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Article ; Online: "There is No Communication": A Qualitative Examination of Deaf Signers' Experiences With Advance Care Planning.

Cerilli, Caroline / Katz, Gabrielle / Volandes, Angelo E / Davis, Aretha Delight / Paasche-Orlow, Michael K / James, Tyler G / McKee, Michael M

Journal of palliative care

2023 Volume 38, Issue 3, Page(s) 372–380

Abstract: Objective(s): ...

Abstract	Objective(s):
MeSH term(s)	Humans ; Deafness ; Sign Language ; Language ; Advance Care Planning ; Terminal Care
Language	English
Publishing date	2023-06-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	639326-3
ISSN	2369-5293 ; 0825-8597
ISSN (online)	2369-5293
ISSN	0825-8597
DOI	10.1177/08258597231179763
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Article ; Online: Self-Reported Accommodation Needs for Patients with Disabilities in Primary Care.

Buning, Grayson E / James, Tyler G / Richards, Blair / McKee, Michael M

Joint Commission journal on quality and patient safety

2023 Volume 50, Issue 1, Page(s) 59–65

Abstract: Background: People with disabilities experience barriers to engaging with health care due to inaccessible social and physical environments at primary care clinics. Despite legal mandates, identification and provision of necessary accommodations for this ...

Abstract	Background: People with disabilities experience barriers to engaging with health care due to inaccessible social and physical environments at primary care clinics. Despite legal mandates, identification and provision of necessary accommodations for this population at primary care clinics are poor. The objective of this cross-sectional study was to assess patient-reported disability status and accommodation needs among patients at a primary care clinic. Methods: An electronic health record-based Disability and Accommodations Questionnaire assessing disability status, types, and accommodation needs was developed by subject matter experts at Michigan Medicine and the University of Michigan Council for Disability Concerns. The questionnaire underwent multiple rounds of reviews and revisions before its use in clinical settings. A paper-based questionnaire was administered to all patients presenting for a wellness-based visit at an academic health system primary care clinic in southeast Michigan. Data were collected between March 2022 and August 2022. Results: Approximately 13% of the 541 patients self-reported a disability, with 54.2% indicating at least one needed accommodation. The most commonly reported disabilities were mental health and hearing-related disabilities, by 4.8% and 4.6% of patients, respectively. The most frequently requested accommodations were communication- or language-based (for example, presence of an American Sign Language interpreter, assistive listening devices), cognitive-based (for example, inclusion of a support person with care decisions), and mobility-based (for example, assistance with transfers). Conclusion: The Disability and Accommodations Questionnaire helped identify the presence of a disability, its types, and any requested accommodations requested at a primary care health center.
MeSH term(s)	Humans ; Self Report ; Cross-Sectional Studies ; Disabled Persons ; Surveys and Questionnaires ; Primary Health Care
Language	English
Publishing date	2023-10-29
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1189890-2
ISSN	1938-131X ; 1549-425X ; 1553-7250 ; 1070-3241 ; 1549-3741
ISSN (online)	1938-131X ; 1549-425X
ISSN	1553-7250 ; 1070-3241 ; 1549-3741
DOI	10.1016/j.jcjq.2023.10.012
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Article: Preventive Care for Adults With Cerebral Palsy and Other Neurodevelopmental Disabilities: Are We Missing the Point?

Whitney, Daniel G / Rabideau, Michelle L / McKee, Michael / Hurvitz, Edward A

Frontiers in integrative neuroscience

2022 Volume 16, Page(s) 866765

Abstract: Preventive care techniques are cornerstones of primary care for people with neurodevelopmental disabilities such as cerebral palsy (CP). However, well-established methods evaluating health constructs may not be applied in the same way for adults with CP, ...

