Amplifying Patient Care The University of Pittsburgh Medical Center is bringing hearing help to medicine’s frontlines: primary care. Features
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Features  |   July 01, 2017
Amplifying Patient Care
Author Notes
  • Lori Zitelli, AuD, CCC-A, is project coordinator in the Department of Otolaryngology at the University of Pittsburgh Medical Center (UPMC) and an instructor in the Department of Communication Science and Disorders in the University of Pittsburgh’s School of Health and Rehabilitation Sciences. zitellild@upmc.edu
    Lori Zitelli, AuD, CCC-A, is project coordinator in the Department of Otolaryngology at the University of Pittsburgh Medical Center (UPMC) and an instructor in the Department of Communication Science and Disorders in the University of Pittsburgh’s School of Health and Rehabilitation Sciences. zitellild@upmc.edu×
  • Catherine Palmer, PhD, CCC-A, is associate professor in the Department of Communication Science and Disorders in the University of Pittsburgh’s School of Health and Rehabilitation Science in the Department of Otolaryngology in the university’s School of Medicine. She is also director of audiology in the UPMC Integrated Health System. palmercv@upmc.edu
    Catherine Palmer, PhD, CCC-A, is associate professor in the Department of Communication Science and Disorders in the University of Pittsburgh’s School of Health and Rehabilitation Science in the Department of Otolaryngology in the university’s School of Medicine. She is also director of audiology in the UPMC Integrated Health System. palmercv@upmc.edu×
  • Elaine Mormer, PhD, CCC-A, is associate professor in the Department of Communication Science and Disorders in the University of Pittsburgh’s School of Health and Rehabilitation Sciences. emormer@pitt.edu
    Elaine Mormer, PhD, CCC-A, is associate professor in the Department of Communication Science and Disorders in the University of Pittsburgh’s School of Health and Rehabilitation Sciences. emormer@pitt.edu×
Article Information
Hearing & Speech Perception / Hearing Disorders / Special Populations / Older Adults & Aging / Professional Issues & Training / Features
Features   |   July 01, 2017
Amplifying Patient Care
The ASHA Leader, July 2017, Vol. 22, 56-60. doi:10.1044/leader.FTR2.22072017.56
The ASHA Leader, July 2017, Vol. 22, 56-60. doi:10.1044/leader.FTR2.22072017.56
As health care providers, we have a responsibility to ensure that our patients can access needed care. The President’s Council on Science and Technology (PCAST) and the National Academies of Science, Engineering, and Medicine (NASEM) have recently provided calls to action related to accessibility and affordability of hearing health care devices and services.
Although these reports focus on hearing aids and related services, another pathway to accessibility is bringing hearing health care to the people who need it—to achieve positive health outcomes. This requires thinking and working outside of the traditional test booth environment.
Many providers are aware of their obligations under the Americans With Disabilities Act to provide physical access to their offices, but much of the recent work of our Audiology Department at the University of Pittsburgh Medical Center (UPMC) has focused on helping other health care providers promote communication access.
Untreated hearing loss is a barrier to effective communication in health care settings and has been linked to poor satisfaction with health care, poor ratings of patient-provider communication, higher medical expenditures, and a higher likelihood of adverse events (see sources below). Addressing unrecognized hearing loss can result in more effective patient-provider communication and a greater likelihood that patients receive appropriate treatment.
That’s the thinking behind our “interventional audiology” initiative at UPMC: It seeks to manage untreated hearing loss in order to help other health concerns. In most cases, hearing loss is neither the patient’s nor the health care provider’s primary concern. Although hearing loss is expected in aging adults, it is not benign—and treatment of the hearing loss can have an impact on the overall well-being of the patient.
Our initiative began 20 years ago in the inpatient setting and has since expanded into several other settings: the outpatient post-trauma clinic, the geriatric outpatient offices, and an interdisciplinary survivorship clinic, as well as senior living communities. Across these settings, we aim to 1) improve communication between patient and provider, 2) refer for follow-up care as needed, and 3) help future patients with hearing loss by raising providers’ awareness of audiology services.

Addressing unrecognized hearing loss can result in more effective patient-provider communication and a greater likelihood that patients receive appropriate treatment.

✔Inpatient setting
To help inpatients communicate effectively with providers (necessary for access to care and shared decision-making), we provide simple, inexpensive solutions. If those with hearing loss do not have or didn’t bring their own hearing aids, we provide simple, inexpensive non-custom headset amplifiers. We bill the cost of the device/service directly to the hospital for a very low fee, so neither the patient nor their insurance is charged. The hospital is paying the audiology department directly in order to meet the obligation of making the hospital accessible to the patient.
Our hospital considers it our responsibility to provide this access to hearing, just as we provide physical access to care. Patients take these devices with them when discharged to promote enhanced communication throughout their recovery, whether that be at home or in a rehabilitation facility.

We aim to 1) improve communication between patient and provider, 2) refer for follow-up care as needed, and 3) help future patients with hearing loss by raising providers’ awareness of audiology services.

