Patient healthcare satisfaction has become increasingly important since Medicare’s introduction of the Hospital Care Quality Information from the Consumer Perspective (HCAHPS) survey. Greater satisfaction is associated with important healthcare outcomes including lower risk of 30-day readmission

Betz, J.F

Deal, J.A

Kucharska-Newton, A.M

Lin, F.R

Reed, N.S

Carolina Digital Repository

Hearing loss and satisfaction with healthcare: an unexplored relationshipNicholas S. Reed, AuD1,2, Joshua F. Betz, MS2,3, Anna Kucharska-Newton, PhD4, Frank R. Lin, MD PhD1,2, and Jennifer A. Deal, PhD2,51Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD2Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD3Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD4Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC5Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MDTo the Editor:Patient healthcare satisfaction has become increasingly important since Medicare’s introduction of the Hospital Care Quality Information from the Consumer Perspective (HCAHPS) survey [1]. Greater satisfaction is associated with important healthcare outcomes including lower risk of 30-day readmission [2].While many factors contribute to patient satisfaction, communication likely plays an underappreciated role [3,4]. Hearing loss (HL) is a barrier to effective communication and highly prevalent, affecting 38 million Americans and increasing with age such that two-thirds of adults over the age of 70 have HL [5]. An emerging body of literature has found HL associated with poorer healthcare outcomes, including increased healthcare costs [6], and increased risk of hospitalization [7].Hearing loss strains communication and may increase cognitive load via degraded auditory encoding, thereby further inhibiting the ability to process and comprehend speech. However, despite its role in communication, there is a paucity of research exploring the impact of HL on satisfaction with care. Notably, a limitation of current research is a use of self-report hearing, which is known to differ from objective measures by important characteristics (e.g. Corresponding Author: Nicholas S. Reed, AuD, Cochlear Center for Hearing and Public Health, 2024 E. Monument Street, Ste 1-500V, Baltimore, MD, 21205, 410.502.4332, Nreed9@jhmi.edu @NickSReed.Author ContributionsStudy concept and design; critical revision of the manuscript for important intellectual content; administrative, technical, or material support: all authors. Acquisition, analysis, or interpretation of data: NSR, JFB, JAD. Drafting of the manuscript: NSR, JAD. Statistical analysis: NSR, JFB, JAD.Sponsor’s RoleSponsors had no role in the design, methods, subject recruitment, data collection, analysis, or preparation of this study.HHS Public AccessAuthor manuscriptJ Am Geriatr Soc. Author manuscript; available in PMC 2020 March 01.Published in final edited form as:J Am Geriatr Soc. 2019 March ; 67(3): 624–626. doi:10.1111/jgs.15689.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor Manuscriptsex, race) that may be related to satisfaction [8]. Given its high prevalence, exploring HL’s impact on patient satisfaction has implications for public health and clinical care planning.METHODSStudy populationA hearing pilot study was conducted in Washington County, MD in the Atherosclerosis Risk in Communities (ARIC) Study in 2013. 256 participants (mean age = 77.4 years) completed audiometric hearing measurements. Due to small numbers, we excluded non-white (n=3) and Medicaid (n=3) participants, as well as those missing outcome (n=3) and/or covariate (n=2) measures, resulting in an analytic sample of 248 Medicare beneficiaries.Outcome measureParticipants were asked: “Overall, how satisfied are you with the quality of care you received from your healthcare providers over the past 12 months?” – “very dissatisfied”, “somewhat dissatisfied”, “somewhat satisfied” or “very satisfied”. We defined satisfaction with care as a binary outcome: less than optimally satisfied (somewhat satisfied, somewhat dissatisfied, or very dissatisfied) vs. optimally satisfied (very satisfied).HearingPure-tone air conduction hearing thresholds at the 500, 1000, 2000, and 4000 Hertz frequencies were obtained using clinically-accepted testing methods in a sound-attenuating booth with a calibrated audiometer. A pure-tone average (PTA) of the four frequencies in decibels hearing level (dB HL) was calculated to identify normal (<25 dB HL), mild (25–40 dB HL), and moderate (>40 dB HL) HL in the better-hearing ear.Statistical analysisThe association between HL (modeled continuously as the better-hearing ear PTA) and satisfaction with care was modeled using logistic regression, adjusting for age, sex, cognition [9] (a global composite z-score of 3 tests measuring 3 domains), and count of comorbidities. We explored for interactions between HL and demographic variables (age, sex). A sensitivity analysis also adjusted for self-reported perceived health compared to peers of the same age.RESULTS70 (28%) participants had normal, 95 (38%) had mild, and 83 (34%) had moderate or greater HL. 178 (72%) reported being very satisfied, 55 (22%) somewhat satisfied, 8 (3%) somewhat dissatisfied, and 7 (3%) very dissatisfied with their medical care over the past 12 months.In multivariable-adjusted analyses, there was a significant (p=.033) interaction between HL and age such that HL had a greater impact on odds of being less than optimally satisfied among older adults (figure 1). For example, in a 75-year-old participant, for every 10 dB increase in HL, the odds of being less than optimally satisfied increased .94 (95% Reed et al. Page 2J Am Geriatr Soc. Author manuscript; available in PMC 2020 March 01.