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TeleAudiology in the Veterans Health Administration
Seth E Pross1, Andrea L Bourne, Steven W Cheung
1*Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland †Audiology and Speech Pathology Service, San Francisco Veterans Affairs Medical Center ‡Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California.
Objective:
To assess effectiveness of TeleAudiology for hearing aid services.
Study Design:
Retrospective case-control.
Setting:
Ambulatory Veterans Health Administration and Community-Based Outpatient Clinics (CBOCs).
Patients:
42,697 veterans who received hearing aids from January through September, 2014.
Intervention(S):
TeleAudiology (TA) and conventional in-person (IP) audiology care.
Main Outcome Measure(S):
International Outcome Inventory for Hearing Aids (IOI-HA) outcomes data. The IOI-HA is a 7-item survey used to assess hearing aid effectiveness. Scored from 7 to 35 points, higher scores are more favorable.
Results:
Among veterans nationwide who received hearing aids and completed the IOI-HA survey, 1,009 received TA and 41,688 received IP care. TA and IP groups have comparable mean IOI-HA values (TA = 29.6, SD = 3.9; IP = 28.7, SD = 4.2). Although comparison showed a statistically significant difference (p < 0.0001, t test), principally because of large sample size, the distinction is not clinically meaningful.Subgroup analysis of veterans from San Francisco and six affiliated CBOCs showed 169 received TA and 338 received IP care. TA and IP groups have similar mean age (TA = 74, SD = 9.8; IP = 76, SD = 10.3) and sex distribution (TA male = 100%; IP male = 96%) with statistically significant (p < 0.01, t test) but clinically insignificant differences. Mean IOI-HA scores (TA = 30.7, SD = 3.6; IP = 30.5, SD = 3.1) are not different between groups (p > 0.05, t test).
Conclusion:
TA and IP encounters to provide hearing aid services to veterans are comparable, as both are highly effective based on IOI-HA results. The noninferiority of TA suggests its adoption to non-veterans may improve access while preserving high satisfaction. Financial impact of migration to TA will require future econometric analysis.
