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: 9505113
• 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 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9505113
• 关键词: Accident and Emergency department; Acute; Address; Affect; Age; Age-Years; Aging; American; Bilateral; Caring; Clinical; Clinical Medicine; Code; Communication; Comorbidity; Consent; Devices; Disabled Persons; 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; combat; 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.

听力损失会干扰沟通，进而危及有效的医疗护理。听力损失是 与精神和身体健康状况不佳有关，并且在老年退伍军人中非常普遍（接近 80岁及以上的人中，80%的人双侧听力损失>40分贝）。每年， 听力损失影响的老年人访问VA急诊室（ED）-嘈杂的环境， 临床医学中最“难听的情况”。许多老年人将在没有听力的情况下到达 助听器在老年人群中的使用率较低。 广泛的研究强调了在“护理过渡”期间良好沟通的重要性- 患者离开一个护理环境到另一个护理环境的时间点。在艾德的情况下，出院回家可能 对于不了解出院说明的患者来说，这是一个危险的过渡，例如哪些药物可以 采取，或如何识别“红旗”症状，表明迫切需要进一步的医疗照顾。 不了解出院指导的患者有重复艾德访视的风险和/或 住院治疗 本研究的目的是测试是否提供听力辅助设备，以老年听力 艾德环境中的受损患者将改善艾德环境中的理解和出院准备。的 VA急诊科的建议干预、听力障碍、策略和结果 （HearVA-ED）将在纽约州曼哈顿和布鲁克林VA的急诊室进行 约克港医疗保健系统，并将招募60岁及以上的听力受损艾德患者， 已被艾德收治，且敏锐度分诊评分较低，表明出院回家的可能性较高。我们 将通过使用老年人听力障碍调查表（HHIE-S）来识别听力障碍。我们 将筛选失败的同意患者随机分配到接受简单助听器， 在艾德住院期间或常规护理期间使用PockeTalkerTM设备。我们将测试是否提供一个 PockeTalkerTM在这种环境下是可行的（通过测量设备使用量），无论是否提供 设备改善了艾德住院期间自我报告的听力和理解质量， 该设备提高了出院后护理的准备质量。 如果这项随机对照试验证明了ED使用简单听力的有益效果， 辅助设备的听力受损患者，这一战略可以在整个VA传播 医疗保健系统。