Vanderbilt Audiology Adult Hearing Aid Outcome Measures: State of the Program and Future Directions

Transcription

1 Vanderbilt Audiology Adult Hearing Aid Outcome Measures: State of the Program and Future Directions rd Annual Convention Tennessee Association of Audiologist and Speech-Language Pathologists and Tennessee Academy of Audiology October 29 and 30, 2015 Chattanooga, TN Sarah Shepherd, Au.D., CCC-A Vanderbilt Bill Wilkerson Center, Division of Audiology

2 Disclosures I am a salaried employee of Vanderbilt University Bill Wilkerson Center, Division of Audiology Thanks to Jill Gruenwald, Au.D. and Devin McCaslin, Ph.D. for their guidance and assistance

3 Objective Outcome Measures Audiogram, PTA, speech-in-noise performance, match to prescriptive targets, etc Subjective Patient satisfaction, activity limitations, participation restrictions, etc

4 VBCW Outcome Measures Program Academic medical center Private pay and financial assistance programs housed together 9 Audiologists working with adult hearing aid patients Clinicians administer a collection of self-report questionnaires aimed to determine Subjective hearing handicap Amplification expectations Amplification satisfaction Subjective benefit from amplification Began in 2014, data collection and analysis ongoing in 2015 Database management using Vanderbilt RedCap

5 Current Outcome Measures Used HHIE (Hearing Handicap Inventory for the Elderly) 25 item self-assessment designed to assess the effects of hearing impairment on the emotional and social adjustment of elderly people 13 item emotional consequences subscale 12 item social and situational consequences subscale Ventry 1982

6 Current Outcome Measures Used ECHO (Expected Consequences of Hearing aid Ownership ) 15 item self-assessment designed to measure pre-fit expectations of hearing aid use Global Score and Four subscales Positive Effect, Service & Cost, Negative Features, and Personal Image Companion to the SADL Cox et. al 2000

7 Current Outcome Measures Used SADL (Satisfaction with Amplification in Daily Life) 15 item self-assessment designed to evaluate the satisfaction that people feel with their current hearing aids Global Score and Four subscales Positive Effect, Service & Cost, Negative Features, and Personal Image Companion to the ECHO Cox et. al 1999

8 Current Outcome Measures Used SSQ12 (Speech, Spatial and Qualities of Hearing Short Form ) 12 item self-assessment designed to evaluate subjective hearing performance Three Subscales Short form of the SSQ (49 items) Gatehouse et. al 2004

9 Current Outcome Measures Used HHIE: pre-selection ECHO: post-selection SADL: post-fit (2 weeks) SSQ12: post-fit (2 weeks)

10 Private Pay vs. Financial Assistance programs Pre-selection self-reported handicap metric (HHIE) Satisfaction metric (SADL) Are these two groups inherently different? Can we improve outcomes by learning more about these two groups?

11 Results Pre-treatment hearing handicap (HHIE) Patients treated through the financial assistance programs report significantly higher pretreatment hearing handicap Total score, social and emotional subscales were significantly different between the groups Paired t-test with resulting p value < 0.05

12 Results Hearing Aid Satisfaction (SADL) Patients treated through the financial assistance programs report equal satisfaction on the SADL, with the exception of one subscale (Paired t-test with resulting p value < 0.05)

13 Results Financial assistance patients may enter their treatment with more subjective handicap, but their satisfaction only differs from the private pay clinic in their selfimage of their hearing aids and hearing loss.

14 Results Cox et. al 2013 VA patients reported higher HHIE scores than those at private pay clinics VA patients, however, noted more satisfaction for positive effect and service/cost than private pay patients on SADL Otherwise, satisfaction metrics were grossly equal

15 Future Directions Build larger database, modeling, prediction of satisfaction, performance Incorporate CI, BAI, and pediatrics into the database Answer questions our clinic wants to know: Does satisfaction with hearing aids impact decision to pursue CI? What specific factors are patients satisfied with? What can we improve for our patients, patient cohorts, our service delivery models, and across all audiology patients?

16 References Cox, RM and Alexander, GC. (1999)"Measuring satisfaction with amplification in daily life: The SADL Scale", Ear and Hearing, 20: Cox, R.M., and Alexander, G.C. (2000)"Expectations about hearing aids and their relationship to fitting outcome." Journal of the American Academy of Audiology, 11: Cox, RM and Alexander, GC. (2001) "Validation of the SADL Questionnaire", Ear and Hearing, 22: Dorner TE, Muckenhuber J, Strongegger WJ, Rasky E, Gustorff B, Freidl W (2001). The Impact of Socio-Economic Status on Pain and the Perception of Disability Due to Pain. Eur J Pain, Jan: 15 (1), Everson S, Maty S, Lynch J, Kaplan GA (2002). Epidemiologic evidence for the relation between socioeconomic status and depression, obesity, and diabetes. Journal of Psychosomatic Research, 53 (4): Gatehouse S, Noble W (2004). The speech, spatial and qualities of hearing scale (SSQ). International Journal of Audiology, 43(2), p Noble W, Jensen NS, Naylor G, Bhullar N, Akeroyd MA (2013). A short form of the Speech, Spatial and Qualities of Hearing scale suitable for clinical use: The SSQ12. International Journal of Audiology, 52(6), Ventry IM, Weinstein BE. (1982) The Hearing Handicap Inventory for the Elderly: A New Tool. Ear Hear. May-Jun;3(3): Weinstein BE, Ventry IM. (1983) Audiometric Correlates of the Hearing Handicap Inventory for the Elderly. J Speech Hear Disord. Nov;48(4): WHO, (1980) International Classification of Impairments, Disabilities, and Handicaps