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Despite available resources, inconsistent adoption of hearing care best practices across the industry highlights the need for more practice standardization and education. By Andy Lundin Adherence to best practices in hearing care clinics reflects a mix of progress and ongoing challenges. Despite the wealth of resources and information available to help hearing care professionals (HCPs) adopt best practices, industry experts observe that implementation across the industry is inconsistent. Various solutions are available to help HCPs recognize the value of best practices and adopt them more effectively in their clinics, including published guidelines, standards, educational programs, and other resources from leading hearing health associations. However, many HCPs may have their own barriers preventing them from adopting evidence-based best practices. Hearing Care Guidelines and Standards Hearing care associations such as the American Speech-Language-Hearing Association (ASHA), International Hearing Society (IHS), American Academy of Audiology (AAA), and the Academy of Doctors of Audiology (ADA) have published guidelines and standards for HCPs in various facets of hearing care for professionals to access insights about industry best practices. “There are a lot of clinical guidelines available that HCPs can access. ADA focuses more on practice ownership guidelines, so we have a good understanding of how to run your practice,” says Jason Leyendecker, AuD, current ADA president and the owner of Audiology Concepts and The Tinnitus Clinic of Minnesota in Edina, Minn. “But we endorse many other guidelines that are available as well as the clinical standards from APSO.” The standards being developed by the Audiology Practice Standards Organization (APSO)—which was formed in 2017—are aimed at helping curb practice variability by establishing minimum standards of care that are accepted industry-wide. “There is a lot of variability in the field of audiology due to the lack of established minimum care standards. With more consistency in standards of care, audiologists will be held in a higher regard—comparable to other healthcare fields. If we want to be recognized as a doctoring level profession, then we need to start acting like it,” says Laura Pratesi, AuD, president of the APSO Board of Directors, and owner of the Citrus Hearing Clinic in Clermont, Fla. “Every state defines things differently. Every university teaches things differently. And that’s a problem because how can we look at patients and acknowledge that the minimum standard of care has been applied if no one has defined what that is?” For example, with regard to adult hearing aid fittings, Pratesi says that APSO standards say that some form of verification and validation must be performed, but APSO leaves it up to the clinician to decide how they’re going to verify and validate. “If we don’t make the effort to define our minimum standards as a profession, then the courts are going to do it for us,” says Pratesi. “And the problem with that is that they don’t understand audiology. You have politicians and judges who don’t understand our field and it should be up to us to define those things; practice standards are the foundation for all areas of clinical practice.”’ As of this writing, APSO has published four standards: General Audiology Intake Standards, Hearing Aid Fitting for Adult & Geriatric Patients, Hearing Aid Fitting for Pediatric Patients, and Comprehensive Diagnostic Hearing Evaluation for Adult Patients. Podcast: Why Establishing Standards of Care is Critical for Audiologists Four Major Barriers to the Adoption of Evidence-Based Practice However, the availability of these guidelines and standards doesn’t guarantee immediate adoption across the hearing care landscape. Indeed, ASHA has identified a few reasons as to why there are barriers to more widespread adoption of evidence-based practice. According to Donna Smiley, PhD, CCC-A, chief staff officer for audiology at ASHA, the top four factors that can present these barriers to evidence-based practice—as reported by audiologists through ASHA surveys—include: The time required to find and read through the literature; The relevance of the literature to address specific clinical questions can be hit or miss; The additional time required during the clinical encounter to provide a recommended approach is not feasible Additional costs for equipment and human resources “To mitigate some of these challenges, ASHA has produced tools to support practitioners being able to quickly access high quality research evidence (ASHA Evidence Maps) and facilitate their ability to apply that knowledge in clinical practice (ASHA Practice Portal),” says Smiley. Leanne Polhill, BA, BC-HIS, IHS executive board member, observes that in some cases, appointment time and clinical value determine the use of a complete battery of best practice tasks. “Is real ear done on every single patient by every practitioner? Anecdotally, some practices require that real-ear measurements be utilized with each and every new fitting,” says Polhill. “On the other hand, many practitioners use real-ear as needed, generally to solve a patient’s concern or to meet clinical targets. Other practitioners simply do not have the equipment or feel the need to use it. And, in my opinion, this applies to both hearing aid specialists