Cost-effective hearing aid delivery models: Outcomes, value, and candidacy

项目总结/摘要 与听力损失相关的听力损失是一个重大的国家问题，由于其高患病率和显着的 心理社会后果。虽然助听器（HAs）是管理听力损失的主要干预措施， 在与年龄相关的听力损失中，只有15-30%的人可以从HA中受益，实际上寻求他们。HA 低收入者和少数种族和族裔的收养率甚至更低。之一 人们不寻求医管局干预的最常见原因是医管局费用高昂， 相关的听力学验配服务。因为他们采用了以听力学家为基础的服务模式 (AUD越来越多的美国人（2010年为150万人）购买放大设备 通过非处方服务提供模式（OTC模式）来补偿他们受损的听力。 尽管OTC放大装置越来越受欢迎，并且被认为是用于治疗的重要选择， 促进可获得和负担得起的听力保健，目前还不清楚它们是否是与年龄有关的可行解决方案。 听力损失作为OTC模式排除专业服务。此外，如果之间存在结果差异 AUD和OTC模型，尚不清楚结局的临床改善是否会被改善的 价值（相对于成本的结果），或者是否有可能为每种模式确定适当的候选资格，以确保 为所有患者提供最佳护理。最后，没有先前的研究调查，如果“混合”服务交付模式， 专业人士提供精简的服务，以适应OTC放大设备，提供负担得起的和质量 最近提出的扩大干预措施。该项目的总体目标是描述服务提供模式对以下方面的不同影响： 提供放大功能，以促进可获得和负担得起的听力保健。这个项目 建议进行研究，提供有关结果，价值和候选资格的新知识 OTC、混合和AUD模式的影响以及专业评估/选择服务、患者- 以设备为中心的服务和以结果和价值为中心的服务。这项研究将获得 通过一项双中心、双盲、随机对照的田间试验，获得的结果将 告知患者和听力保健提供者通过不同的服务提供可以实现什么 模型，并将帮助我们制定指导方针，以便于选择最合适和最具成本效益的 针对特定患者的干预。从公共卫生的角度来看，拟议项目的重要性 它不仅可以促进可获得和负担得起的，而且还可以促进高质量的听力保健。

PROJECT SUMMARY/ABSTRACT Age-related hearing loss is a substantial national problem due to its high prevalence and significant psychosocial consequences. Although hearing aids (HAs) are the primary intervention for the management of age-related hearing loss, only 15–30% of those who could benefit from HAs actually seek them out. HA adoption rates are even worse for people with lower income and for racial and ethnic minorities. One of the most commonly reported reasons for people not seeking HA intervention is the high cost of HAs and the associated audiological fitting services. Because HAs fitted using the audiologist-based service-delivery model (AUD model) are unaffordable, more and more Americans (1.5 million in 2010) purchase amplification devices via over-the-counter service-delivery models (OTC models) to compensate for their impaired hearing. Although OTC amplification devices are gaining popularity and are regarded as an important option for promoting accessible and affordable hearing healthcare, it is unclear if they are viable solutions for age-related hearing loss as OTC models exclude professional services. Further, if there are outcome differences between AUD and OTC models, it is unknown if the clinical improvement in outcomes will be offset by the improved value (outcome relative to cost), or if it is possible to identify appropriate candidacy for each model to ensure optimal patient care for all. Finally, no prior research has investigated if “hybrid” service-delivery models, in which professionals provide streamlined services to fit OTC amplification devices, offer affordable and quality amplification interventions as has been recently advocated. The overall goal of this project is to characterize the differential effect of service-delivery models on provision of amplification so that accessible and affordable hearing healthcare can be facilitated. This project proposes to conduct research that would provide new knowledge about the outcome, value, and candidacy of OTC, hybrid, and AUD models and the effect of professional evaluation/selection services, patient- centered services, and device-centered services on outcome and value. The proposed study will acquire this knowledge through a two-site, double-blinded, randomized controlled field trial. The results obtained will inform patients and hearing healthcare providers about what can be achieved with different service-delivery models, and will help us develop guidelines to facilitate the selection of the most appropriate and cost-effective intervention for a particular patient. The significance of the proposed project from the public health point of view is that it will facilitate not only accessible and affordable, but also quality, hearing healthcare.