From Outcomes to Evidence: Establishing Best Practices for Audiologists

ABSTRACTS

One of the major challenges in health care today is to ensure optimum outcomes for patients presenting with similar problems no matter where or from whom they receive their treatment. One of our objectives as clinicians, and as a profession, should be to capture and systemize the practices that lead to the best outcomes and eliminate those that result in less than optimal results. Fortunately, there are methods to assist us in achieving this goal. This article reviews these methods through examining how we can use outcome measures and evidence-based practice principles to establish best clinical practices in audiology. Although the focus of this review is on hearing aid-related intervention, the principles discussed are applicable to all aspects of audiologic diagnostics and treatment.

Outcomes assessment (health care) - evidence-based medicine - audiology

REFERENCES

• 1 World Health Organization .International Classification of Impairments, Disabilities and Handicaps-A Manual of Classification Relating to the Consequences of Disease Geneva; World Health Organization 1980
• 2 World Health Organization .International Classification of Functioning, Disability and Health (ICF). Geneva; World Health Organization 2001
• 3 French N R, Steinberg J C. Factors governing the intelligibility of speech sounds.  J Acoust Soc Am. 1947;  19 90-119
• 4 Ventry I M, Weinstein B E. The hearing handicap inventory for the elderly: a new tool.  Ear Hear. 1982;  3 128-133
• 5 Cox R, Alexander G. The Abbreviated Profile of Hearing Aid Benefit.  Ear Hear. 1995;  16 176-186
• 6 Dillon H, James A, Ginis J. Client Oriented Scale of Improvement (COSI) and its relationship to several other measures of benefit and satisfaction provided by hearing aids.  J Am Acad Audiol. 1997;  8 27-43
• 7 Beck L B. The role of outcomes data in health-care resource allocation.  Ear Hear. 2000;  21 89S-96S
• 8 Mulrow C D, Aguilar C, Endicott J E et al.. Association between hearing impairment and quality of life of older individuals.  J Am Geriatr Soc. 1990;  38 45-50
• 9 Abrams H B, Hnath Chisolm T, McArdle R. A cost utility analysis of adult group audiologic rehabilitation: are the benefits worth the cost?.  J Rehabil Res Dev. 2002;  39 549-558
• 10 Ware J E, Sherbourne C D. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection.  Med Care. 1992;  30 473-481
• 11 Bess F H. The role of generic health-related quality of life measures in establishing audiological rehabilitation outcomes.  Ear Hear. 2000;  21 74S-79S
• 12 World Health Organization .Disablements Assessment Schedule Geneva; World Health Organization 1999
• 13 Abrams H B, McArdle R, Hnath Chisolm T, Doyle P, Wilson R M. Functioning, disability and quality of life in the adult hearing impaired. Poster session presented at the biannual International Hearing Aid Research Conference; August. 2004 Lake Tahoe, CA;
• 14 Drummond M, O’Brien B, Stoddart G, Torrance G. Methods for the Economic Evaluation of Health Care Programmes. 2nd ed New York; Oxford University Press 1997
• 15 Piccirillo J F, Merritt M G, Valente M, Littenberg B, Nease R F. U-titer: a new tool for measuring preferences for hearing. Poster session presented at the Second Biennial Hearing Aid Research and Development Conference; September 1997 Bethesda, MD;
• 16 Abrams H B, Hnath Chisolm T, Kenworthy M. Utility approach to measuring hearing aid outcomes. Poster session presented at the biannual International Hearing Aid Research Conference; August 2002 Lake Tahoe, CA;
• 17 Cox R M, Alexander G C. The International Inventory for Hearing Aids (IOI-HA): psychometric properties of the English version.  Int J Audiol. 2002;  41 30-35
• 18 Cox R M, Alexander G C. Measuring satisfaction with amplification in daily life: the SADL scale.  Ear Hear. 1999;  20 306-320
• 19 Gatehouse S. Glasgow Hearing Aid Benefit Profile: derivation and validation of a client-centered outcome measure for hearing aid services.  J Am Acad Audiol. 1999;  10 80-103
• 20 Palmer C V, Killion M C, Wilber L A, Ballard W J. Comparison of two hearing aid receiver-amplifier combinations using sound quality judgments.  Ear Hear. 1995;  16 587-598
• 21 Hnath Chisolm T, Abrams H B. Measuring hearing aid benefit utilizing a willingness-to-pay approach.  J Am Acad Audiol. 2001;  12 383-389