and audiologists alike. As an educator, it is apparent to me that more real-ear training is needed, especially with newcomers to the professions.” When Practice Variability Works Smiley of ASHA acknowledges that while “unwarranted” practice variability can contribute to inconsistent patient outcomes, some degree of variability is both expected and necessary to accommodate the diverse needs of patients. She offers an example demonstrating an instance of valid practice variability in pediatric audiology: when a patient is concerned about a specific listening condition which leads to the practitioner modifying the speech recognition testing component. “This could involve using a speech-to-noise ratio (SNR) that isn’t necessarily a part of the standard battery,” Smiley elaborates. “The data obtained would allow me to address a specific issue that is important and relevant to that patient. It could impact device programming and/or the addition of remote microphone technology.” Take Advantage of Education Opportunities Central to any HCP’s ability to consistently keep pace with hearing care best practices is simply the knowledge they possess. One way to stay on top of hearing care technology, techniques, trends, and more is through resources such as The Hearing Review. For their part, to help keep practitioners current, associations have created educational programs that address the latest industry best practices. For example, IHS emphasizes its educational component via its distance learning program, which prepares aspiring hearing aid specialists for their licensing examinations and independent practice. “According to the law of primacy, what we learn first, right or wrong, can follow us through our entire career. Therefore, it’s imperative that the educational materials we use to learn, and skill sets we’re taught and develop, are priceless! Adherence to best practices ultimately lead to a better fit that will enable our patients to achieve high levels of satisfaction and success,” says Polhill. Continuously staying educated on the latest industry developments is also essential, which ASHA offers via its suite of continuing education opportunities. “ASHA promotes the adoption of evidence-based practices by offering many opportunities for continuing education, professional development, and to learn from curated resources, including from the ASHA journals,” says Smiley of ASHA. “These educational opportunities and resources are highly consumed. For example, the Clinical Practice Guideline on Aural Rehabilitation for Adults with Hearing Loss has been downloaded 12,260 times since publication in March 2023." The American Academy of Audiology (AAA) also offers a continuing education program as well as an online learning platform that offers live and on-demand web seminars, certificate programs, a journal, and ethics-based opportunities. The standards being developed by the Audiology Practice Standards Organization (APSO)—which was formed in 2017—are aimed at helping curb practice variability by establishing minimum standards of care that are accepted industry-wide. Graphic: APSO Keeping Pace with an Ever-changing Industry While educational programs help HCPs stay informed about the latest industry best practices, gaps in knowledge remain, particularly around emerging technologies and innovations as a result of the constantly evolving nature of the field. New technologies are reshaping hearing care delivery and are often outpacing the creation of relevant guidelines. Pratesi of APSO highlights several innovations driving this change, including the availability of OTC hearing aids, the growing use of AI in audiology, and the expansion of telehealth services. She says that the APSO is working to develop standards for newer industry innovations, such as one for OTC devices. “OTC, by its very nature, says that the professionals aren’t involved at all in the process, so what is the minimum that we should be doing for patients who wear one?” says Pratesi. “If someone were to ask us to make a recommendation for a device, how do we do that? Where are the best practice guidelines when it comes to being an audiologist working with OTC? And what should the minimum standards of care be?” Smiley also emphasizes the importance of ongoing efforts to close the research-to-practice gap, and says that ASHA has been actively working to promote the adoption of evidence-based practices through initiatives like the Dissemination and Implementation Science Travel Award (DISTAnce) Program. “Eventually, ASHA hopes that we will have better data about the adoption by audiologists of best, recommended, and/or evidence-based practices,” she says. ADA President Leyendecker acknowledges the industry’s progress but says there is always room for improvement. He says that the hearing care guidelines available to HCPs play a crucial role in driving continued advancements in the field. “Every health profession should be constantly evaluating whether their guidelines and their clinical standards are meeting the needs of the patient,” he says. “So I think that that is something that is still evolving and adapting. As healthcare continues to grow, and there are fewer providers than there are patients, we have to become efficient.” Original citation for this article: Lundin A, Hearing Care Best Practices: Bridging Gaps for Adoption. Hearing Review. 2024;31(10):10-14. Photo: Dreamstime