Hearing loss is one of the most common service-connected disabilities and may have a significant impact on quality of life and health. Comprehensive hearing health services mandate tailored treatments offered for individuals based on degree of hearing loss and patient preferences. The VA is the ideal setting to study management of severe hearing loss as this is a prevalent condition among veterans and data from the Audiometric Repository is available to allow identification of patient, system and provider factors associated with receipt of particular treatment strategies. A sequential explanatory design using interviews will be conducted with various stakeholders including Veterans and providers. Results from this pilot will provide new information on barriers and facilitators of management of severe hearing loss. Educational materials will be developed to develop and test an implementation approach to achieve best practices in the treatment of severe hearing loss.
Background: Tinnitus and hearing loss are among the most common service-connected disabilities with Veterans being at particular risk for severe hearing loss. Comprehensive hearing health services are available within the VA to qualifying veterans. The delivery of optimal hearing healthcare mandates tailored treatments are offered based on degree of hearing loss and patient preferences. These options are defined in practice guidelines including the VA since 2004. Significance/Impact: Despite the prevalence of hearing loss among Veterans, there are few projects studying the management of those with severe hearing loss. Ensuring appropriate treatments for those most severely affected represents an important access to care issue with implications for patients? communication, quality of life and overall health. This also facilitates patient communication in health care settings as being able to hear is a cornerstone of participation in shared-decision making. Innovation: The VA is the ideal setting to study management of severe hearing loss as this is a prevalent condition among veterans, interested patients are offered comprehensive treatments for hearing loss and longitudinal audiometric data are available to allow identification of factors associated with receipt of particular treatment strategies. Stakeholder engagement including interviews with affected Veterans and providers are incorporated in the study design. Specific Aims: 1. Define the prevalence, modes of treatment and time to treatment of Veterans with severe hearing loss using the Audiometric Repository, a national database of audiograms and a registry of assistive listening devices, hearing aids and cochlear implants within the VA, between 2005-2017. 2. Identify which factors are associated with different treatment approaches for Veterans with severe hearing loss using the Audiometric Repository linked to administrative data from the electronic medical record during years 2005-2017. 3. Identify facilitators and barriers for distinct management of severe hearing loss among hearing aid users (including referral for cochlear implants) through semi-structured interviews with current VHA providers (audiologists, otolaryngologists and primary care providers) and affected Veterans. Methodology: A mixed methods study using a sequential explanatory design will be employed. Data from the Audiometric Repository will be linked to administrative data from the electronic health record to understand management of Veterans with severe hearing loss. Interviews will be conducted with various stakeholders including Veterans and providers to identify barriers and facilitators to particular treatment modalities. Next Steps/Implementation: Results from this pilot will provide new information on barriers and facilitators of management of severe hearing loss. In addition to a planned manuscript describing our findings, we will develop educational materials for providers on CI indications and criteria for referral. We will also develop an educational brochure for Veterans and families to address potential attitudinal/knowledge barriers. These materials will form the basis for a Merit application to study trajectories of hearing loss and to develop and test an implementation approach to achieve best practices in the treatment of severe hearing loss.