Abstract	Preventive care techniques are cornerstones of primary care for people with neurodevelopmental disabilities such as cerebral palsy (CP). However, well-established methods evaluating health constructs may not be applied in the same way for adults with CP, as compared to the general population, due to differences in anatomy/physiology, leading to missed opportunities for interventions, medication modifications, and other primary/secondary prevention goals. One barrier to care prevention comes from misinterpretation of values to capture health constructs, even when measurements are accurate. In this Perspective, we emphasize the need for differential interpretation of values from commonly used clinical measures that assess for well-known medical issues among adults with CP obesity risk, bone health, and kidney health. We provide technical, but simple, evidence to showcase why the underlying assumptions of how some measures relate to the health construct being assessed may not be appropriate for adults with CP, which may apply to other neurodevelopmental conditions across the lifespan.
Language	English
Publishing date	2022-04-07
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2452962-X
ISSN	1662-5145
ISSN	1662-5145
DOI	10.3389/fnint.2022.866765
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Article: Model Clinic to Increase Preventive Screenings Among Patients With Physical Disabilities: Protocol for a Mixed Methods Intervention Pilot Study.

Palazzolo, Beatrice / Carbone, Loretta / James, Tyler G / Heizelman, Robert / Sen, Ananda / Mahmoudi, Elham / McKee, Michael

JMIR research protocols

2023 Volume 12, Page(s) e50105

Abstract: Background: People with physical disabilities often experience premature multimorbidity and adverse health events. A tailored primary care approach for this vulnerable population that also accounts for social and functional risk factors could promote ... ...

Abstract	Background: People with physical disabilities often experience premature multimorbidity and adverse health events. A tailored primary care approach for this vulnerable population that also accounts for social and functional risk factors could promote healthier aging and more equitable health care. Objective: This project will evaluate the implementation of a health program designed for people with physical disabilities. The proposed evaluation result is to generate the first best-practice protocol focused specifically on developing primary care to help reduce preventable causes of morbidity and improve functioning among people with physical disabilities. Methods: We will design and implement a pilot health program for people with physical disabilities at a primary care clinic within Michigan Medicine. The health program for people with physical disabilities will be an integrated intervention involving a tailored best practice alert designed to prompt family medicine providers to screen and monitor for common, preventable health conditions. The program will also collect social and functional status information to determine the patient's need for further care coordination and support. Adult participants from this clinic with identified physical disabilities will be targeted for potential enrollment. To create a quasi-experimental setting, a separate departmental clinic will serve as a control site for comparison purposes. A quantitative analysis to estimate the treatment effect of implementing this health program will be conducted using a difference-in-differences approach. Outcomes of interest will include the use of preventative services (eg, hemoglobin A Results: This study was funded in September 2018, data collection started in September 2021, and data collection is expected to be concluded in September 2023. Conclusions: This study is a mixed methods evaluation of the effectiveness of an integrated health program designed for people with physical disabilities, based on a quasi-experimental comparison between an intervention and a control clinic site. The intervention will be considered successful if it leads to improvements in greater use of screening and monitoring for preventable health conditions, increased social worker referrals to assist with health and functioning needs, and improvements in emergency and hospital-based services. The findings will help inform best practices for people with physical disabilities in a primary care setting. International registered report identifier (irrid): DERR1-10.2196/50105.
Language	English
Publishing date	2023-10-25
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2719222-2
ISSN	1929-0748
ISSN	1929-0748
DOI	10.2196/50105
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Article ; Online: Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients.

James, Tyler G / Sullivan, Meagan K / McKee, Michael M / Rotoli, Jason / Maruca, David / Stachowiak, Rosemarie / Cheong, JeeWon / Varnes, Julia R

Health expectations : an international journal of public participation in health care and health policy

2023 Volume 26, Issue 6, Page(s) 2374–2386

Abstract: Background: Deaf and hard-of-hearing (DHH) patients are a priority population for emergency medicine health services research. DHH patients are at higher risk than non-DHH patients of using the emergency department (ED), have longer lengths of stay in ... ...