✔Outpatient clinics
Based on our success with improving communication in the inpatient setting, we have since expanded into outpatient clinics. In each setting, we are the first person in the room so that the patient is equipped to communicate with providers before the consult starts.
Interprofessional post-trauma clinic
Patients who have been admitted to the hospital as a result of trauma are instructed to follow up approximately two weeks post-discharge in this clinic. There they see an audiologist, nutritionist, speech-language pathologist, occupational therapist, physical therapist and advanced practice provider (APP: a nurse practitioner or physician assistant). Patients experiencing this level of trauma often require a detailed treatment plan from each provider. Our goal is to consolidate rehabilitation resources so that the patient doesn’t have to attend multiple appointments.
The audiologist is the first to conduct an evaluation, and based on the results, places a colored sticker on the paper chart: green indicates normal hearing, yellow indicates a need for providers to use good communication strategies, and red indicates the patient should use their personal hearing aids or an assistive listening device provided for the day. Audiologists also fix patients’ personal hearing aids as needed, for which patients are grateful. (It is typically difficult for them to travel to multiple appointments.) If patients receive temporary hearing assistance for the day, audiologists provide them with a pathway to pursue hearing health care.
Interprofessional survivorship clinic
In this clinic to help patients manage the effects of treatment for head and neck cancer, the treatment team includes a head and neck surgeon, SLP, dentist, audiologist, physical therapist, and nurse.
Patients who have undergone treatment for this type of cancer frequently have issues with swallowing, poor dentition, hearing loss and neck stiffness, among other problems. As of April, 77 percent of patients seen in the clinic had some degree of measurable hearing loss. Audiologists in this clinic follow the same treatment and follow-up care format as in the trauma clinic.
Outpatient geriatric care center
Most recently, in January of this year, we embedded audiology into this clinic to bolster accessibility for this particularly access-challenged population. Family members often have to take time off work or rearrange schedules to bring these older adults to appointments, so providing audiologic services during the appointment may result in more patients taking advantage of services.
As of April, audiologists had screened 93 patients for hearing loss, with 48 (52 percent) having their hearing tested the same day. Of the 93 patients seen, 85 (92 percent) had hearing loss (measured either by comprehensive audiometry, a 30 dB HL hearing screening, or reported based on the fact that they were experienced hearing aid users). Only 24 (26 percent) of these patients already wore hearing aids—consistent with nationally reported data regarding hearing aid uptake.
We plan to track these patients to see if our intervention in this clinic produces an uptake in use of audiology services and technology. As part of this program, we provide non-custom amplifiers to patients with hearing loss to use during the appointment. After seeing the change in a patient’s communication with this amplification, a number of families have chosen to purchase the non-custom amplifier on the same day.

Family members often have to take time off work or rearrange schedules to bring these older adults to appointments, so providing audiologic services during the appointment may result in more patients taking advantage of services.

✔Senior facilities
We also have introduced hearing services to our assisted-living communities through a communication facilitator. Supervised by an audiologist, this full-time provider is employed as an extender of services. The facilitator may put in hearing aids, troubleshoot hearing aids, ensure that the sound-field system is used in the activity room, and ensure that residents watching group TV use headsets as needed. The facilitator also assesses residents’ amplification needs in their apartments and recommends TV devices, phone amplifiers and any necessary alerting signals. Residents, families and staff have welcomed this program because simple non-custom hearing solutions and hearing aid troubleshooting can now be done in-house.
As UPMC continues its interventional audiology initiative, we hope to produce measurably better hearing outcomes for patients. The goal of reducing (or eliminating) the negative consequences of untreated hearing loss in a health care setting may be achievable. By placing University of Pittsburgh audiology students on interdisciplinary teams in these various clinics, we are preparing them to think “out of the booth” as they position audiology as an essential part of successful health care.
Sources
Bartlett, G., Blais, R., Tamblyn, R., Clermont, R. J., & MacGibbon, B. (2008). Impact of patient communication problems on the risk of preventable adverse events in acute care settings. Canadian Medical Association .Journal, 178(12), 1555–1562. [Article]
Bartlett, G., Blais, R., Tamblyn, R., Clermont, R. J., & MacGibbon, B. (2008). Impact of patient communication problems on the risk of preventable adverse events in acute care settings. Canadian Medical Association .Journal, 178(12), 1555–1562. [Article] ×
Foley, D. M., Frick, K. D., & Lin, F. R. (2014). Association of hearing loss and health care expenditures in older adults. Journal of the American Geriatrics Society, 62(6), 1188. [Article] [PubMed]
Foley, D. M., Frick, K. D., & Lin, F. R. (2014). Association of hearing loss and health care expenditures in older adults. Journal of the American Geriatrics Society, 62(6), 1188. [Article] [PubMed]×
Fook, L., Morgan, R., Sharma, P., Adekoke, A., & Turnbull, C. J. (2000). The impact of hearing on communication. Postgraduate Medical Journal, 76(892), 92–95. [Article] [PubMed]
Fook, L., Morgan, R., Sharma, P., Adekoke, A., & Turnbull, C. J. (2000). The impact of hearing on communication. Postgraduate Medical Journal, 76(892), 92–95. [Article] [PubMed]×
Hoffman, J. M., Yorkston, K. M., Shumway-Cook, A., Ciol, M. A., Dudgeon, B. J., & Chan, L. (2005). Effect of communication disability on satisfaction with health care: A survey of Medicare beneficiaries. American Journal of Speech-Language Pathology, 14(3), 221–228. [Article] [PubMed]
Hoffman, J. M., Yorkston, K. M., Shumway-Cook, A., Ciol, M. A., Dudgeon, B. J., & Chan, L. (2005). Effect of communication disability on satisfaction with health care: A survey of Medicare beneficiaries. American Journal of Speech-Language Pathology, 14(3), 221–228. [Article] [PubMed]×
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July 2017
Volume 22, Issue 7