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Audiology Clinical Practice Algorithms and Statements

AudiologyClinicalPracticeAlgorithmsandSt atementsAUDIOLOGY TODAY 32 SPECIAL ISSUE 2000 Audiology TODAY 33 SPECIAL ISSUE 2000 Communication disorders are among the commonest ofdisabling conditions in the population of the UnitedStates. Problems affecting hearing, speech, and/or lan-guage are estimated to affect 10-15% of the populace, and the numberof people with such problems increases as the population ages. Totake but one example, 20-26 million citizens have hearing loss. In 1996 and 1997, three major national organizations whose mem-bership is comprised of or includes audiologists and speech patholo-gists, professionals who deal with hearing, speech, and language prob-lems, began exploring ways to make Clinical services and Clinical deci-sion making provided by their members more effective.

Audiology Clinical Practice Algorithms and Statements AUDIOLOGY TODAY 32 SPECIAL ISSUE 2000

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Transcription of Audiology Clinical Practice Algorithms and Statements

1 AudiologyClinicalPracticeAlgorithmsandSt atementsAUDIOLOGY TODAY 32 SPECIAL ISSUE 2000 Audiology TODAY 33 SPECIAL ISSUE 2000 Communication disorders are among the commonest ofdisabling conditions in the population of the UnitedStates. Problems affecting hearing, speech, and/or lan-guage are estimated to affect 10-15% of the populace, and the numberof people with such problems increases as the population ages. Totake but one example, 20-26 million citizens have hearing loss. In 1996 and 1997, three major national organizations whose mem-bership is comprised of or includes audiologists and speech patholo-gists, professionals who deal with hearing, speech, and language prob-lems, began exploring ways to make Clinical services and Clinical deci-sion making provided by their members more effective.

2 This was donein the context of the efforts by the Agency for Health Care Policy andResearch, Department of Health and Human Services, toenhance the quality, appropriateness, and effectiveness of health careservices and access to such services. The three organizations the American Speech-Language-HearingAssociation (ASHA), the American Academy of Audiology (AAA), andthe Department of Veterans Affairs (VA) are officially incorporated ordefined agencies whose memberships encompass virtually all board-cer-tified public- and private-sector audiologists and speech-languagepathologists in the United States.

3 In addition, the VA is the largestsingle employer of such professionals in the nation. Although each ofthese organizations and many smaller and/or affiliated groups has madeattempts in the past to look at quality, effectiveness, and appropriate-ness of the Clinical services provided by their members, no coordinatedeffort by the three had occurred, either in development of Clinical guide-lines and standards, or in discussing related issues and preliminary planning, a first meeting involving top adminis-tration from each group was held in Ft. Lauderdale in 1997. Out ofthat meeting grew a plan to identify and develop Clinical practicestatements that met the 1990 Institute of Medicine definition that.

4 Clinical Practice guidelines are systematically developed Statements toassist practitioner and patient decisions about appropriate health carefor specific Clinical circumstances. The proposed joint enterprisesought to achieve professional consensus. It recognized longstandingefforts to define Clinical Practice patterns and guidelines by ASHA,additional relevant positions and products of AAA, and the goal of theVA to establish Clinical guidelines including step-by-step decision treescalled Clinical Algorithms . After agreeing on the need for such an effort, a Joint AudiologyCommittee on Clinical Practice was established.

5 It had members thatincluded and/or were chosen by the top administration of the threeorganizations. Four face-to-face meetings and several telephone con-ferences were held in 1997-1999. The focus of all of the meetingswas to achieve consensus and to identify areas in which common poli-cy for the entire profession would benefit recipients of care, to developpractice documents that reflected common ground among the partici-pants, and to make decisions that incorporated the best of research, Clinical study, and national peer review in the areas of members of the Joint Audiology Committee onClinical Practice Algorithms and Statements (and theirresponsibilities when appointed) included:Gene Bratt, PhD; Chief, Audiology and SpeechPathology, Nashville VA.

6 Medical Center; Past-Chair,VA National Field Advisory; Council in Audiology andSpeech Campbell, PhD; Associate Professor ofAudiology, Southern Illinois University; Chair, NationalTask Force on Professional Practice Standards,American Academy of Cherow, MA; Director, Audiology Division,American Speech- Language-Hearing Grimes, MA; Director, Providence Speech andHearing Center (CA); Member, Board of Directors,American Academy of Haskell, PhD; Chief, Audiology and SpeechPathology, Iowa City VA; Medical Center; Member,VA National Field Advisory Council in Audiology andSpeech Higdon, MA; Director, Audiolabs (TX); VicePresident for Professional practices in Audiology ,American Speech- Language-Hearing McCarthy, PhD, Director of Audiology , Rush-Presbyterian-St.

7 Luke s Medical Center, Chicago; Past-President and Member, Board of Directors, AmericanAcademy of Noffsinger, PhD, Professional DepartmentChair, Audiology and Speech Pathology, VA Greater LosAngeles Healthcare System; Chair, VA National FieldAdvisory Council in Audiology and Speech professionals served in ex-officio orconsultant capacities to the committee during its delib-erations, including: Lucille Beck, PhD; National Director, VA Program inAudiology and Speech Pathology; Deborah Hayes, PhD; President, American Academy ofAudiology; Gay Ratcliffe, PhD; Vice President for Administrationand Planning, American Speech-Language-HearingAssociation; Kyle Dennis, PhD; Chief, Audiology and SpeechPathology, VA Greater Chicago Healthcare System; andCharles Martinez, MA.

8 Associate Chief, Audiology and Speech Pathology, VA West Los AngelesHealthcare TODAY 34 SPECIAL ISSUE 2000 Goals and PhilosophyThe overall goal of the Audiology projects was to maximizethe value of health care delivered to patients and consensus was sought on ideal practices , on maxi-mizing quality through achieving desired outcomes, on cus-tomer satisfaction, and on efficient and appropriate use ofprocedures and resources. The target measures audiologicassessment, hearing aid selection and fitting, and cochlearimplant procedures were procedures that were done fre-quently, were expensive, and/or carried some risk.

9 The effortassumed that Clinical Practice Statements and Algorithms areuseful to the degree that: 1) they reflect the best of basic andclinical research and experience; 2) they offer both guidanceand opportunities for education in Clinical decision making;and 3) they reduce variation in care where appropriate, there-by optimizing resource of Audiology Services:Statement 1 and algorithm 1 of the JointAudiology CommitteeA Joint Audiology Committee consisting of representa-tives of the American Academy of Audiology (AAA), theAmerican Speech-Language-Hearing Association (ASHA)and the Department of Veterans Affairs (VA) was formed todevelop a set of Practice Statements and accompanyingAlgorithms for the profession of Audiology in order to pro-vide a concise framework for the provision of quality audio-logic services.

10 These Practice Statements and accompanyingalgorithms are not intended to replace policy documents ofthe respective organizations that comprise the JointCommittee on Audiology . These Statements and Algorithmsrepresent the collaboration and cooperation of the threenamed Audiology purpose of Clinical Practice Statements and their asso-ciated decision trees ( Algorithms ) is to recommend doing ornot doing procedures to solve a Clinical problem. Audiol-ogists use them to outline the types of procedures they mayconduct and interpret based on a patient s presenting con-cern and history.


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