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor ManuscriptConfidence Interval [CI]:0.74–1.20). However, in an 85-year-old participant, for every 10 dB increase in HL, the odds of being less than optimally satisfied increased 1.33 (95% CI:0.96–1.83). Sensitivity analysis did not alter inference.CONCLUSIONSIn this pilot study of 248 Medicare beneficiaries (67–89 years), HL is associated with being less than optimally satisfied with healthcare over the past year among older individuals. However, HL did not impact satisfaction with care among younger participants. To our knowledge, this is the first analysis to quantify the association of objective (i.e., audiometric) HL and healthcare satisfaction.Our findings support a previous study indicating self-reported communication problems are associated with reduced healthcare satisfaction [3]. Hearing loss’ negative impact on patient-provider communication may contribute to this relationship. Our findings suggest an interaction between age and HL. It may be that younger adults are better able to cope with HL’ impact on their cognitive load. Future studies are needed to replicate these findings.Our study is limited by demographic homogeneity and modest sample size. These results lend support for recent calls to address HL via screening and intervention techniques to improve patient-provider communication in the healthcare system [10].AcknowledgmentsConflict of InterestJAD was supported by National Institutes of Health/National Institute on Aging Grant K01AG054693. NSR was supported by National Institutes of Health Grant 5KL2TR001077–05. The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). The authors thank the staff and participants of the ARIC study for their important contributions. NSR reports non-financial scientific advisory role with Clearwater Clinical. FRL reports being a consultant to Cochlear and receiving speaker honoraria from Amplifon. No other reported conflicts of interest.References1. Centers for Medicare and Medicaid Services. (2011). Hospital care quality information from the consumer perspective.2. Boulding W, Glickman SW, Manary MP, Schulman KA, & Staelin R. Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. Am J Manag Care 2011; 17(1): 41–48. [PubMed: 21348567] 3. Barnett DD, Koul R, Coppola NM. Satisfaction with health care among people with hearing impairment: a survey of Medicare beneficiaries. Disabil Rehabil 2014; 36(1):39–48. [PubMed: 23594058] 4. Mick P, Foley DM, Lin FR. Hearing loss is associated with poorer ratings of patient–physician communication and healthcare quality. J Am Geriatr Soc 2014; 62(11):2207–9. [PubMed: 25413192] 5. Lin FR, Niparko JK, Ferrucci L. Hearing loss prevalence in the United States. Arch Intern Med. 2011 11 14; 171(20):1851–3. [PubMed: 22083573] 6. Foley DM, Frick KD, Lin FR. Association between hearing loss and healthcare expenditures in older adults. J Am Geriatr Soc. 2014; 62(6):1188–9. [PubMed: 24925555] Reed et al. Page 3J Am Geriatr Soc. Author manuscript; available in PMC 2020 March 01.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor Manuscript7. Genther DJ, Betz J, Pratt S, et al. Health, Aging and Body Composition Study. Association between hearing impairment and risk of hospitalization in older adults. J Am Geriatr Soc 2015; 63(6):1146–52. [PubMed: 26096388] 8. Agrawal Y, Platz EA, Niparko JK. Prevalence of hearing loss and differences by demographic characteristics among US adults: data from the National Health and Nutrition Examination Survey, 1999–2004. Arch Intern Med. 2008; 168(14):1522–30. [PubMed: 18663164] 9. Deal JA, Sharrett AR, Albert MS, et al. Hearing impairment and cognitive decline: a pilot study conducted within the atherosclerosis risk in communities neurocognitive study. AM J Epidemiol. 2015; 181(9):680–90. [PubMed: 25841870] 10. Blustein J, Weinstein BE, Chodosh J. Tackling hearing loss to improve the care of older adults. BMJ, 2018; 360: k21. [PubMed: 29348197] Reed et al. Page 4J Am Geriatr Soc. Author manuscript; available in PMC 2020 March 01.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor ManuscriptFigure 1. The Probability of Being Less than Optimally Satisfied (not ‘Very Satisfied’) by Hearing Loss for a 70-, 75-, and 80-year old. Logistic regression model for odds of less than optimal satisfaction and hearing loss adjusted for age, sex, global cognitive score, comorbidity count (diabetes, hypertension, myocardial infarction, asthma, cancer, stroke, and hospital stay).Reed et al. Page 5J Am Geriatr Soc. Author manuscript; available in PMC 2020 March 01.Author ManuscriptAuthor ManuscriptAuthor ManuscriptAuthor Manuscript

Hearing loss and satisfaction with healthcare: An unexplored relationship

http://cdr.lib.unc.edu/downloads/2v23w564g

Hearing loss and satisfaction with healthcare: An unexplored relationship

Abstract

Similar works

Full text

Available Versions

Carolina Digital Repository