Allison Biever, Au.D. David C Kelsall, M.D. Eric Lupo, M.D. Judith Stucky, M.A. Rocky Mountain Ear Center/Colorado Neurological Institute

Transcription

1 Allison Biever, Au.D. David C Kelsall, M.D. Eric Lupo, M.D. Judith Stucky, M.A. Rocky Mountain Ear Center/Colorado Neurological Institute

2 Disclosure Serve on Cochlear s Audiology Advisory Board

3 Improving Access & Care Improving Access: Remote Programming Remote Clinics (CPN Clinics) Improving Care: Standardizing Programming Standardizing Protocols Creating National Benchmarks

4 REMOTE PROGRAMMING & CLINICS - IMPROVING ACCESS

5 Remote Programming Improving Access University of Michigan University of North Carolina College of Wisconsin Rocky Mountain Ear Center

6 Remote Programming Improving Access

7 Remote Programming Improving Access No difference in average CNC words for remote Map created with facilitator compared to face-to-face Map. No difference in average CNC words for remote Map created with NO facilitator compared to face-to-face Map.

8 Remote Programming Improving Access

9 Remote Clinics (CPN Model) Improving Access Training of audiologists in rural and local communities to evaluate implant candidates and program recipients Comprehensive training provided by Cochlear Americas Good communication between surgeon and remote clinic Checks & Balances uses experienced implant center as a resource when working with challenging cases

10 Remote Clinics (CPN Clinics) Improving Access From June 2015 to February 2018, the surgeons at RMEC currently work with 7 CPN Clinics 30 patients (29 adults and 1 child) with access limitations have received a cochlear implant These are patients who either live too far from an implant center, and therefore, would not be willing to travel to follow-up appointments or who would not have been referred by their local dispensing audiologist without the CPN Model.

11 Remote Clinics (CPN Clinics) Improving Access IMPLANTS * CPN CLINICS STARTED IN 2015

12 IMPLANTS Remote Clinics (CPN Clinics) Improving Access Total Implants CPN Implant Center

13 STANDARDIZING PROGRAMMING IMPROVING CARE

14 Standardizing Programming Improving Care Investigation of a CI delivery model for adults Goals: Use of clinical decision support software Use of evidence-based decisions for programming changes Use of closed-loop system, MAP changes are tested Helps standardize testing and programming which leads to standardized protocols

15 Standardizing Programming Improving Care GROUP I: NEW PATIENTS IA 1 MO 3 MO 6 MO GROUP II: ESTABLISHED PATIENTS IA 1 MO

16 Standardizing Programming Improving Care To date, we have experience with Group II (established recipients). The programming process is new and less tedious than traditional models. Subjects are performing equivalently with the MAPs generated by the study software.

17 STANDARDIZING PROTCOLS IMPROVING CARE

18 Standardizing Protocols Improving Care Minimal Test Battery for Adults How much noise? 5, 7 or 10 db SNR Some clinics not obtaining word score Some clinics don t collect outcome data Some clinics don t provide patients with average outcome scores Use of binomial table (CNC words) to determine whether benefit would be significant, assuming pt had average outcome

19 Standardizing Protocols Improving Care Bilateral vs Bimodal? How much low frequency is beneficial for safety hearing, music appreciation, or improved performance in noise? What is functional residual hearing? Do we have the appropriate tools to measure what we need to measure?

20 Standardizing Protocols Improving Care Use of normative data as benchmark RMEC database with outcome data on approximately 1,500 ears allowing us to provide patients with info on average pre-op and post-op scores Use of National Registry as benchmark demonstrated the feasibility of a novel user friendly, webbased, national CI database to analyze CI outcomes (Chen et al, Otology and Neurotology 2017).

21 Summary Be part of the solution Responsibility to improve access & care Be willing to accept change if it s in the best interest of our patients

22 Binomial Table