AZOS-project: Modified care model for hearing impaired listeners

Researcher(s): M. Boymans, PhD., B.A.M. Franck, PhD.
Supervisor(s): prof. W.A. Dreschler, PhD., in cooperation with

J. Verschuure, PhD., (EUMC) and

L.J. Anteunis, PhD. (AZM)

Background:
The prevalence of hearing impairment is relatively high, with a strong increase with advancing age; 5% under 50 years of age and up to 40% for people of 70 years and older (Van den Brink 1995). Hearing impaired listeners present themselves at different counters: physicians, ENT-specialists, Audiologic Centres and hearing aid dispensers. These professional groups have overlapping tasks in the health care organisation for hearing impaired subjects, with partly different responsibilities / competences and expertise. The cost of hearing aid dispensing is increasing because of ageing of the population and due to improved possibilities of rehabilitation using expensive innovative hearing aids.

Aim:
AZOS stands for “Aangepast Zorgmodel Slechthorenden”, which is Dutch for “Adapted Care system Hearing Impaired”. The main aim of the project is the implementation of an efficient and accessible health care system for adult hearing impaired listeners with the preservation of the current quality by shifting the consumer/patient streams. The shift should reduce the workload of physicians, ENT-specialists and Audiological Centres”. Further information on this project can be found on www.azos.org.

Method:
The research is conducted by PACT at the Audiological Centres of the AMC, azM (L.C.J. Anteunis) and EMC (J. Verschuure) by order of CvZ. In the region of each of these centres three to four hearing aid dispensers take part in the project. The project is supported by the department of GP medicine at the University of Maastricht (F.G. van der Horst) and the department KEMTA-azM (M.A. Joore). The project has been started officially in the beginning of 2003 and will be completed in the fall of 2005.
The design is a non-experimental development-oriented evaluation study. The reason for this is that the development and implementation of this new health care system is regarded as implementation (improvement project) and intervention. The project can therefore be seen as a quality improvement in terms of improvement cycles. The essence is the set up and organisation of a process of continuous health care improvement involving a recurring quality cycle. The improvement project begins with a description of the current situation, the reference measurement. After that the developed implementation scheme is executed, during which continuous monitoring will take place. Effective implementation of the new health care system demands a systematic approach according to the following steps:

Formulation of a specific and well founded guide line with quality criteria;
Analysis of the target group and setting in order to identify bottlenecks and limiting and beneficial factors;
Development and selection of strategies for implementation of changes;
Development and execution of an implementation scheme;
Cyclic evaluation and possible adjustment by repeated monitoring of the factors;
Securing of the new health care system.

Results:
In 2003 agreement has been reached with all involved parties on the procedures to use in the project and the reference measurement has been conducted. Further the competences needed by the hearing aid dispensers to perform the correct referral and to perform rehabilitation with hearing aids without interference of a prescriber were formulated. The missing competences have been improved be extra training of the participating hearing aid dispensers.
In September 2004 the first improvement cycle was completed. Analysis of the results showed that at several stages refinements and improvements were necessary in order to implement the new health care system successfully. Adjustments have been implemented and will be verified in the second cycle starting in January 2005.

Future research:
It is too early to draw conclusions, but the project has led to a detailed insight in the current approach and the conditions necessary for a successful implementation of the new health care system. CvZ has obtained a preliminary report in December 2004. The final report is scheduled for August 2005.


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General Otology Prevention of hearing loss Auditory profile Rehabilitation Evaluation of Noise Reduction in (digital) Hearing Aids AZOS-project: Modified care model for hearing impaired listeners Classification of hearing aids in CLiQ Interactive fitting of hearing aids “Self learning” or trainable hearing aid Evaluation of advanced hearing aid features Optimalisation of hearing aids through paired comparisons Field trials with innovative hearing instruments The added value of a bilateral hearing aid fitting Hearing at work Publications Presentations	AZOS-project: Modified care model for hearing impaired listeners Researcher(s): M. Boymans, PhD., B.A.M. Franck, PhD. Supervisor(s): prof. W.A. Dreschler, PhD., in cooperation with J. Verschuure, PhD., (EUMC) and L.J. Anteunis, PhD. (AZM) Background: The prevalence of hearing impairment is relatively high, with a strong increase with advancing age; 5% under 50 years of age and up to 40% for people of 70 years and older (Van den Brink 1995). Hearing impaired listeners present themselves at different counters: physicians, ENT-specialists, Audiologic Centres and hearing aid dispensers. These professional groups have overlapping tasks in the health care organisation for hearing impaired subjects, with partly different responsibilities / competences and expertise. The cost of hearing aid dispensing is increasing because of ageing of the population and due to improved possibilities of rehabilitation using expensive innovative hearing aids. Aim: AZOS stands for “Aangepast Zorgmodel Slechthorenden”, which is Dutch for “Adapted Care system Hearing Impaired”. The main aim of the project is the implementation of an efficient and accessible health care system for adult hearing impaired listeners with the preservation of the current quality by shifting the consumer/patient streams. The shift should reduce the workload of physicians, ENT-specialists and Audiological Centres”. Further information on this project can be found on www.azos.org. Method: The research is conducted by PACT at the Audiological Centres of the AMC, azM (L.C.J. Anteunis) and EMC (J. Verschuure) by order of CvZ. In the region of each of these centres three to four hearing aid dispensers take part in the project. The project is supported by the department of GP medicine at the University of Maastricht (F.G. van der Horst) and the department KEMTA-azM (M.A. Joore). The project has been started officially in the beginning of 2003 and will be completed in the fall of 2005. The design is a non-experimental development-oriented evaluation study. The reason for this is that the development and implementation of this new health care system is regarded as implementation (improvement project) and intervention. The project can therefore be seen as a quality improvement in terms of improvement cycles. The essence is the set up and organisation of a process of continuous health care improvement involving a recurring quality cycle. The improvement project begins with a description of the current situation, the reference measurement. After that the developed implementation scheme is executed, during which continuous monitoring will take place. Effective implementation of the new health care system demands a systematic approach according to the following steps: Formulation of a specific and well founded guide line with quality criteria; Analysis of the target group and setting in order to identify bottlenecks and limiting and beneficial factors; Development and selection of strategies for implementation of changes; Development and execution of an implementation scheme; Cyclic evaluation and possible adjustment by repeated monitoring of the factors; Securing of the new health care system. Results: In 2003 agreement has been reached with all involved parties on the procedures to use in the project and the reference measurement has been conducted. Further the competences needed by the hearing aid dispensers to perform the correct referral and to perform rehabilitation with hearing aids without interference of a prescriber were formulated. The missing competences have been improved be extra training of the participating hearing aid dispensers. In September 2004 the first improvement cycle was completed. Analysis of the results showed that at several stages refinements and improvements were necessary in order to implement the new health care system successfully. Adjustments have been implemented and will be verified in the second cycle starting in January 2005. Future research: It is too early to draw conclusions, but the project has led to a detailed insight in the current approach and the conditions necessary for a successful implementation of the new health care system. CvZ has obtained a preliminary report in December 2004. The final report is scheduled for August 2005.