Addressing Barriers to Adult Hearing Healthcare

解决成人听力保健的障碍

• 批准号: 9385356
• 负责人: Debara L. Tucci
• 金额: $ 54.79万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-01-01 至 2020-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9385356
• 关键词: Address; Adult; Affect; Age; Appointment; Attitude; Audiology; Caring; Case Report Form; Chronic; Clinic; Clinical Research; Communication impairment; Community Practice; Community of Practice; Competence; Complement; Costs and Benefits; Data; Decision Making; Development; Diagnosis; Diagnostic; Diagnostic tests; Ear; Ear Diseases; Education; Educational Materials; Effectiveness; Elderly; Eligibility Determination; Enrollment; Ensure; Evaluation; Evaluation Studies; Failure; Focus Groups; Funding; Future; Goals; Gold; Head and Neck Surgery; Health Policy; Health Services Accessibility; Health system; Healthcare; Hearing; Hearing Aids; Home environment; Incidence; Intensive Care; Intervention; Leadership; Medical; Methods; Modeling; Morbidity - disease rate; Network-based; North Carolina; Otolaryngology; Partner Communications; Patients; Phase; Physicians; Policies; Population; Presbycusis; Prevalence; Primary Health Care; Procedures; Protocols documentation; Provider; Questionnaires; Recommendation; Recording of previous events; Recruitment Activity; Research; Resources; Sales; Sampling; Site; Specialist; Surveys; Telephone; Testing; Time; Training; United States National Institutes of Health; Validity and Reliability; Work; adverse outcome; base; care delivery; clinical practice; cohort; cost; cost effective; cost efficient; design; group intervention; health care delivery; hearing impairment; hearing screening; interest; patient population; primary care setting; primary outcome; public health relevance; routine practice; screening; symposium; tv watching; waiver; willingness

 DESCRIPTION (provided by applicant): The goals of this application are to: 1) determine what level of involvement by the primary care practitioner (PCP) is required to inform and encourage adults age 65-75 to follow through with routine hearing screening; 2) develop a model of effective adult hearing screening, based on resource utilization and screening compliance in each intervention group, that maximizes identification of hearing loss in affected patients and minimizes burden to the PCP and patient; 3) determine what factors are important to adults 65-75 in making decisions about hearing screening and interventions and develop strategies to optimize appropriate intervention; and 4) provide data on the ability of patients, audiologists and primary care providers to identify significant medical conditions that should be evaluated by an ear specialist prior to hearing aid procurement. This latter goal could help to inform FDA policy which currently requires either medical evaluation and clearance or a waiver to forego medical evaluation prior to hearing aid fitting. The current recommendation by the FDA is not evidence-based, and has been interpreted by some as prohibitive of less resource-intensive care delivery models such as remote hearing aid sales or over the counter (OTC) procurement. In the proposed research, we will compare implementation of three PCP-based hearing screening strategies (total N=660) that include progressive levels of PCP time and guidance to complete telephone-based hearing screening. Those who fail screening (estimate: N=100) go on to a medical referral study and receive (1) diagnostic audiological testing and (2) determination of the reliability and validity of identification of conditions that should require medical referral pior to hearing aid provision. The N in the medical referral study from the PCP-based screening is complemented by a sample of 500 patients from the NIH-funded CHEER network seen for ear related problems. A successful implementation of the study will help us understand: 1) the most effective and cost-efficient strategy for hearing screening implementation in this population; 2) the factors that are important to patients in their decisions regarding hearing healthcare; 3) the level of medical care required to insure that hearing aid fitting is safe, and whether the 'medical model' of hearing aid procurement is warranted. Our team of collaborators includes providers and academics of diverse backgrounds, to provide wide expertise and perspective. The study will utilize both PCP practices from the Primary Care Research Consortium in the Duke Health System, and the NIH-supported CHEER practice-based network, to ensure diversity of patient enrollment and generalizability to community practice. Our research will serve as the basis for future efforts to meaningfully influence health care approaches to hearing loss and health care policy related to hearing health care delivery, including FDA policy on hearing aid care delivery. Our ultimate goal is to provide information to inform changes in health care policy to facilitate accessible and affordable hearing health care.

 描述（由申请人提供）：本申请的目标是：1）确定初级保健医生（PCP）参与的程度，以告知并鼓励65-75岁的成年人进行常规听力筛查; 2）根据每个干预组的资源利用和筛查依从性，开发有效的成人听力筛查模型，最大限度地识别受影响患者的听力损失，并最大限度地减少PCP和患者的负担; 3）确定哪些因素对65-75岁的成年人在做出听力筛查和干预决策时很重要，并制定策略以优化适当的干预;以及4）提供患者，听力学家和 初级保健提供者确定在购买助听器之前应由耳专科医生评估的重要医疗条件。这后一个目标可以帮助告知FDA政策，该政策目前要求在助听器装配之前进行医疗评估和许可或放弃医疗评估。FDA目前的建议不是基于证据的，并且被一些人解释为禁止资源密集型护理提供模式，如远程助听器销售或非处方（OTC）采购。在拟议的研究中，我们将比较三个PCP为基础的听力筛查策略（总N=660），其中包括渐进水平的PCP时间和指导，以完成基于电话的听力筛查的实施。筛选失败者（估计：N=100）继续进行医疗转诊研究，并接受（1）诊断性听力学测试和（2）确定在提供助听器之前需要医疗转诊的情况的可靠性和有效性。来自PCP筛查的医疗转诊研究中的N由来自NIH资助的CHEER网络的500名患者样本补充，这些患者因耳部相关问题而就诊。这项研究的成功实施将帮助我们了解：1）在这一人群中实施听力筛查的最有效和最具成本效益的策略; 2）对患者做出听力保健决定的重要因素; 3）确保助听器验配安全所需的医疗护理水平，以及“医疗”是否 助听器的使用方法我们的合作者团队包括不同背景的供应商和学者，以提供广泛的专业知识和视角。该研究将利用杜克卫生系统初级保健研究联盟的PCP实践和NIH支持的基于实践的CHEER网络，以确保患者入组的多样性和社区实践的普遍性。我们的研究将作为未来努力的基础，以有意义地影响听力损失的医疗保健方法和与听力保健提供相关的医疗保健政策，包括FDA关于助听器护理提供的政策。我们的最终目标是提供信息，告知医疗保健政策的变化，以促进可获得和负担得起的听力保健。