Abstract	Background: Deaf and hard-of-hearing (DHH) patients are a priority population for emergency medicine health services research. DHH patients are at higher risk than non-DHH patients of using the emergency department (ED), have longer lengths of stay in the ED and report poor patient-provider communication. This qualitative study aimed to describe ED care-seeking and patient-centred care perspectives among DHH patients. Methods: This qualitative study is the second phase of a mixed-methods study. The goal of this study was to further explain quantitative findings related to ED outcomes among DHH and non-DHH patients. We conducted semistructured interviews with 4 DHH American Sign Language (ASL)-users and 6 DHH English speakers from North Central Florida. Interviews were transcribed and analysed using a descriptive qualitative approach. Results: Two themes were developed: (1) DHH patients engage in a complex decision-making process to determine ED utilization and (2) patient-centred ED care differs between DHH ASL-users and DHH English speakers. The first theme describes the social-behavioural processes through which DHH patients assess their need to use the ED. The second theme focuses on the social environment within the ED: patients feeling stereotyped, involvement in the care process, pain communication, receipt of accommodations and discharge processes. Conclusions: This study underscores the importance of better understanding, and intervening in, DHH patient ED care-seeking and care delivery to improve patient outcomes. Like other studies, this study also finds that DHH patients are not a monolithic group and language status is an equity-relevant indicator. We also discuss recommendations for emergency medicine. Patient or public contribution: This study convened a community advisory group made up of four DHH people to assist in developing research questions, data collection tools and validation of the analysis and interpretation of data. Community advisory group members who were interested in co-authorship are listed in the byline, with others in the acknowledgements. In addition, several academic-based co-authors are also deaf or hard of hearing.
MeSH term(s)	Humans ; Deafness ; Persons With Hearing Impairments ; Language ; Sign Language ; Emergency Service, Hospital
Language	English
Publishing date	2023-08-09
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2119434-8
ISSN	1369-7625 ; 1369-6513
ISSN (online)	1369-7625
ISSN	1369-6513
DOI	10.1111/hex.13842
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Article ; Online: Clinician use of the Statin Choice Shared Decision-making Encounter Tool in a Major Health System.

Martinez, Kathryn A / Montori, Victor M / Rodriguez, Fatima / Tereshchenko, Larisa G / Kovach, Jeffrey D / Hurwitz, Heather McKee / Rothberg, Michael B

Journal of general internal medicine

2024

Abstract: Background: Effective shared decision-making (SDM) tools for use during clinical encounters are available, but, outside of study settings, little is known about clinician use of these tools in practice.: Objective: To describe real-world use of an ... ...

Abstract	Background: Effective shared decision-making (SDM) tools for use during clinical encounters are available, but, outside of study settings, little is known about clinician use of these tools in practice. Objective: To describe real-world use of an SDM encounter tool for statin prescribing, Statin Choice, embedded into the workflow of an electronic health record. Design: Cross-sectional study. Participants: Clinicians and their statin-eligible patients who had outpatient encounters between January 2020 and June 2021 in Cleveland Clinic Health System. Main measures: Clinician use of Statin Choice was recorded within the Epic record system. We categorized each patient's 10-year atherosclerotic cardiovascular disease risk into low (< 5%), borderline (5-7.5%), intermediate (7.5-20%), and high (≥ 20%). Other patient factors included age, sex, insurance, and race. We used mixed effects logistic regression to assess the odds of using Statin Choice for statin-eligible patients, accounting for clustering by clinician and site. We generated a residual intraclass correlation coefficient (ICC) to characterize the impact of the clinician on Statin Choice use. Key results: Statin Choice was used in 7% of 68,505 eligible patients. Of 1047 clinicians, 48% used Statin Choice with ≥ 1 patient, and these clinicians used it with a median 9% of their patients (interquartile range: 3-22%). In the mixed effects logistic regression model, patient age (adjusted OR per year: 1.04; 95%CI 1.03-1.04) and 10-year ASVCD risk (aOR for 5-7.5% versus < 5% risk: 1.28; 95%CI: 1.14-1.44) were associated with use of Statin Choice. Black versus White race was associated with a lower odds of Statin Choice use (aOR: 0.83; 95%CI: 0.73-0.95), as was female versus male sex (aOR: 0.83; 95%CI: 0.76-0.90). The model ICC demonstrated that 53% of the variation in use of Statin Choice was clinician-driven. Conclusions: Patient factors, including race and sex, were associated with clinician use of Statin Choice; half the variation in use was attributable to individual clinicians.
Language	English
Publishing date	2024-01-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-023-08597-3
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Article ; Online: Molecular Characterization of a Novel Relapsing Fever Borrelia Species from the Desert Cottontail (Sylvilagus audubonii) in New Mexico, USA.

