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• W4376131586 abstract "Many healthcare organizations have adopted patient-centered approaches by implementing programs that prioritize patients' needs, values, and preferences into care,1 reflecting a growing recognition that patients should be active participants in their own care. Patient-centered care is associated with improved satisfaction and health outcomes.2 Hearing loss places considerable strain on patient–provider communication which is fundamental to patient-centered care. Moreover, race has previously been associated with poorer patient-centered care experiences yet minimal work evaluates this at the intersection of race and hearing loss.3, 4 The objectives of the present study are (1) to characterize the association of perception of patient-centered healthcare experiences among those with and without hearing loss, and (2) to explore whether race modifies the association. We pooled data of participants who completed at least one hearing measure from the Physical Measure module from the 2016 (n = 7674) and 2018 (n = 6839) waves of the Health & Retirement Study (HRS), a representative longitudinal panel study of Americans 50 years and older designed to understand health and well-being among aging and retired adults in the United States. The HRS captures information on income, work, physical/mental health, health care, and disability. The outcome of interest was perception of patient-centered care. Participants were asked: “Thinking about your experiences with the healthcare system over the past year, how often were your wishes for care taken into account [Always, Usually, Sometimes, Never]?” We derived a binary variable of optimal (always or usually) versus suboptimal (sometimes or never) perception of patient-centered care. Hearing was measured using the HearCheck Screener (Siemens, Germany), a screening tool that presents three tones at 1000 Hz (20, 35, 55 dB HL) and 3000 Hz (35, 55, 75 dB HL) in each ear (6 tones). Respondents indicated whether or not they heard each tone. Consistent with previous work, we defined hearing less than all 6 tones in the best ear as possible hearing loss.5, 6 Logistic regression was used to characterize the association of suboptimal perception of patient-centered care by hearing status. Covariates included: age, sex, race/ethnicity, marital status, educational attainment, insurance status, has usual source of care, and number of self-reported chronic comorbidities. To explore the presence of modification by race, the logistic regression was stratified by White and non-White groups. In the analytic sample, 28.5% reported suboptimal patient-centered care. Overall, 58.2% of respondents had possible hearing loss; however, there was a higher proportion of hearing loss among those reporting suboptimal patient-centered care (64.0% vs. 55.9%, p-value <0.001) (Table 1). In an adjusted model, individuals with hearing loss had 17% greater odds of having suboptimal perception of patient-centered care (odds ratio = 1.17, 95% CI = [1.07, 1.27]) relative to those without hearing loss (Table 2). Stratified models revealed a significant association between suboptimal patient-centered care and hearing loss among non-White participants (odds ratio = 1.21; 95% CI = [1.07–1.37]). However, no association was found among White individuals. In a sample of Americans over 50 years old, hearing loss was associated with higher odds of perceiving suboptimal patient-centered care during healthcare encounters. This may be attributable to hearing loss as a barrier to effective patient–provider communication which limits the ability to adequately express care preferences and participate in care decisions.7 Moreover, it is possible hearing loss among patients may contribute to implicit bias from clinicians who may avoid discussions to prevent communication breakdown or speak with companions rather than directly to adults with hearing loss.7 Following stratification, the association remained present only among non-White participants. It is possible this may reflect racial disparities and implicit bias in the healthcare system such that White Americans with hearing loss receive accommodations while non-White Americans do not. Suboptimal patient-centered care may mediate previous work on the association of hearing loss and poorer health utilization, dissatisfaction with care, and unmet health needs. It is plausible that poorer patient-centered care not only leads to poor health outcomes but also negatively impacts future help-seeking behaviors.8, 9 This work is strengthened by use of an objective hearing screener as opposed to previous work that relied on self-report data characterized by weak sensitivity. Future longitudinal work is necessary to understand whether changes in hearing loss predate poorer perceptions of patient-centered care and whether this mediates healthcare utilization outcomes. Our work is limited by an inability to examine the effects of intervention or accommodations such as amplifiers without data on the encounter. Given the high prevalence of hearing loss at two-thirds of adults over 70 years of age, creating universal accommodations for hearing loss in healthcare settings, such as voice amplification and minimizing background noise,7, 10 could improve patient-centered care and health outcomes for millions of Americans. Nicholas S. Reed and Grace Gahlon had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Nicholas S. Reed, Grace Gahlon. Acquisition, analysis, or interpretation of data: Nicholas S. Reed, Esther S. Oh, Grace Gahlon. Drafting of the manuscript: Grace Gahlon. Critical revision of the manuscript for important intellectual content: Nicholas S. Reed, Esther S. Oh. Statistical analysis: Grace Gahlon. Supervision: Nicholas S. Reed. This study was supported by grant K23AG065443 (Nicholas S. Reed) from the National Institutes of Health/National Institute on Aging. Nicholas S. Reed reported grants from the National Institute on Aging, being a scientific advisory board member of Neosensory. The National Institutes of Health had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication." @default.
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• W4376131586 date "2023-05-11" @default.
• W4376131586 modified "2023-09-23" @default.
• W4376131586 title "Association of perception of patient‐centered care with hearing loss by race" @default.
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• W4376131586 doi "https://doi.org/10.1111/jgs.18411" @default.
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