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The Hearing Aid Effectiveness After Aural Rehabilitation (HEAR) Trial
Margaret P. Collins, PhD MS
VA Puget Sound Health Care System Seattle Division, Seattle, WA
Funding Period: January 2006 - June 2009
Hearing impairment is the most common body system disability in veterans. In 2008, nearly 520,000 veterans had a disability for hearing loss through the Department of Veterans Affairs (VA). Changes in eligibility for hearing aid services, along with the aging population, contributed to a greater than 300% increase in the number of hearing aids dispensed from 1996 to 2006. In 2006, the VA committed to having no wait times for patient visits while providing quality clinically-appropriate care. One approach to achieving this goal is the use of group visits as an alternative to individual visits.
We sought to determine: 1) if group hearing aid fitting and follow-up visits were at least as effective as individual visits, and 2) whether group visits lead to cost savings through the six month period after the hearing aid fitting.
Participants were recruited from the VA Puget Sound Health Care System Audiology Clinic. Eligible patients were those who had no previous hearing aid use and monaural or binaural air-conduction hearing aids were ordered at the evaluation visit. Participants were randomized to receive the hearing aid fitting and the hearing aid follow-up in an individual or group visit. The primary outcomes were hearing-related function, measured with the first module of the Effectiveness of Aural Rehabilitation (Inner EAR), and hearing aid adherence. We tracked the total cost of planned and unplanned audiology visits over the 6-month interval after the hearing aid fitting.
A cohort of 659 participants was randomized, with 644 completing the study. Baseline characteristics were evenly distributed between treatment groups. Because the interactions between the fit and follow-up visits based on the Inner EAR (p=0.65) and adherence (p=0.98) were not significant, we conducted separate analyses for the fitting and follow-up visits. Analysis of unadjusted six-month outcomes showed no significant differences in Inner EAR scores between individual (62.1) and group (62.1) fitting (p=0.98), or individual (61.5) and group (62.7) follow-up (p=0.39). We found no significant difference (p=0.25) in the proportion of participants adherent to hearing aid use between individual (95.4%) and group (97.2%) fitting or between individual (96.2%) and group (96.3%) follow-up (p=0.98). Adjusting for the primary endpoint (Inner EAR), age, gender, degree of hearing loss, mental and physical health status, site, provider, binaural vs. monaural fit, and group clustering yielded similar findings.
There were no significant differences between the individual and group fitting groups in the number of unplanned visits that occurred: (a) between the fitting and follow up visit (p=0.06), with an average of 0.14 and 0.18 visits, respectively; or (b) between the fitting and six months post fitting (p=0.88), with an average of 0.62 and 0.59 visits, respectively. We found significantly higher cost for individual compared to group fitting of $108.80 versus $32.5, respectively (p<0.0001), and for individual follow-up compared to group follow-up of $41.50 versus $31.80 (p<0.0001).
Group hearing aid fitting and follow-up visits for new hearing aid users yielded equivalent outcomes, compared to providing the same care in an individual format, with substantial cost savings. These results support routine use of group hearing aid fitting and follow-up visits in order to reduce strain on limited resources. Additional research is needed to better understand the effects of staffing mix between audiologists and technicians, and group session format.
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DRA: Health Systems, Sensory Loss
Keywords: Cost effectiveness, Hearing, Practice patterns
MeSH Terms: none