Goodrich, Irina / McKee, Clifton / Margos, Gabriele / Kosoy, Michael

Journal of wildlife diseases

2022 Volume 58, Issue 3, Page(s) 646–651

Abstract: The Borrelia genus comprises vector-borne, spirochete bacteria infecting vertebrates worldwide. We characterized a novel relapsing fever Borrelia species from a desert cottontail (Syvilagus audubonii) from New Mexico, US, using an established multilocus ... ...

Abstract	The Borrelia genus comprises vector-borne, spirochete bacteria infecting vertebrates worldwide. We characterized a novel relapsing fever Borrelia species from a desert cottontail (Syvilagus audubonii) from New Mexico, US, using an established multilocus sequence analysis approach. Phylogenetic analysis of the flagellin gene (flaB) and four other protein-coding loci (clpX, pepX, recG, rplB) grouped the novel Borrelia species with hard tick relapsing fever borreliae Borrelia lonestari, Borrelia theileri, and Borrelia miyamotoi. The identity of the vectors and other vertebrate hosts, geographic distribution, and zoonotic potential of this novel Borrelia species deserve further investigation.
MeSH term(s)	Animals ; Borrelia/genetics ; New Mexico ; Phylogeny ; Relapsing Fever/epidemiology ; Relapsing Fever/microbiology ; Relapsing Fever/veterinary
Language	English
Publishing date	2022-06-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	410709-3
ISSN	1943-3700 ; 0090-3558
ISSN (online)	1943-3700
ISSN	0090-3558
DOI	10.7589/JWD-D-21-00148
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Article ; Online: Experiences of Sign Language Interpreters and Perspectives of Interpreting Administrators During the COVID-19 Pandemic: A Qualitative Description.

Roman, Gretchen / Samar, Vincent / Ossip, Deborah / McKee, Michael / Barnett, Steven / Yousefi-Nooraie, Reza

Public health reports (Washington, D.C. : 1974)

2023 Volume 138, Issue 4, Page(s) 691–704

Abstract: Objective: Interpreting during the COVID-19 pandemic caused stress and adverse mental health among sign language interpreters. The objective of this study was to summarize the pandemic-related work experiences of sign language interpreters and ... ...

