The Hearing Impaired Patient Experience: How are Audiologists Doing?
Hearing Health & Technology Matters
September 8, 2015
Barbara Weinstein PhD

Barbara Weinstein PhD

Downstream Consequences of Age-Related Hearing Loss is a new bi-monthly column at Hearing Economics, written by Barbara Weinstein, PhD.  As described in her introductory post,  the theme is to quantify the patient’s hearing health care experience and focus on the role of these measures in clinical practice, new developments in aging,  and their relevance to health economics.  

Today, Dr. Weinstein introduces Audiologists to a new measurement term, “PROs” (patient related outcomes).  


Aging and Health Economics


Population aging is a demographic phenomenon posing major challenges and opportunities for geriatric health care professionals and medical economists. Decisions regarding resource allocations are often constrained by opposing forces namely the need to expand and optimize existing services in the face of economic considerations.

Health economics dictates that equitable decisions should be based on systematic comparison of costs and benefits of interventions for conditions known to be a burden to patients and society{{1}}[[1]]Ratcliffe, J., Laver, K., Couzner, L., & Crotty, M. (2012). Health Economics and Geriatrics: Challenges and Opportunities, In Geriatrics. Edited by Atwood, P. Rijeka Intech Open Science; 2012:209-234. Retrieved Sept 5, 2015.[[1]]. To this end, measuring and improving the health care experience of older adults has been gaining the attention of policy makers for purposes of accreditation and reimbursement in the form of paying for performance.


Measuring PROs for Accountability


Measuring and monitoring the patient experience sheds light on how treatment and care impact a patient’s life and their journey, and provides a form of accountability to the practitioner.  Structured questionnaires used to collect patient-reported outcomes (PROs) are among the most common approaches to quantifying aspects of the patient experience.

Combining information about the patient experience with PROs quantifying self-reported health status, function, health/health-related quality of life, will most likely provide the best picture of the patient journey, the process and outcomes of care. The latter domains are likely to influence how resources are allocated in the future health care climate{{2}}[[2]]LaVela, S., & Gallan, A. (2014) Evaluation and measurement of patient experience. Patient Experience Journal: 1: 28-36.  Retrieved Sept 5, 2015.[[2]].

 PROs Can Show Buffer Effects of Hearing Loss Treatments


Hearing loss has cascading effects psychologically, physically and socially. Difficulty understanding speech in noise,  self reported participation restrictions and activity limitations have been described as proximal consequences (Table 1).

table 1 post 1

In contrast, downstream effects include poor self reported health, activity limitations, cognitive decline, etc. (Table 2).

table 2 post 1

If audiologists gather PROs from their patients which demonstrate how hearing health care interventions such as hearing aids and cochlear implants serve as a buffer against some of these negative consequences, stakeholders across the quality enterprise would take notice of the value of the work in which audiologists are engaged.


Audiologists Can Balance the Value/Cost Equation


While the definition of quality and priorities differ dramatically across stakeholders, it is widely accepted that the patient experience and the perceived value of care which accrue must be high relative to costs in terms of money and time expended. As Charlotte Yeh, Chief Medical Officer of AARP Services eloquently reminded attendees at the Institute of Medicine Workshop on Hearing and Healthy Aging{{3}}[[3]]Yeh, C. (2014).   The difference that hearing can make. Comments at the Hearing loss and healthy aging workshop, pp 87-89 in workshop summary. Retrieved September 5, 2015.[[3]], audiologists must change the conversation they are having with their patients and health care providers.

Audiologists must talk about why hearing and the ability to communicate are important in terms of social engagement, improved affect, the experience of care, family connections, improved self rated health, improved health care transitions. In her IOM presentation, Yeh urged audiologists to emphasize what people gain from being able to hear and live better; and to acknowledge that hearing loss is not a stand alone disability but it is important to nearly every activity in which older adults are engaged.


Start Spreading the Word


In my blog series, I will discuss evidence of the downstream and proximal outcomes of hearing health care interventions. I will discuss how PROs can be used by audiologists to differentiate their audiology practices thereby convincing stakeholders, especially physicians, of the value of the work each of us does. Framing management decisions within the context of risks, benefits, and PROs will convey to physicians our crucial role in helping to optimize quality of care.

A visiting medical scientist with whom I am working who has a long standing bilateral hearing loss expressed the importance of the work audiologists do and must communicate to stakeholders in a most eloquent way.  She volunteered that

“the benefits of using hearing aids and communication strategies are easy for me to quantify; hearing aids make me feel part of society, I no longer feel lonely, I am experiencing a good quality of life, I am feeling satisfied and re-integrated, I am once again enjoying my life.”{{4}}[[4]]Moser, S. (2015). Personal communication.[[4]]

Let’s not be afraid to measure these outcomes and as Frank Sinatra intoned.…start spreading the news.


Barbara E. Weinstein, Ph.D. earned her doctorate from Columbia University, where she continued on as a faculty member and developed the Hearing Handicap Inventory with her mentor, Dr. Ira Ventry. Dr. Weinstein’s research interests range from screening, quantification of psychosocial effects of hearing loss, senile dementia, and patient reported outcomes assessment. Her passion is educating health professionals and the public about the trajectory of untreated age-related hearing loss and the importance of referral and management. The author of both editions of Geriatric Audiology, Dr. Weinstein has written numerous manuscripts and spoken worldwide on hearing loss in the elderly.  Dr. Weinstein is the founding Executive Officer of Health Sciences Doctoral Programs at the Graduate Center, CUNY which included doctoral programs in public health, audiology, nursing sciences and physical therapy. She was the first Executive Officer the CUNY AuD program and is a Professor in the Doctor of Audiology program and the Ph.D. program in Speech, Language and Hearing Sciences at the Graduate Center, CUNY.

feature photo courtesy of shannon christy

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