Healthcare Outcomes and Accommodations for Persons with Communication Disabilities

沟通障碍人士的医疗保健成果和住宿

• 批准号: 10389376
• 负责人: Jennifer Y Oshita
• 金额: $ 4.28万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10389376
• 关键词: Address; Admission activity; Adopted; Adult; Adverse event; Americans with Disabilities Act; Amplifiers; COVID-19 pandemic; Career Choice; Caring; Case Study; Clinical; Clinical Data; Clinical Medicine; Cognitive; Collaborations; Communication; Communication Barriers; Communication Board; Communication Disability; Cross-Sectional Studies; Data; Data Analyses; Data Collection; Data Reporting; Data Set; Diagnosis; Documentation; Electronic Health Record; Emergency department visit; Epidemiologic Methods; Epidemiology; Face; Fellowship; Future; Goals; Health; Health Services; Health Services Accessibility; Health Services Research; Healthcare; Healthcare Systems; Hearing; Hospitals; Improve Access; Interdisciplinary Education; Intervention; Interview; Joints; Knowledge; Language; Learning; Length of Stay; Linear Regressions; Maps; Measures; Methods; National Institute on Deafness and Other Communication Disorders; Needles; Outcome; Pathway interactions; Patient Self-Report; Patient-Focused Outcomes; Patients; Persons; Policies; Population; Process; Provider; Qualitative Methods; Quality of Care; Quebec; Resources; Sampling; Services; Speech; Strategic Planning; Structure; System; Thinking; Time; Training; Translational Research; Universities; Vermont; Voice; Work; care outcomes; clinical care; college; communication behavior; comparison group; disability; epidemiologic data; experience; health care quality; health care service organization; health care settings; improved; innovation; multi-component intervention; novel; peer; pre-doctoral; programs; skills; social communication; system-level barriers

PROJECT SUMMARY/ABSTRACT PwCD (PwCD) are challenged by the lack of high quality and readily available accommodations in healthcare settings. This may contribute to lower quality care though there is a paucity of rigorous epidemiologic data. This project will investigate the healthcare outcomes of PwCD and the healthcare system-level factors impacting their accommodation. Aim 1 will compare emergency department (ED) visits, admissions, and lengths of stay per year in PwCD to those without communication disabilities. We will conduct a retrospective (2019) cross-sectional analysis of the electronic health record (EHR) data of 47 healthcare organizations, composed of 58.7 million patients. Communication disability types will be broken down into hearing, speech/language/cognitive, voice, and pragmatic groups. The comparison group for each communication disability type will be adults in the total sample without any communication disabilities. Relationships between communication disability and the healthcare outcomes of ED visits and admissions will be assessed using negative binomial regression. Four admission diagnoses will be selected to compare lengths of stay in 2019 between groups. The relationship between communication disability and length of stay will be assessed using multiple linear regression. We hypothesize that PwCD will have higher rates of ED visits and admissions, and longer lengths of stay. The innovation and feasibility of this aim is supported by our use of the TriNetX platform, a federated network of cross-organizational EHR data. The second aim will determine the healthcare system factors impacting accommodations for PwCD. We will conduct a collective case study of early adopting healthcare systems through key stakeholder interviews and policy document reviews. A novel pathway adapted from the Americans with Disabilities Act and the Joint Commission will structure data collection and analysis. The innovation and feasibility of this aim is supported by our connections with a national learning collaborative of disability coordinators representing 30 U.S. healthcare systems. The knowledge gained from completion of these objectives will pave the way for multifaceted interventions which address systems level contributors. It will also establish baseline clinical outcomes on which to measure health impact and guide future policy. My fellowship training will take place at the Larner College of Medicine’s (LCOM) Clinical Translational Sciences (CTS) program at the University of Vermont which provides a robust and highly interdisciplinary education with ample opportunities for cross-disciplinary collaboration. My two-year, pre- doctoral fellowship training will capitalize on the LCOM CTS program’s strengths in health services research. Through my F31 fellowship training, I will advance my skills in both epidemiologic and qualitative methods. This training plan is uniquely tailored to my career aspiration of contributing critical health services knowledge to improve the healthcare of PwCD.

项目概要/摘要 普华永道 (PwCD) 面临医疗保健领域缺乏高质量和现成住宿的挑战 尽管缺乏严格的流行病学研究，但这可能会导致护理质量下降。 该项目将调查 PwCD 的医疗保健结果和医疗保健系统层面的因素。 目标 1 将比较急诊室 (ED) 就诊、入院和住院情况。 没有沟通障碍的人每年在残疾人士中心的停留时间 我们将进行回顾。 (2019) 47 个医疗机构的电子健康记录 (EHR) 数据的横断面分析， 由 5870 万名患者组成，沟通障碍类型将分为听力、 言语/语言/认知、声音和语用组。 残疾类型将是总样本中没有任何沟通障碍的成年人。 沟通障碍以及急诊就诊和入院的医疗保健结果将使用 将选择四项入院诊断来比较 2019 年的住院时间。 将使用以下方法评估沟通障碍与住院时间之间的关系。 我们追求 PwCD 的急诊就诊率和入院率更高，并且 我们使用 TriNetX 平台支持了这一目标的创新和可行性， 第二个目标将确定跨组织 EHR 数据的联合网络。 影响残疾人士住宿的因素 我们将对早期收养进行集体案例研究。 通过关键利益相关者访谈和政策文件审查的医疗保健系统。 改编自《美国残疾人法案》，联合委员会将构建数据收集和 我们与国家学术界的联系支持了这一目标的创新和可行性。 代表 30 个美国医疗保健系统的残疾协调员的合作。 完成这些目标将为解决系统层面问题的多方面干预措施铺平道路 它还将建立基线临床结果，以衡量健康影响和指导。 未来的政策 我的进修培训将在拉纳医学院 (LCOM) 临床进行。 佛蒙特大学的转化科学 (CTS) 项目提供了强大且高度 我的跨学科教育有充足的跨学科合作机会。 博士奖学金培训将利用 LCOM CTS 项目在卫生服务研究方面的优势。 通过 F31 奖学金培训，我将提高流行病学和定性方法方面的技能。 该培训计划专门针对我贡献关键卫生服务知识的职业愿望而量身定制 改善 PwCD 的医疗保健。