Hearing Impairment, Strategies and Outcomes in VA Emergency Departments

退伍军人管理局急诊科的听力障碍、策略和结果

• 批准号: 9927923
• 负责人: JOSHUA CHODOSH
• 金额: --
• 依托单位: VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9927923
• 关键词: Accident and Emergency department; Acute; Address; Affect; Age; Age-Years; Aging; American; Bilateral; Caring; Clinical; Clinical Medicine; Code; Communication; Consent; Devices; Elderly; Emergency Care; Emergency Department patient; Emergency department visit; Environment; Equipment and supply inventories; Goals; Health; Health Care Costs; Health Services Accessibility; Healthcare; Healthcare Systems; Hearing; Hearing Aids; Home environment; Hospitalization; Hospitals; Instruction; Intervention; Interview; Knowledge; Measures; Medical; Mental Health; New York; Noise; Nurses; Outcome; Patient Outcomes Assessments; Patient Self-Report; Patients; Personal Satisfaction; Pharmaceutical Preparations; Physicians; Population; Preparation; Provider; Quality of Care; Randomized; Randomized Controlled Trials; Recording of previous events; Reporting; Research; Risk; Speech; Structure; Surveys; Symptoms; Testing; Time; Translating; Triage; Veterans; Vietnam; Visit; clinical encounter; combat; comorbidity; cost; disability; group intervention; hearing impairment; hearing screening; improved; medical attention; normal hearing; older patient; physical conditioning; point of care; recruit; screening; sound; treatment as usual; willingness

Hearing loss disrupts communication, which in turn jeopardizes effective medical care. Hearing loss is associated with poor mental and physical health, and is remarkably prevalent among older Veterans (close to 80% with bilateral >40 decibel hearing loss, among those 80 and older). Every year, several hundred thousand hearing loss-impacted older persons visit VA Emergency Departments (EDs) – noisy settings that are among the most “difficult listening situations” in clinical medicine. Many older adults will arrive without a hearing assistance device, given the low rate of hearing aid use in the elderly population. Extensive research underscores the importance of good communication during “care transitions” – points in time when patients leave one care setting for another. In the case of the ED, discharge to home may be a risky transition for patients who do not understand discharge instructions, such as which medications to take, or how to recognize “red flag” symptoms that indicate the urgent need for further medical attention. Patients who lack understanding of discharge instructions are at risk for repeat ED visits and/or hospitalizations. The goal of this study is to test whether providing hearing assistance devices to older age hearing impaired patients in the ED setting will improve in-ED understanding and preparation for discharge. The proposed intervention, the Hearing Impairment, Strategies and Outcomes in VA Emergency Departments (HearVA-ED) will be conducted in the Emergency Departments of the Manhattan and Brooklyn VAs of the New York Harbor Healthcare System and will recruit hearing impaired ED patients who are 60 years and older and have been admitted to the ED with a low acuity triage score indicating a high likelihood of discharge home. We will identify hearing impairment by using the Hearing Handicap Inventory for the Elderly survey (HHIE-S). We will randomize consenting patients who fail the screening to either receipt of a simple hearing assistance device (a “PockeTalkerTM”) during their ED stay or usual care. We will test whether the provision of a PockeTalkerTM is feasible in this environment (by measuring the amount of device use), whether providing the device improves self-reported quality of hearing and understanding during the ED stay, and whether use of the device improves the quality of preparation for post-discharge care. If this randomized controlled trial demonstrates beneficial effects for in-ED use of a simple hearing assistance device for hearing impaired patients, this strategy can be disseminated throughout the VA healthcare system.

听力损失破坏了沟通，这反过来危害有效的医疗服务。听力损失是 与精神和身体健康不良有关，在老年退伍军人中非常普遍（接近 在80岁及以上的80％的双边> 40分贝听力损失）。每年，几十万 受听力损失影响的老年人访问VA急诊室（EDS） - 嘈杂的环境 临床医学中最困难的聆听情况。许多老年人将无听觉到达 鉴于老年人口的助听器使用率较低，辅助设备。 广泛的研究强调了“护理过渡”期间良好沟通的重要性 - 患者留下一个护理设置的时间点。对于急诊室，出院可能 对于不了解出院说明的患者，例如哪种药物，是一种冒险的过渡 采取或如何识别“危险信号”符号，表明迫切需要进一步的医疗救助。 缺乏对出院指示的患者有重复访问和/或的风险 住院。 这项研究的目的是测试是否为年龄段听力提供听力辅助设备 ED环境中受损的患者将改善内部的理解和排放准备。这 拟议的干预措施，听力障碍，策略和弗吉尼亚州急诊室的成果 （Hearva-Ed）将在曼哈顿和布鲁克林VAS的急诊部门进行 约克港医疗保健系统，并将招募60岁以上的听力受损的ED患者 已被接纳为敏锐分类较低的ED，表明出院的可能性很高。我们 将通过使用听力障碍库存（HHIE-S）来确定听力障碍。我们 将随机同意筛查的患者，要么收到简单的听力援助 设备（“ Pocketalkertm”）在其ED停留期间或通常的护理过程中。我们将测试是否提供 在这种环境中，Pocketalkertm是可行的（通过测量设备使用的量），无论是否提供 设备可以提高ED住宿期间自我报告的听力和理解质量，以及是否使用 设备提高了入院后护理的准备质量。 如果该随机对照试验显示出对简单听证的内部使用的有益效果 听力受损患者的辅助设备，可以在整个VA中传播此策略 医疗保健系统。