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Deaf Patients Experience Delays in Time to Outpatient Orthopedic Appointments
Arezo Ahmadi, BS, Sophia S Yin, BS, Yew Song Cheng, MD; Lauren M Shapiro, MD, MS
University of California, San Francisco, San Francisco, CA
INTRODUCTION: Several studies have demonstrated that patients communicating in languages other than English, including American Sign Language (ASL), often face barriers accessing timely healthcare in the U.S. In this study, we evaluated the time to orthopedic outpatient appointments for deaf patients communicating in ASL with distal radius fractures (DRFx).
MATERIALS & METHODS: Researchers called 132 randomly selected orthopedic offices (community and academic) across the U.S. to request appointments for fictitious patients with DRFx. Investigators called each office twice on the same weekday of different weeks, one call on behalf of a hearing patient and the other for a deaf patient communicating in ASL. The primary outcome was time to appointment. Secondary analysis included provider type, ASL interpreter availability, interpreter modality, and requests for family interpretation. A paired t-test was used to analyze statistical differences in appointment time between hearing and deaf patients. Subgroup analysis, including a t-test and ANOVA, was used to understand the effect of hospital type and region on disparities in time to appointment.
RESULTS: Data from 132 clinics was analyzed (63 academic, 69 community / private practice). The time to appointment for patients across all regions, practices, and providers was 3.9 days. Deaf patients experienced significantly longer wait times for physician appointments (4.96 vs. 3.32 days, p-value: 0.0031, Figure 1). This difference remained significant for MD appointments within practice type (p-values: 0.032 at academic and 0.042 at community / private practice, Figure 2). When all providers were considered (MD, NP, or PA), deaf patients had longer wait times (4.43 vs. 3.38 days), but the difference was not statistically significant (p-value: 0.060, Figure 1). Paired t-test and ANOVA found disparities between time to appointment for hearing and deaf patients to be similar between hospital types (p-value: 0.55) and region (p-value: 0.99), respectively. 70.45% of hearing patients secured appointments, while 72.72% of deaf patients secured appointments with a provider. Interpreters were provided in most offices (81.2%), with 68.2% of community hospitals / private practices and 95.5% of academic institutions guaranteeing ASL interpretation (Figure 3). Some offices (17.9%) requested family members interpret instead.
CONCLUSIONS: DRFx are common, and evidence suggests prompt care results in better outcomes and quicker return-to-work time. This study demonstrates delays for deaf patients seeking surgical appointments with MDs and reliance on ad hoc interpreters. Although the clinical significance of such inequities is unknown, future investigation is warranted to evaluate drivers of delays and limited interpreter access.
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