Current Uses of TeleAudiology in the VA

Transcription

1 Current Uses of TeleAudiology in the VA Rachel McArdle, PhD Chief, Audiology & Speech Pathology Bay Pines VA Healthcare System, Bay Pines, FL Chad Gladden, AuD Telehealth Program Manager William S. Middleton Memorial VA Hospital, Madison, WI Gail Takahashi, PhD Chief, Audiology & Speech Pathology Iowa City VA Healthcare System, Iowa City, Iowa

2 Outline Overview of workload in VA Audiology Miami VAMC experience Madison VAMC experience VA Audiology pilot study Telephone hearing screening study

3 Current VA Audiology Applications Audiologic rehabilitation groups Tinnitus groups Hearing aid programming Hearing aid troubleshooting and follow-up

4 Telehealth Audiology

5 Percent of Workload 2011 For FY11, Audiology was the largest provider of telehealth care in the VA rehabilitation family

6 Why TeleAudiology? Veteran is here V Provider is here

7 High ly Rural, Rural and Census Defined Urban Areas,,,,,,.,, " ",, D VISN Rural l.;;)l H':l hl)' Rural Counti es _ Census Urban """" Map QE<1er<ied IJ,' VHA Plann l1 Q Systems Suppm Group, fie kj unit for the VHA O". ~ e ci A ssista ri Del'Jty Un de r Secret,.-y I e.' Health for P ~ icy & PI,.,nit>;l, Ap rl 6, 2007

8 Potential Connections MC with CBOC MC/CBOC with pt s home CBOC to CBOC MC/CBOC with Specialty Center Polytrauma I/II sites with Level III/CBOC VA with DoD

9 Why TeleAudiology? Decrease in travel time for patients and travel costs for VA Decrease in demand for parking Decrease in costs associated with feebasis clinicians (or difficulty finding clinicians)

10 Why TeleAudiology? Improved Access Increased use of clinical services (especially rural patients) Increased patient satisfaction

11 Miami VA experience Erika Dombrowsky, AuD Staff Audiologist, Bruce W. Carter Medical Center Miami, FL

12 Why Miami started using Telehealth: Significant number of patients from Key West and Key Largo no-showed for their follow-ups A - Miami VAMC C miles from the Medical Center; Approx 1 hr, 10 mins drive. C B -159 miles from the Medical Center; Approx 3 hrs, 44 mins drive.

13 Why Miami started using Telehealth: Significant number of patients from Key West and Key Largo no-showed for their follow-ups No-shows due to : Distance Travel time Lack of transportation Misinterpretation of appointments No show rate part of performance measure

14 Telehealth Usage at the Miami VA Used for: Tinnitus Management classes Living With Hearing Loss class Walk-in clinic

15 How does it work? Clinical Video Telehealth (CVT) allows patients and clinician to see and hear each other in real time

16 Tinnitus Management Began broadcasting Tinnitus management classes from Hollywood CBOC in Jan 2009

17 Why Telehealth For Tinnitus Education? Subject Matter Expert on Tinnitus was stationed at the Hollywood CBOC Barriers to non-telehealth provision at the Hollywood CBOC: Lack of classroom space at the CBOC Distance to Hollywood CBOC from the Medical Center and the Keys CBOCs for patients that drive themselves Lack of shuttle service to the Hollywood CBOC for patients that do not drive

18 What are the benefits? Can now schedule patients on the same day at the Hollywood CBOC, the Key West CBOC, and the Medical Center. Decreased travel time for veterans Decreased travel costs for VA

19 What are the benefits? Able to accommodate many more patients than were previously able to be seen due to lack of space. Improved Access Increased uptake of clinical services Increased patient satisfaction Limited involvement needed by staff at remote sites Frees up staff at other sites to provide care to other veterans

20 Telehealth Living With Hearing Loss Broadcast from the Medical Center to the Key West, Key Largo, and Homestead CBOCs Requires little to no involvement by the staff at the CBOC Participants at Medical Center and CBOCs Can schedule up to 10 patients at the Medical Center and 5 at each CBOC

21 Telehealth Walk-in Clinic Began November 2009 Currently only at the Key West CBOC but start up in Key Largo is scheduled for Originally used for minor repairs and counseling issues. Since October 2011 have been doing remote programming As of this week one remote fitting will occur every Friday

22 Madison VAMC Experience Chad Gladden, AuD Telehealth Program Manager William S. Middleton Memorial VA Hospital, Madison, WI

23 Baraboo Beaver Dam Madison

24 How the program works Initial appointment The veteran receives a hearing test and a hearing aid evaluation at the Madison VA clinic. Recall appointments The veteran reports to his/her local VA clinic at the designated appointment time and works with a credentialed professional who is stationed at the Madison VA. Hearing aid services including the fitting, orientation to the new hearing aids, and follow up care, are provided through live interaction via a television screen.