Abstract	Objective: Interpreting during the COVID-19 pandemic caused stress and adverse mental health among sign language interpreters. The objective of this study was to summarize the pandemic-related work experiences of sign language interpreters and interpreting administrators upon transitioning from on-site to remote work. Methods: From March through August 2021, we conducted focus groups with 22 sign language interpreters in 5 settings, 1 focus group for each setting: staff, educational, community/freelance, video remote interpreting, and video relay services. We also conducted 5 individual interviews with interpreting administrators or individuals in positions of administrative leadership in each represented setting. The 22 interpreters had a mean (SD) age of 43.4 (9.8) years, 18 were female, 17 were White, all identified as hearing, and all worked a mean (SD) of 30.6 (11.6) hours per week in remote interpreting. We asked participants about the positive and negative consequences of transitioning from on-site to remote at-home interpreting. We established a thematic framework by way of qualitative description for data analysis. Results: We found considerable overlap across positive and negative consequences identified by interpreters and interpreting administrators. Positive consequences of transitioning from on-site to remote-at-home interpreting were realized across 5 overarching topic areas: organizational support, new opportunities, well-being, connections/relationships, and scheduling. Negative consequences emerged across 4 overarching topic areas: technology, financial aspects, availability of the interpreter workforce, and concerns about the occupational health of interpreters. Conclusions: The positive and negative consequences shared by interpreters and interpreting administrators provide foundational knowledge upon which to create recommendations for the anticipated sustainment of some remote interpreting practice in a manner that protects and promotes occupational health.
MeSH term(s)	Humans ; Female ; Adult ; Male ; Communication Barriers ; Pandemics ; Sign Language ; COVID-19/epidemiology ; Allied Health Personnel
Language	English
Publishing date	2023-05-27
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	120953-x
ISSN	1468-2877 ; 0033-3549
ISSN (online)	1468-2877
ISSN	0033-3549
DOI	10.1177/00333549231173941
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Article ; Online: Promoting health equity for deaf patients through the electronic health record.

James, Tyler G / Sullivan, Meagan K / Butler, Joshua D / McKee, Michael M

Journal of the American Medical Informatics Association : JAMIA

2021 Volume 29, Issue 1, Page(s) 213–216

Abstract: Language status can be conceptualized as an equity-relevant variable, particularly for non-English-speaking populations. Deaf and hard-of-hearing (DHH) individuals who use American Sign Language (ASL) to communicate comprise one such group and are ... ...

Abstract	Language status can be conceptualized as an equity-relevant variable, particularly for non-English-speaking populations. Deaf and hard-of-hearing (DHH) individuals who use American Sign Language (ASL) to communicate comprise one such group and are understudied in health services research. DHH individuals are at high-risk of receiving lower-quality care due to ineffective patient-provider communication. This perspective outlines barriers to health equity research serving DHH ASL-users due to systems developed by large-scale informatics networks (eg, the Patient-Centered Clinical Outcomes Research Network), and institutional policies on self-serve cohort discovery tools. We list potential to help adequate capture of language status of DHH ASL-users to promote health equity for this population.
MeSH term(s)	Electronic Health Records ; Health Equity ; Health Promotion ; Humans ; Persons With Hearing Impairments ; Sign Language
Language	English
Publishing date	2021-11-05
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1205156-1
ISSN	1527-974X ; 1067-5027
ISSN (online)	1527-974X
ISSN	1067-5027
DOI	10.1093/jamia/ocab239
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Article ; Online: Spotlighting Disability in a Major Electronic Health Record: Michigan Medicine's Disability and Accommodations Tab.

Halkides, Heather / James, Tyler G / McKee, Michael M / Meade, Michelle A / Moran, Christa / Park, Sophia

JMIR formative research

2022 Volume 6, Issue 12, Page(s) e38003

Abstract: People with disabilities represent the largest minority group in the United States and a priority population for health services research. Despite federal civil rights law, people with disabilities face inaccessible health care environments that fail to ... ...

Abstract	People with disabilities represent the largest minority group in the United States and a priority population for health services research. Despite federal civil rights law, people with disabilities face inaccessible health care environments that fail to accommodate their disability. We present Michigan Medicine's Disability and Accommodations Tab. This patient-facing questionnaire and shared data field in the electronic health record enables the collection and reporting of patient disability-related accommodations. The Disability Tab seeks to address provider- and clinic staff-reported barriers to providing accommodations and fosters an opportunity to redesign health care to meet the needs of people with disabilities.
Language	English
Publishing date	2022-12-02
Publishing country	Canada
Document type	Journal Article
ISSN	2561-326X
ISSN (online)	2561-326X
DOI	10.2196/38003
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