In a first-of-its-kind initiative, clinicians from Cleveland Clinic’s Head & Neck Institute and Cleveland Clinic Community Care have been awarded grant funding from the organization’s Healthcare Delivery & Implementation Science Center (HDISC) to reform the hearing loss care model. This initiative aims to quantify the success of tablet-based hearing screening technology towards improving primary care physician (PCP) referral patterns for hearing loss in the adult (>50 years) population.
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Recent research has suggested that untreated hearing loss can have more significant consequences for patients than just needing to turn the volume up higher or steering clear of noisy restaurants. Hearing loss may be associated with cognitive decline, depression, anxiety, falls and social isolation. Despite new awareness of this possible connection, the process for investigating and managing hearing loss has not improved.
PCP visits represent an ideal opportunity to assess hearing. But at least half of primary care physicians (PCP) are unaware of the options available to improve hearing loss so most don’t ask their patients about their hearing routinely. Even if the PCP asks, up to one-third of people mischaracterize their hearing ability and may not recognize or report the difficulty they are experiencing. Therefore, it is important that physicians are comfortable collaborating with an audiologist to ensure a thorough assessment of hearing.
To make the screening process for hearing loss more efficient for physicians, and to help them feel more confident recommending a consult to audiology, Cleveland Clinic’s Primary Care, Center for Geriatric Medicine and Audiology departments have teamed up to ease the path to optimal hearing care. Fifteen tablet-based hearing screening systems will be distributed to two practice settings — Successful Aging Program sites across the region and the Rocky River – Beachcliff Family Medicine health center. Hearing screening using the tablets will be treated as routine care for adults age 50 and up – similar to taking their weight and blood pressure.
“The future direction of healthcare is to keep people healthy and living full and fulfilling lives,” says David Brill, DO, Vice-Chair of Family Medicine and project team member. “This initiative aligns exactly with the intention of healthcare as a whole – to care for the hearing health of those most likely to experience the effects of hearing loss before their quality of life suffers.”
Simplifying testing could increase frequency and accessibility
The tablet-based screening test can be administered in approximately two minutes, and patients wear headphones so the results can be accurately obtained outside of a sound booth, such as in a waiting or patient care room. For patients who are identified as having diminished or very diminished hearing, an order will be placed for a consult to audiology so that patients can undergo a thorough assessment of their hearing ability with an audiologist. Implementation will begin in mid-2021 following the acquisition of the devices and necessary training of physicians and physician assistants.
Sarah Sydlowski, AuD, PhD, MBA, Audiology Director of the Hearing Implant Program in Cleveland Clinic’s Head & Neck Institute and the project lead, notes that one of the primary goals of this study is to empower PCPs by equipping them with better tools to generate hearing recommendations. “PCPs influence patient behaviors and can be the best advocates for patient wellness,” she says. “We want to encourage physicians to be proactive with their patients’ hearing rather than waiting for patients to report concerns or express interest in hearing aids so more time than necessary without optimal hearing doesn’t go by.”
Ardeshir Hashmi, MD, Director of the Center for Geriatric Medicine and Endowed Chair for Geriatric Innovation and member of the project team, recognizes the value that the partnership between audiology and Geriatrics offers. “Our Successful Aging specialist Geriatricians look to offer our patients access to the most appropriate care in a timeframe that allows them to take a preventative approach to optimize their health, and that includes their hearing health. If we can avoid misinterpreting communication challenges as cognitive decline, or reduce the risk for true cognitive decline by taking two minutes to screen hearing as a risk factor, that’s two minutes well spent.”
Expanding the influence
After several months, the team will analyze how successful the tablets have been for increasing the focus of PCPs on hearing as well as referral frequency. “We aim to assess the value of using a tablet-based system from the providers’ perspectives as well as the objective outcomes,” says Dr. Sydlowski. “PCPs will be given pre- and post-implementation surveys to determine whether the quick and easy hearing assessments make them more likely to routinely address hearing loss.” Results will also be analyzed to determine if the tablets resulted in more referrals to audiology, whether more patients were ultimately seen in audiology and whether the assessments resulted in hearing loss confirmation and hearing aid recommendation. Measured success will be used to scale the project to other practices across Cleveland Clinic.
As research continues to stress the importance of early hearing loss detection among the growing population of adults over 50 years, the value of incorporating strategies to identify and manage hearing loss early becomes greater. “Estimates suggest 75% of hearing loss is under-diagnosed and under-treated, and untreated hearing loss is associated with avoidable health challenges,” says Dr. Sydlowski. “The ultimate aim of the current project is to position Cleveland Clinic as a thought leader in hearing care delivery by improving overall outcomes for patients. This is done not just by improving access to high-quality hearing care, but ultimately by improving overall health outcomes for our patients.”