Progressive Tinnitus Management: An Assessment of Readiness

渐进式耳鸣管理：准备情况评估

• 批准号: 8732214
• 负责人: JAMES A HENRY
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-10-01 至 2015-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8732214
• 关键词: Address; Adoption; Audiology; Auditory; Awareness; Blast Cell; Caring; Chronic; Clinic; Clinical; Clinical Research; Clinical Services; Collaborations; Communities; Controlled Study; Counseling; Country; Data; Development; Effectiveness; Environment; Explosion; Family; Feedback; Future; Goals; Health; Hearing; Home environment; Hybrids; Injury; Intervention; Interview; Learning; Life; Location; Medical center; Mental Health; Mental Health Services; Methods; Military Personnel; Mission; Modality; Noise; Outcome; Outpatients; Pacific Northwest; Patient-Centered Care; Patients; Perception; Peripheral; Phase; Practice Management; Preparation; Provider; Randomized; Randomized Controlled Trials; Reaction; Readiness; Recommendation; Reporting; Research; Research Infrastructure; Resources; Self Management; Services; Site; Speech Pathology; Structure; Support System; Surveys; Symptoms; System; TBI Patients; Technology; Testing; Tinnitus; Training; Traumatic Brain Injury; Veterans; Work; base; design; disability; effective intervention; evidence base; experience; functional disability; hazard; health administration; hearing impairment; improved; interest; peer; point of care; prevent; programs; response; satisfaction; scale up; telehealth

Tinnitus is the most prevalent service-connected disability for Veterans; it is also strongly associated with traumatic brain injury (TBI) and polytrauma. The Veterans Health Administration (VHA) is committed to providing access to tinnitus services to improve patient engagement in self management and health outcomes. We have developed Progressive Tinnitus Management (PTM), a cross-disciplinary (Mental Health and Audiology) counseling/self-management program that has been shown in controlled studies to reduce symptoms and improve life satisfaction for tinnitus sufferers. VA Audiology and Speech Pathology (ASP) Service has endorsed PTM as an effective intervention for tinnitus and has recommended its use at VA medical centers (VAMCs). However, PTM is not routinely offered to Veterans suffering from tinnitus. In partnership with VA Program Offices (Mental Health Services and ASP Service) and the Polytrauma and Blast- Related Injuries (PT/BRI) QUERI, we plan to examine provider- and systems-level contributors to this gap between evidence-based VA recommendations and provider practices. This 1-year mixed-methods study will be conducted in three phases: (1) conduct an online survey to describe current tinnitus management practices in VA Audiology and Mental Health (MH) programs nationwide; (2) conduct interviews to determine barriers and facilitators to providing PTM in selected VA clinics nationwide; and (3) conduct interviews to determine readiness of clinics in VISN 20 to conduct an implementation study of PTM. The goal is to better understand provider and systems factors associated with implementation of PTM services in VA outpatient Audiology and MH clinics. Of interest are both providers' experiences and the context in which they occur in VA environments that both facilitate and impede the ability to implement PTM services. The study directly addresses all three PT/BRI QUERI priority goals: (1) Support and enhance implementation of evidence-based, integrated, patient-centered care for patients with TBI/polytrauma. (2) Improve patients' ability to manage their persistent TBI/polytrauma-related symptoms, impairments, and functional difficulties. (3) Optimize Veterans' support systems, including family, peers, VA, and community resources. Through team collaboration with the VA Program Offices and the PT/BRI QUERI, the dissemination of these study results will be widespread. Data findings from this research will inform the development of a program of research that will evaluate the dissemination and implementation of VA tinnitus management programs nationally, with focus on PTM. Following successful completion of the Rapid Response Project, we intend to conduct a "point of care" study to evaluate three modalities for delivering PTM in VISN 20: (1) in the clinic; (2) using Clinical Video Telehealth at VA sites of care; and (3) Home Telehealth for Veterans who cannot otherwise access VA tinnitus services. We are currently completing two randomized clinical studies evaluating two of the three modalities for delivering the PTM intervention: In-Clinic Care and In-Home Telehealth. Preliminary analyses, both quantitative and qualitative, reveal that both modalities provide efficacious intervention (see Appendices 1 and 2). Long-term, implementation of PTM can provide access to effective tinnitus services for Veterans everywhere. The two telehealth modalities could be delivered from major VAMCs and/or from a centralized location. A centralized program could provide tinnitus telehealth services directly to Veterans, and could also support VA clinicians in their efforts to provide tinnitus services to their patients. A centralized tinnitus program would promote uniform tinnitus care on a national basis, and would result in a new standard of efficiency and improved outcomes for managing the needs of all Veterans suffering from tinnitus.

