持和将听力纳入 EMR 和临床记录中，可能会增加护理团队对听力损失的可见性。
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