# Development of a conceptual model of emergency department utilization among deaf and hard-of-hearing patients: A mixed methods study

> **NIH AHRQ R36** · UNIVERSITY OF FLORIDA · 2020 · $41,062

## Abstract

PROJECT SUMMARY
Individuals experiencing limited English proficiency use emergency departments (EDs) more frequently than
their English-proficient counterparts; however, this research largely excludes individuals who are Deaf and
hard-of-hearing (DHH). DHH patients are at risk of being limited English-proficient, and experience unique
barriers to effective patient-provider communication and healthy living. Health services research focusing on
this population is scarce but indicates that DHH adults are at higher risk than their hearing English-speaking
counterparts of using the ED for less emergent conditions. Importantly, the majority of research on DHH health
disparities is from Rochester, NY; Rochester has one of the highest per capita populations of DHH people, who
likely have higher educational attainment and more access to healthcare than the broader Deaf community.
Even in this more optimal setting, disparities in ED utilization have been observed; yet, there has not been
further investigation of the extent of this disparity in more representative contexts. The lack of an empirical,
holistic understanding of the unique factors influencing ED utilization among DHH patients represents a critical
barrier to progress in the field, and hinders efforts to improve care and reduce health disparities for DHH
patients. Thus, the purpose of this study is to develop and refine a conceptual model of ED utilization among
DHH patients which will allow us to gain a more in-depth understanding of this population’s health behavior.
Our research design is multistage: we start with a critical literature review to develop a preliminary conceptual
model, and then revise this model from evidence obtained through an explanatory sequential mixed methods
study. The specific aims are to: 1) conduct a critical review of the peer reviewed and gray literature to develop
a preliminary conceptual model of DHH patient ED utilization; 2) evaluate differences in ED utilization and
presenting clinical characteristics among DHH and hearing patients through a retrospective chart review of
patient electronic medical records; 3) qualitatively assess ED utilization and experience perspectives among
DHH patients and ED providers; and, 4) integrate the findings from Aim 2 and 3 through mixed methods
integrative data analysis to revise the conceptual model. This proposal directly responds to AHRQ’s priority
area of harnessing data to gain a 360-degree view of patient outcomes among members of an AHRQ-identified
priority population (i.e., individuals with special healthcare needs – people with disabilities). The expected
outcome of this study will be a conceptual framework that can be used to identify intervention targets to
improve healthcare delivery and ensure efficient healthcare utilization for the 55 million DHH patients in the
U.S.

## Key facts

- **NIH application ID:** 9988020
- **Project number:** 1R36HS027537-01
- **Recipient organization:** UNIVERSITY OF FLORIDA
- **Principal Investigator:** Tyler G James
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $41,062
- **Award type:** 1
- **Project period:** 2020-04-01 → 2021-08-15

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9988020

## Citation

> US National Institutes of Health, RePORTER application 9988020, Development of a conceptual model of emergency department utilization among deaf and hard-of-hearing patients: A mixed methods study (1R36HS027537-01). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/9988020. Licensed CC0.

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