25 Miles Saved Miles saved ranged from per veteran Average miles saved: (n = 66) Baraboo Beaver Dam Madison

26 Patient satisfaction with Teleaudiology appointment (n=66) Telehealth Patient Satisfaction tool Number of respondents Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12 Strongly agree Agree Neutral Disagree Strongly disagree Question (by number)

27 Patient satisfaction survey questions Q1: I felt comfortable with the equipment used Q2: I was able to see the clinician clearly. Q3: I was able to hear the clinician clearly. Q4: There was enough technical assistance for my meeting with the clinician. Q5: My relationship with the clinician was the same with this appointment as it is in person. Q6: The location of the telehealth clinic is convenient for me. Q7: My needs were met during the session Q8: I received good care during the session Q9: The telehealth clinic provided the care I expected. Q10: Overall, I am satisfied with this telehealth session. Q11: I would recommend this type of session to other veterans. Q12: I would rather travel to receive this service than use telehealth (majority strongly disagreed)

28 Subjective IOI-HA results Patients with mild to moderate loss (n=34) Mean response on 5-item scale Use Benefit RAL Sat RPR Ioth QOL IOI-HA item USE=hours of use; Ben=perceived benefit; RAL=Residual activity limitation; Sat=satisfaction; RPR=Residual participation restriction; Ioth=Impact on others, QOL=Quality of life Cox et al. (2003) Smith et al. (2009) Madison

29 Subjective IOI-HA results Patients with moderate-severe loss (n=32) Mean response on 5-item scale Use Benefit RAL Sat RPR Ioth QOL IOI-HA item Cox et al. (2003) Smith et al. (2009) Madison USE=hours of use; Ben=perceived benefit; RAL=Residual activity limitation; Sat=satisfaction; RPR=Residual participation restriction; Ioth=Impact on others, QOL=Quality of life

30 How does remote hearing aid fitting and programming work? Remote control of computer at patient s site to program hearing aids

31 Audiology telehealth equipment Madsen Aurical Plus Fitting System Madsen OTOflex 100 Diagnostic Immittance Unit Madsen Astera Audiometer

32 Digital Otoscope Clear image of all tympanic landmarks Extremely useful: Primary Care ENT Audiology AMD 2014 Otoscope Welch Allyn Digital MacroView Otoscope

33 TeleAudiology Pilot Funded by the Office of Telehealth Services (OTS) Joint OTS and National A&SP Effort Phase I Hearing aid fitting and f/u Phase II Diagnostic audiology

34 Pilot sites Denver, Durham, Hines, Iowa City, Madison, Mountain Home, Omaha, San Juan, Togus, and Washington, DC 3 sites are currently seeing patients: Iowa City Durham Mountain Home 2 more sites have patients scheduled: Madison/Iron Mountain San Juan

35 Update All 10 sites should be seeing patient by the end of the calendar year Equipment contract was established for the audiology telehealth equipment. Staff have been identified at pilot sites Establishing a training curriculum through the Rocky Mountain Telehealth Training Center (RMTTC). Number of audiologists involved in the pilot are establishing themselves as mentors or clinical champions within their facility and/or network through the RMTTC Master Preceptor Program.

36 Getting started Facility Leadership Front-line staff Telehealth Coordinator CBOC Managers and Personnel IT/BioMed

37 Development of a Telephone Hearing Screening Protocol Rachel McArdle, PhD Bay Pines VAHCS, Bay Pines, FL Richard H Wilson, PhD James H Quillen VAMC, Mountain Home, TN Andrea Bourne, AuD San Francisco VAMC Charles S Watson, PhD Communication Disorders Technology, Inc Gary R Kidd, PhD Indiana University

38 Development of a Telephone Hearing Screening Protocol 3 VA clinics: Bay Pines, Mountain Home, and San Francisco Validation study as subjects have been tested in the clinic prior to enrolling Over 700 subjects have been run on the task Goal is to develop a screening task for use in the VA

39 Procedures Veterans recruited from clinic at the time of hearing consult Randomized to take the telephone test at home or at the VA Veteran keyed in a code for one ear, listened to each digit triplet and then keyed in on the telephone the three digits they heard Repeated the process for the other ear

40 Age distribution

41 Mean thresholds

42 Relationship between WIN and PTA (.5, 1, 2, 4) r = 0.79

43 Two noise paradigms

44

45 Current VA Audiology Applications Audiologic rehabilitation groups Tinnitus groups Hearing aid programming Hearing aid troubleshooting and follow-up

46 Potential Audiology Applications CI programming Hearing screening Hearing monitoring Diagnostic audiology Consultations with experts (Econsults)

47 Thank you

48 Comparison with normative data IOI-HA Cox et al. (2003) n=71 Mild to Moderate Smith et al. (2009) n=53 Madison n=34 Moderate-severe to Profound Cox et al. (2003) n=73 Smith et al. (2009) n=79 Madison n=32 1. USE Ben Ral Sat RPR Ioth Qol USE=hours of use; Ben=perceived benefit; RAL=Residual activity limitation; Sat=satisfaction; RPR=Residual participation restriction; Ioth=Impact on others, QOL=Quality of life