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.

项目摘要/摘要 普华永道(PwCD)面临着缺乏高质量和现成的医疗设施的挑战 设置。这可能会导致医疗质量较低，尽管缺乏严格的流行病学研究 数据。该项目将调查普华永道的医疗保健结果和医疗保健系统层面的因素 影响了他们的住宿。目标1将比较急诊科(ED)就诊、入院和 无沟通障碍者每年在普华永道停留的时间。我们将进行一次回顾 (2019年)对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。沟通障碍类型将被细分为听力障碍， 言语/语言/认知、语音和语用群体。每次通信的比较组 残疾类型将是总样本中没有任何沟通障碍的成年人。两国之间的关系 交流障碍和急诊就诊和入院的医疗保健结果将使用以下方法进行评估 负二项回归。将选择四个入院诊断来比较2019年的住院时间 在小组之间。沟通障碍与逗留时间之间的关系将使用以下方法进行评估 多元线性回归。我们假设普华永道将有更高的急诊率和入院率，以及 更长的停留时间。我们使用TriNetX平台支持这一目标的创新性和可行性， 跨组织的电子病历数据的联合网络。第二个目标将决定医疗保健系统 影响普华永道医院住宿的因素。我们将进行早期采用的集体案例研究 通过与关键利益相关者的面谈和政策文件审查，建立医疗保健系统。一种新的途径 改编自《美国残疾人法》和联合委员会将组织数据收集和 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30个美国医疗保健系统的残疾协调员的协作。从以下方面获得的知识 完成这些目标将为针对系统层面的多方面干预铺平道路 贡献者。它还将建立基线临床结果，以衡量对健康的影响并指导 未来的政策。我的奖学金培训将在拉纳医学院(LCOM)临床学院进行 佛蒙特大学的翻译科学(CTS)项目提供了强大和高度的 跨学科教育，有充足的跨学科合作机会。我两年的预科- 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团契培训，我将提高我在流行病学和定性方法方面的技能。 这个培训计划是为我的职业抱负量身定做的，那就是贡献关键的卫生服务知识 改善普华永道的医疗保健。