Hearing Health Care for Adults Priorities for Improving Access and Affordability (2016) / Chapter Skim
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Globally, hearing loss has been identified as the fifth leading cause of years lived with disability. Age-related hearing loss is of increasing public health concern as the older adult population grows.
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and hearing technologies (hearing aids and hearing assistive technologies) relevant to hearing loss.
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Goal 1: Improve Population-Based Information on Hearing Loss and Hearing Health Care Recommendation 1: The National Institutes of Health, the Centers for Disease Control and Prevention, the Patient-Centered Outcomes Research Institute, the Department of Defense, the Department of Veterans Affairs, state public health agencies, and other relevant gov ernment agencies, as well as nonprofit organizations, hearing health care professional associations, academic institutions, and researchers, should strengthen efforts to collect, analyze, and disseminate prospec tive population-based data on hearing loss in adults and the effects of hearing loss and its treatment on patient outcomes. Specifically, • Support and conduct studies to develop, evaluate, strengthen, and align metrics for hearing loss and communication abilities; • Support and conduct studies, including longitudinal studies, in diverse populations to better understand o risk and natural history of hearing loss, the o risk factors and comorbidities of hearing loss, o hearing health care needs, and o impact of hearing loss and its treatment on health, func the tion, economic productivity, and quality of life; and • Develop and strengthen research training programs to address hearing loss as a public health concern with attention to cross- disciplinary training on sensory disorders, epidemiological methods,
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Guidelines, standards, and metrics must be regularly reviewed and updated to ensure that the most recent evidence is translated into best practices for hearing health care professionals and is disseminated to people with hearing loss and their families. Goal 2: Develop and Promote Measures to Assess and Improve Quality of Hearing Health Care Services Recommendation 2: The Centers for Medicare & Medicaid Services, the National Institutes of Health, the Department of Defense, the Depart ent of Veterans Affairs, other relevant federal agencies, hearing m health care professional associations and providers, advocacy organiza tions, health care quality improvement organizations, health insurance companies, and health systems should collaborate to • Align and promote best practices and core competencies across the continuum of hearing health care, and implement mechanisms to ensure widespread adherence; and • Research, develop, and implement a set of quality metrics and mea sures to evaluate hearing health care services with the end goal of improving hearing- and communication-focused patient outcomes.
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Relatedly, individuals should be able to obtain their hearing health care records, including audiogram and hearing aid programming history, from their hearing health care professional to enable them to be better informed about their health and change providers if they so choose. Goal 3: Remove FDA Regulation for Medical Evaluation or Waiver to Purchase a Hearing Aid Recommendation 3: The Food and Drug Administration should re move the regulation that an adult seeking hearing aids be required to first have a medical evaluation or sign a waiver of that evaluation and should ensure consumers receive information about the medical condi tions that could cause hearing loss through continued inclusion of that information in hearing aid user instructional brochures.
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However, increasing evidence shows that hearing is important for health, and the potential for miscommunication with health care providers due to hearing loss demonstrates the importance of paying attention to hearing ability during medical and wellness visits. Furthermore, health care providers should be aware of the importance of hearing and the need to emphasize, rather than dismiss, hearing concerns during health care visits.
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HEARING TECHNOLOGIES The hearing technology landscape is ever-evolving and encompasses a wide range of products from traditional hearing aids regulated as medical devices to consumer-technology products and hearing assistive technologies. The broad spectrum of types and severity of hearing loss necessitates a wide range of technologies to meet each individual's needs while also meeting requirements for safety and interoperability with other technologies (e.g., cell phones, televisions, and emergency alert systems)
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Individuals with hearing loss frequently use hearing aids with telecoils or other hearing assistive technologies that couple with cell phones and a range of other communications systems. Efforts are needed to standardize the interfaces and connection of hearing aids, hearing assistive technologies, and OTC wearable hearing devices with other types of technologies and communications systems.
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that describes PSAPs as products that are not to be offered or promoted to address hearing loss and are subject to the electronic product provisions of the Federal Food, Drug, and Cosmetic Act through its 2009 PSAP guidance document or a revision of its 2013 PSAP draft guidance document. The PSAP guidance document would establish the distinction between PSAPs for normal hearing and the OTC wearable hearing device category for hearing loss.
