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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

基本信息

批准号：
10660951
负责人：
JOSHUA CHODOSH
金额：
--
依托单位：
VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-07-01 至 2024-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10660951
关键词：
Acceleration Accident and Emergency department Acute Address Admission activity 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 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 Quality of Care Questionnaires Randomized Randomized, Controlled Trials Recording of previous events Reporting Research Risk Speech Structure Surveys Symptoms Testing Time Translating Triage United States Department of Veterans Affairs Veterans Vietnam Visit clinical encounter combat comorbidity cost disability group intervention hearing impairment hearing screening human old age (65+)improved medical attention noise exposure normal hearing older patient physical conditioning point of care provider communication recruit screening sound treatment as usual willingness

项目摘要

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.

听力损失会扰乱交流，进而危及有效的医疗保健。听力损失是与心理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岁及以上的人中，80%的人双侧听力损失&40分贝)。每年，数十万人受听力损失影响的老年人去退伍军人事务部(EDs)就诊-噪音环境属于临床医学中最“难听的情况”。许多老年人会在没有听证的情况下到达助听器，鉴于老年人助听器使用率较低。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前往另一个护理环境的时间点。就教育署而言，出院回家可对于不了解出院说明的患者来说，这是一个有风险的过渡，例如应该使用哪些药物采取，或如何识别“危险信号”症状，表明迫切需要进一步的医疗护理。对出院说明缺乏了解的患者有重复急诊和/或住院治疗。这项研究的目的是测试是否为老年人听力提供助听器处于急诊室环境中的受损患者将提高对急诊室的理解和出院准备。这个退伍军人事务部急诊科的建议干预、听力障碍、策略和结果 (HearVA-ED)将在纽约曼哈顿和布鲁克林的急诊科进行约克港医疗系统，并将招募60岁及以上的听力障碍ED患者已入住教育署，视力分流分数低，显示出院的可能性很高。我们将通过使用老年人听力残疾调查问卷(HHIE-S)来识别听力障碍。我们是否会将未通过筛查的同意患者随机分为接受简单助听器的患者设备(“PockeTalkerTM”)在急诊住院期间或平时护理期间。我们将测试是否提供一个 PockeTalkerTM在此环境中是可行的(通过测量设备使用量)，无论是否提供在急诊室停留期间，设备可改善自我报告的听力和理解质量，以及是否使用设备提高了出院后护理准备的质量。如果这项随机对照试验显示了简单听力训练的有益效果为听障患者提供辅助装置，这一策略可以在整个退伍军人管理局传播医疗保健系统。