耳鸣是退伍军人最普遍的服务连接的残疾。它也与 创伤性脑损伤（TBI）和多发性疾病。退伍军人卫生管理局（VHA）致力于 提供耳鸣服务，以改善患者参与自我管理和健康成果。 我们已经开发了跨学科的渐进耳鸣管理（PTM）（心理健康和 听力学）咨询/自我管理计划已在对照研究中显示以减少 症状并提高耳鸣患者的生活满意度。 VA听力学和语音病理学（ASP） 服务已认可PTM作为耳鸣的有效干预措施，并建议在VA上使用。 医疗中心（VAMCS）。但是，PTM并未经常向患有耳鸣的退伍军人提供。在 与VA计划办公室（心理健康服务和ASP服务）以及Polytrauma和Blast的合作伙伴关系 - 相关伤害（pt/bri）queri，我们计划检查提供者和系统级别的贡献者 在基于证据的VA建议和提供商实践之间。 这项为期1年的混合方法研究将分为三个阶段：（1）在线调查 描述当前在全国范围内VA听力学和心理健康（MH）计划的耳鸣管理实践； （2）进行访谈，以确定在全国选定的VA诊所提供PTM的障碍和促进者； （3）进行访谈以确定VISN 20中诊所的准备就绪，以进行实施研究 PTM。目标是更好地了解提供商和与实施PTM相关的系统因素 VA门诊听力学和MH诊所的服务。感兴趣的是提供者的经验和背景 它们发生在VA环境中，既可以促进并阻碍实施PTM服务的能力。 该研究直接解决了所有三个pt/bri queri优先目标：（1）支持和增强实施 针对TBI/Polytrauma患者的循证，综合，以患者为中心的护理。 （2）改善患者 能够管理其持续性TBI/多曲与症状，障碍和功能困难的能力。 （3） 优化退伍军人的支持系统，包括家庭，同行，VA和社区资源。 通过与VA计划办公室和PT/Bri Queri的团队合作，传播 这些研究结果将是普遍的。这项研究的数据发现将为开发 研究计划将评估VA耳鸣管理的传播和实施 全国计划，重点是PTM。成功完成快速响应项目后，我们 打算进行“护理点”研究，以评估三种在VISN中传递PTM的方式：（1） 诊所; （2）在VA护理站点使用临床视频远程医疗； （3）不能为退伍军人提供远程医疗 否则访问VA耳鸣服务。我们目前正在完成两项评估的随机临床研究 提供PTM干预措施的三种方式中的两种：临床护理和家庭远程医疗。 定量和定性的初步分析表明，这两种方式都提供了有效的 干预（请参阅附录1和2）。 长期实施PTM可以为退伍军人提供有效的耳鸣服务 到处。这两种远程医疗模式可以从主要的VAMC和/或集中式传递 地点。集中计划可以直接向退伍军人提供耳鸣远程医疗服务，也可以 支持VA临床医生为患者提供耳鸣服务的努力。集中的耳鸣计划 将在全国范围内促进统一的耳鸣护理，并将导致新的效率标准 改善了管理所有患有耳鸣的退伍军人需求的结果。