A Framework That Puts Patients at the Center of Audiologic Care: Audiologists: Try this tool that puts your patients in the center of audiologic rehabilitation.

Paula C. Schauer

doi:10.1044/leader.AEA.21072016.18

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All Ears on Audiology | July 01, 2016

A Framework That Puts Patients at the Center of Audiologic CareAudiologists: Try this tool that puts your patients in the center of audiologic rehabilitation.

Paula C. Schauer, AuD, CCC-A

Author Notes

Article Information

The ASHA Leader, July 2016, Vol. 21, 18-19. doi:10.1044/leader.AEA.21072016.18

As upcoming regulatory changes require audiologists to show the efficacy of their services and to involve patients in their own rehabilitation plan, it will no longer suffice to use the audiologic test battery alone to define hearing loss “severity.”

Instead, according to the patient-centered biopsychosocial model of the International Classification of Functioning, Disability and Health (ICF), audiologists will need to determine hearing loss severity through collective analysis of activity limitations, participation restrictions and psychosocial consequences resulting from a patient’s hearing loss. In turn, the patient will participate in developing their treatment plan, and subjective and objective measures will determine the outcomes of services rendered as part of the plan.

To reformulate standards of practice to meet the requirements of these new regulations, many audiologists have already adopted the Client Oriented Scale of Improvement (COSI) as their subjective measure of choice to foster patient-centered rehabilitation. Originally developed by Harvey Dillon and his colleagues in 1997 as a subjective measure of hearing aid satisfaction, the COSI has been expanded to elicit patients’ self-assessment of their communicative abilities pre- and post-rehabilitation.

Patient goals

In phase one of the original COSI format, patients identify and prioritize up to five situations in which they want to improve their hearing. The clinician records this information and documents baseline performance before the patient begins using hearing aids.

Phase two requires patients to revisit each identified situation, rating the degree of change they have experienced as well as their hearing ability after using amplification for a period of time. Both patient and clinician review the outcome data, jointly acknowledging successes and/or generating next steps in the rehabilitation plan.

But the original format may have drawbacks: The COSI facilitates self-assessment, but some patients may be in denial or not fully aware of the effects of hearing loss—or may even be apprehensive to admit experiencing a loss because of the associated stigma—which could obscure a complete picture of a patient’s activity limitations, participation restrictions and psychosocial consequences.

Visual aids

To combat these barriers, the Ida Institute has used the COSI format as inspiration in the development of visual aids to assist in patient self-assessment. One such aid, Communication Rings, comprises a series of concentric circles; the patient is in the center and the surrounding rings represent communication partners and/or listening environments they most commonly encounter. By walking the person through a dialogue about their listening experiences within each ring, the patient gains greater insight into the scope of communication loss caused by their hearing impairment.

Another more recently developed aid, Living Well, uses pictures to enable self-assessment. After scanning through a set of 25 picture cards depicting various listening situations, the patient selects four to six of the cards that best represent the situations they find most challenging.

The selected cards, later prioritized by “importance markers,” encourage patients to share their challenges and the strategies they have used to mitigate the communication loss in each setting.

The audiologist then uses a documentation form to summarize the target situations to be addressed and outline the details of the rehabilitation plan. More important, the form also defines the roles and responsibilities of the individual, significant others and the audiologist in implementing the plan and serves as a formal document to measure outcomes.

Personalization and documentation

Although some may question the time required to complete these activities, audiologists can include the identification of target listening situations in any one of the formats within a hard-copy intake form that is mailed to the patient or completed in the waiting room. Or the patient could complete the same identification portion electronically to further expedite the process. Reviewing the information during the appointment stimulates the patient-clinician relationship and facilitates the collaboration needed to develop a personalized treatment plan.

The COSI also provides a platform for counseling on effective communication strategies, self-advocacy, realistic expectations and hearing-assistive technology options, all essential for effective management of hearing loss.

Personalized audiologic rehabilitation is the new standard and cornerstone of high-quality hearing health care. Adopting the ICF framework along with the COSI, in its existing form or new formats, will foster patient-centered care. Moreover, its use will efficiently document subjective benefits of amplification, demonstrate the efficacy of rehabilitative services, and validate audiologists as qualified providers of audiologic rehabilitation.

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