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Greater public awareness and user-friendly instructions about the availability, portability, connectivity, and use of hearing aids and hearing assistive technologies, as well as comparable details on product features, are needed to enable informed decision making. Goal 8: Improve the Compatibility and Interoperability of Hearing Technologies with Communications Systems and the Transparency of Hearing Aid Programming Recommendation 8: The Federal Communications Commission, the Federal Trade Commission, the Food and Drug Administration, the National Institutes of Health, and other relevant federal agencies; the American National Standards Institute and other standards-setting or ganizations; manufacturers; and industry, professional, and consumer advocacy organizations should • develop standards that ensure that hearing aids and over-the counter wearable hearing devices are compatible and interoperable with other technologies and communications systems; • increase public awareness and consumer-friendly information on the availability, connectivity, and use of hearing aids and hearing assistive technologies; and • develop and implement standards for an open platform approach for hearing aid programming that allows any hearing health care professional (or, as evolving technology allows, the device owner)
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Furthermore, young adults who have had hearing loss since childhood can face unique financial challenges in transitioning from programs that provided them with hearing aids and services as children and youth to receiving limited, if any, benefits as adults. Given the high numbers of Americans who have hearing loss and the high cost of hearing health care, changes to the cost of hearing health care are needed.
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Goal 10: Evaluate and Implement Innovative Models of Hearing Health Care to Improve Access, Quality, and Affordability Recommendation 10: The Centers for Medicare & Medicaid Services, the Patient-Centered Outcomes Research Institute, the Agency for Healthcare Research and Quality, the National Institutes of Health, the Centers for Disease Control and Prevention, the Health Resources & Services Administration, the Department of Defense, the Department of Veterans Affairs, researchers, and health care systems should prioritize and fund demonstration projects and studies, including randomized controlled trials, to improve the evidence base for current and innova tive payment and delivery models for treating hearing loss.
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Supporting individuals with hearing loss requires adaptable solutions that span society -- not just solutions within the context of a medical model that revolves around delivery of care and services in a health care setting. These solutions should reduce stigma and negative media perceptions and ensure that consumers understand their hearing test results and have the information they need to compare devices and products and to determine pathways to accessing hearing health care services.
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Specifically, • Strengthen publicly available, evidence-based information on hearing through multiple avenues (e.g., centralized websites, community-based services, local councils on aging) that explain hearing and related health concerns for adults of all health literacy levels, and address the breadth of services and technologies, includ ing their comparative effectiveness and costs; • through media, social marketing, and public education cam Work paigns to disseminate and evaluate key evidence-based messages about hearing and hearing health and to promote accuracy in media portrayals; • Implement and support a consumer-based metric to enable indi viduals to understand and track their communication abilities and hearing needs and a consumer-oriented format for audiogram and other hearing test results; • Adopt standardized terminology across manufacturers about the features and capabilities of hearing aids and hearing assistive tech nologies so that consumers and hearing health care professionals can make easy, clear, unambiguous comparisons; and • Develop and disseminate criteria that individuals and families can use to evaluate and compare hearing-related products and services.
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should promote work and community environments that are conducive to effective communication and that support individuals with hearing loss. Specifically, they should o Ensure compliance with the Americans with Disabilities Act and other related laws supporting people with disabilities and strive to exceed their minimum requirements and o Research and incorporate features into buildings and public spaces that improve hearing and communication (e.g., univer sal design, hearing assistive technologies)
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• Hearing loss is a public health and societal concern; engagement and a ction are needed across the spectrum of relevant stake olders, including h individuals and families, professionals, nonprofit organizations, industries, government, and the health care community. Recommended Actions: • Improve population-based information on hearing loss and hearing health care • Develop and promote measures to assess and improve quality of hearing health care services • Remove FDA regulation for medical evaluation or waiver of that evaluation prior to hearing aid purchase • Empower consumers and patients in their use of hearing health care • Improve access to hearing health care for underserved and vulnerable populations • Promote hearing health care in wellness and medical visits for those with concerns about their hearing • Implement a new FDA device category for over-the-counter wearable hearing devices • Improve the compatibility and interoperability of hearing technologies with communications systems and the transparency of hearing aid programming • Improve affordability of hearing health care by actions across federal, state, and private sectors • Evaluate and implement innovative models of hearing health care to im prove access, quality, and affordability • Improve publicly available information on hearing health • Promote individual, employer, private-sector, and community-based actions to support and manage hearing health and effective communication aAll findings and recommendations are of equal importance and are not prioritized.
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