• 22 Wyatt J R, Niparko J K, Rothman R, DeLissovoy G. Cost of utility of the multichannel cochlear implant in 258 profoundly deaf individuals.  Laryngoscope. 1996;  106 816-821
• 23 Sackett D L, Rosenberg W M, Gray J A, Haynes R B, Richardson W S. Evidence-based medicine: what it is and what it isn’t.  BMJ. 1996;  312 71-72
• 24 Larson V D, Henderson W G, Williams D W et al.. Efficacy of 3 commonly used hearing aid circuits, a crossover trial.  JAMA. 2000;  284 1806-1813
• 25 Bentler R, Niebuhr D, Johnson T, Flamme G. Impact of digital labeling on outcome measures.  Ear Hear. 2003;  24 215-224
• 26 Nich C, Carroll K. Intention-to-treat meets missing data: implication of alternate strategies for analyzing clinical trials data.  Drug Alcohol Depend. 2002;  68 121-130
• 27 Overall J, Shobaki G, Shivakumar C, Steele J. Adjusting sample size for anticipated dropouts in clinical trials.  Psychopharmacol Bull. 1988;  34 25-33
• 28 Legislative Counsel ASHA .Preferred practice patterns for the profession of audiology. [On-line]. 1997 http://Available at: Hostname: www.asha.org
• 29 Joint Committee on Clinical Practice Algorithms and Statements .Statement 3 & algorithm 3, hearing aid fitting (adult). Reprinted by the American Academy of Audiology from Audiology Today [On-line]. 2000 http://Available at: www.audiology.org/professional/positions/algorithms.pdg
• 30 ASHA Ad Hoc Committee on Hearing Aid Selection and Fitting .Guidelines for hearing aid fitting for adults. [On-line]. 1997 http://Available at: www.asha.org
• 31 Humes L E, Christensen L A, Bess F H, Hedley-Williams A. A comparison of the benefit provided by well-fit linear hearing aids and instruments with automatic reductions of low-frequency gain.  J Speech Lang Hear Res. 1997;  40 666-685
• 32 Surr R K, Cord M T, Walden B E. Comparison of linear and K-amp circuits.  Ear Hear. 1997;  18 140-146
• 33 Cox R M, Gilmore C. Development of the profile of hearing aid performance (PHAP).  J Speech Hear Res. 1990;  33 343-347
• 34 Ricketts T, Henry P. Evaluation of an adaptive, directional-microphone hearing aid.  Int J Audiol. 2002;  41 100-112
• 35 Cord M T, Surr R K, Walden B E, Dyrlund O. Relationship between laboratory measures of directional advantage and everyday success with directional microphone hearing aids.  J Am Acad Audiol. 2004;  15 353-364
• 36 Amlani A M. Efficacy of directional microphone hearing aids: a meta-analytic perspective.  J Am Acad Audiol. 2001;  12 202-214
• 37 Newman C, Sandridge S. Review of research on digital signal processing. In: M. Valente Hearing Aids: Standards, Options, and Limitations. 2nd ed New York; Thieme Medical 2002: 347-381
• 38 Taylor R S, Paisley S, Davis A. Systematic review of the clinical and cost effectiveness of digital hearing aids.  Br J Audiol. 2001;  35 271-288
• 39 Abrams H, Hnath-Chisolm T, Guerreiro S, Ritterman S. The effects of intervention strategy on self-perception of hearing handicap.  Ear Hear. 1992;  13 371-377
• 40 Primeau R L. Hearing aid benefit in adults and older adults.  Semin Hear. 1997;  18 29-36
• 41 Hnath Chisolm T, Abrams H B, McArdle R. Short and long-term outcomes of Adult Audiologic Rehabilitation.  Ear Hear. 2004;  25 464-477
• 42 Demorest M, Erdman S. Scale composition and item analysis of the Communication Profile for the Hearing Impaired.  J Speech Hear Res. 1986;  29 515-535
• 43 Kazis L E, Ren X S, Lee A et al.. Health status in VA patients: results from the Veterans Health Study.  Am J Med Q. 1999;  14 28-38

APPENDIX A RECOMMENDED EVIDENCE-BASED MEDICINE WEB SITES

Agency for Healthcare Research & Quality

http://www.ahrq.gov/

International Classification of Functioning, Disability & Health

http://www3.who.int/icf/icftemplate.cfm?myurl=homepal&mytitle=Home%20Page

*Center for Evidence-Based Medicine

http://www.cebm.net/

The Cochrane Collaboration

http://www.cochrane.org/

Database of Abstracts of Reviews of Effects (DARE)

http://nhscrd.york.ac.uk/darehp.htm

Clinical Evidence

http://clinicalevidence.com

Evidence Based Medicine Online

http://ebm.bmjjournals.com/

Evidence-Based Medicine Resource Center

http://www.ebmny.org/

*Introduction to Evidence-Based Medicine

http://www.hsl.unc.edu/lm/ebm/

Evidence-Based Medicine Learning and Information Services

http://www.herts.ac.uk/lis/subjects/health/ebm.htm

*Highest recommendation as an excellent starting point.