Healthcare Outcomes and Accommodations for Persons with Communication Disabilities

项目概要/摘要 PwCD（PwCD）面临着缺乏高质量和现成的医疗保健设施的挑战 设置.这可能会导致较低的质量护理，尽管缺乏严格的流行病学研究， 数据本项目将调查PwCD的医疗结果和医疗系统层面的因素 影响他们的住宿。目标1将比较急诊科（艾德）就诊、入院和 每年在PwCD的停留时间延长到没有沟通障碍的人。我们将进行回顾 （2019）对47家医疗机构的电子健康记录（EHR）数据进行了横断面分析， 5870万患者。沟通障碍类型将分为听力， 言语/语言/认知，语音和语用组。每次来文的对照组 残疾类型将是总样本中没有任何沟通障碍的成年人。之间的关系 沟通障碍和艾德访视和入院的医疗保健结果将使用 负二项回归将选择四个入院诊断来比较2019年的住院时间 在群体之间。沟通障碍和住院时间之间的关系将使用 多元线性回归我们假设PwCD将有更高的艾德就诊率和入院率， 更长的停留时间。这一目标的创新性和可行性得到了TriNetX平台的支持， 跨组织EHR数据的联合网络。第二个目标将决定医疗保健系统 影响PwCD住宿的因素。我们将进行一个集体案例研究， 通过与主要利益相关者的访谈和政策文件审查，建立医疗保健系统。一种新的途径 根据《美国残疾人法案》改编，联合委员会将组织数据收集， 分析.这一目标的创新性和可行性得到了我们与国家学习的联系的支持 代表美国30个医疗保健系统的残疾协调员的合作。知识来自于 这些目标的完成将为系统一级的多方面干预铺平道路 贡献者。它还将建立基线临床结果，以衡量健康影响并指导 未来政策。我的奖学金培训将在Larner医学院（LCOM）的临床 佛蒙特大学的转化科学（CTS）计划提供了一个强大的，高度 跨学科教育，有充分的跨学科合作机会。我的两年，预- 博士奖学金培训将利用LCOM CTS计划在卫生服务研究方面的优势。 通过我的F31奖学金培训，我将提高我在流行病学和定性方法方面的技能。 这个培训计划是专门为我的职业抱负贡献关键的卫生服务知识 改善PwCD的医疗保健。

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.