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) 需要何种程度的参与来告知和鼓励 65-75 岁的成年人完成常规听力筛查 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) 确定哪些因素对成人很重要； 65-75 做出有关听力筛查和干预的决策，并制定优化适当干预的策略；4) 提供有关患者、听力学家和患者能力的数据； 初级保健提供者确定在购买助听器之前应由耳科专家进行评估的重大医疗状况，后一个目标可能有助于告知 FDA 政策，该政策目前要求在助听器之前进行医疗评估和许可或放弃医疗评估。 FDA 目前的建议并非基于证据，并且被一些人解释为禁止资源密集型护理提供模式，例如远程助听器销售或非处方药 (OTC) 采购。将对三种基于 PCP 的听力筛查策略进行实施比较（总计 N=660），其中包括 PCP 时间的渐进水平以及完成电话听力筛查的指导。那些未通过筛查的人（估计：N=100）继续进行医疗转诊研究并接受 (1) 诊断听力学测试和。 (2) 确定在提供助听器之前需要医疗转诊的状况的可靠性和有效性 基于 PCP 的筛查的医疗转诊研究中的 N 由 NIH 资助的 500 名患者样本进行补充。针对耳朵相关问题的 CHEER 网络的成功实施将帮助我们了解：1）在该人群中实施听力筛查的最有效和最具成本效益的策略；2）对患者做出决策的重要因素。听力保健；3) 确保助听器验配安全所需的医疗护理水平，以及是否“医疗” 我们的合作者团队包括不同背景的提供者和学者，以提供广泛的专业知识和观点。该研究将利用杜克大学卫生系统初级保健研究联盟和 NIH 的 PCP 实践。 -支持 CHEER 基于实践的网络，以确保患者注册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方法和与听力保健提供相关的医疗保健政策，包括 FDA 政策我们的最终目标是提供信息以告知医疗保健政策的变化，以促进可及且负担得起的听力医疗保健。