Conceptual Model of Emergency Department Utilization among Deaf and Hard-of-Hearing Patients: A Critical Review.

Tyler G James,Jeewon Cheong,M David Miller,Thomas A Pearson,Julia R Varnes,Ali M Yurasek,Meagan K Sullivan,Michael M Mckee

doi:10.3390/ijerph182412901

Abstract

Deaf and hard-of-hearing (DHH) populations are understudied in health services research and underserved in healthcare systems. Existing data indicate that adult DHH patients are more likely to use the emergency department (ED) for less emergent conditions than non-DHH patients. However, the lack of research focused on this population’s ED utilization impedes the development of health promotion and quality improvement interventions to improve patient health and quality outcomes. The purpose of this study was to develop a conceptual model describing patient and non-patient (e.g., community, health system, provider) factors influencing ED utilization and ED care processes among DHH people. We conducted a critical review and used Andersen’s Behavioral Model of Health Services Use and the PRECEDE-PROCEED Model to classify factors based on their theoretical and/or empirically described role. The resulting Conceptual Model of Emergency Department Utilization Among Deaf and Hard-of-Hearing Patients provides predisposing, enabling, and reinforcing factors influencing DHH patient ED care seeking and ED care processes. The model highlights the abundance of DHH patient and non-DHH patient enabling factors. This model may be used in quality improvement interventions, health services research, or in organizational planning and policymaking to improve health outcomes for DHH patients.

Highlights

The United States is facing increasing rates of emergency department (ED) utilization paired with the closure of EDs nationwide [1,2]
There is no standardized method for developing conceptual models, previous research in the health sciences has employed qualitative studies, narrative reviews, and systematic reviews to assist in conceptual model development
In health education and promotion, Earp and Ennett [17] recommend a conceptual model development process including identifying endpoints of interest, starting with existing conceptual frameworks and theories, and identifying concepts based on the empirical literature and researcher knowledge

Summary

Introduction

ED utilization, compared to other sources of care, is more prevalent for specific priority populations (e.g., publicly insured, limited English proficient (LEP), and racially, ethnically, and linguistically minoritized populations) [3,4,5,6]. It is necessary to first understand what influences ED care-seeking among these priority populations, to further investigate disparities in health service utilization and delivery and justify the implementation of quality improvement programs. The DHH community is one such priority population experiencing widespread determinants of ED utilization that are understudied [9].

Objectives

Methods

Conclusion