Early Auditory Referral in Primary Care



Status:Active, not recruiting
Conditions:Other Indications
Therapuetic Areas:Other
Healthy:No
Age Range:55 - Any
Updated:4/5/2019
Start Date:April 2014
End Date:April 1, 2020

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Early Auditory Referral in Primary Care (EAR-PC)

Busy Primary Care providers (PCPs) have complex practices with many competing demands, making
it difficult to improve their HL identification rates. Little research has been conducted to
identify effective approaches to address the poor PCP knowledge and provide tools for them to
better identify/refer patients with HL for appropriate intervention. Current data suggests
there is a critical need to redesign how PCPs deliver hearing health care (HHC) by developing
focused educational programs and simple clinical management tools to help them integrate HHC
into their practices. To address this need, this study will educate providers on hearing loss
(HL) screening/treatment as well as create a Best Practice Alert (BPA), or clinical prompt,
that is configured for maximal effectiveness in reminding PCPs to ask their patients if they
think they have a HL. This combination of education for providers and clinical reminder could
help increase HL screening rates but how much is not clear. This 5 year R21/R33 study funded
by National Institute of Deafness and Communicative Disorders seeks to provide detailed
understanding of both how educating providers on HL and the use of an effective BPA affects
HL screening rates and identification for people with mild to moderate hearing loss.

The Best Practice Alert (BPA) was developed via an iterative process during a two year pilot
phase at one site at each health system. First, a "standard" BPA was developed to be launched
at each site during the pilot phase. Similarly, a pilot 10-minute education system was
developed to be presented just before the above BPA was launched. Pre and post surveys of
clinicians were conducted to evaluate the effectiveness of the education program. After
clinicians had experience with the BPA, Cognitive Task Analyses (CTAs) with clinicians were
conducted to identify ways to make the BPA more effective, and then the BPA was iteratively
improved. Similarly, the CTAs helped the investigators understand why clinicians do or do not
use BPAs in general. Using this process, a highly rated, easy to use BPA was created and will
be utilized in the actual study. The investigators also revamped the education program to a
10 minute video that focused on clinicians mental models of HL, to be used in the actual
study. The bigger study, i.e., the R33 phase, will launch at several Family Medicine
practices within each of the two different health systems. One of these systems is a
traditional academic institution with only academic faculty (physicians and audiologists),
midlevels and residents, and the other is a newer academic system, based within a private
health system, that includes non-academic physicians and private audiologists. Patients who
trigger the BPA will be 55 years or older, do not have an open referral in their chart to
audiology, and do not have a known hearing loss already on their problem summary list (PSL).
These patients are asked to complete a Hearing Handicap Inventory (HHI) at check-in, a common
hearing loss screening tool (score of 10+ indicates probable hearing loss); the results of
this will not be shared with clinicians. If the physician chooses to address the prompt
during the patient encounter, the BPA design allows them to, 1) Indicate that the patient
declines hearing screening (BPA is dismissed for 1 year), 2) Indicate that the patient
already has a known hearing loss (HL) and add HL to the PSL (The BPA will be permanently
dismissed), 3) Indicate that the patient does not have any HL at this time (The BPA is
dismissed for one year), or 4) refer the patient to audiology for hearing screening. The data
generated by the BPA is extracted from the electronic health record (EHR) and analyzed to
determine if HL screening rates improve when compared to baseline data, whether or not
providers are interacting with the BPA, and whether HL is being added to the PSL. The HHI
results are used as the "gold standard," i.e., when compared to the data generated by the
BPA, indicate whether or not patients with probable HL are getting appropriate care. When an
enrolled patient shows up in Audiology the audiologist is asked to complete a three question
survey to verify that 1) the referral was appropriate, 2) what is the severity of hearing
loss if any, and 3) were hearing aids recommended. This step is to study whether the BPA is
generating appropriate referrals. 20% of patients that score 10 or above on their HHI and/or
were referred to audiology are contacted by phone and researchers ask them questions about
any conversation they may recall related to HL at their appointment as well as their
experience in audiology. Iterative improvements will be made to the BPA based on Cognitive
Task Analysis (CTA) interviews with randomly selected providers (mostly family physicians).
Finally, the implementation of the BPA into clinical practice is observed using the
principles of Normalization Process Theory (NPT) to study whether there are other potential
issues that may impact whether patients at risk for HL are being screened and referred. The
revamped educational video will be shown a week prior to the BPA going live at each site, and
repeating the pre and post evaluations. The investigators will be studying whether the
education video increases identification and referral of patients at high risk for HL.

Inclusion Criteria:

-55 years or older, doesn't have a known hearing loss on their problem summary list (found
in the electronic health record), doesn't already have an open referral to audiology in
their chart, and has an encounter with a provider at a participating Family Medicine
clinic.

Exclusion Criteria:

- None
We found this trial at
10
sites
200 Arnet Street
Ypsilanti, Michigan 48198
Phone: 517-648-5897
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2951 Earhart Road
Ann Arbor, Michigan 48105
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14700 East Old US Highway 12
Chelsea, Michigan 48118
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Dexter, Michigan 48130
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Dexter, MI
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20321 Farmington Road
Livonia, Michigan 48152
Phone: 517-648-5897
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Rochester Hills, Michigan 48307
Phone: 248-551-6407
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Rochester Hills, MI
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Roseville, Michigan 48066
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Roseville, MI
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Saint Clair Shores, Michigan 48080
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Saint Clair Shores, Michigan 48081
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Washington, Michigan 48095
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Washington, MI
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