EHR alert significantly increases audiologist referrals among older adults
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An electronic health record alert that reminded clinicians to ask patients aged older than 55 years about their hearing significantly increased the number referrals to an audiologist, data show.
Hearing loss affects nearly one-third of adults in that age group, according to researchers, and untreated hearing loss is a major risk factor for dementia, depression, diabetes and hypertension.
Philip Zazove, MD, professor and chair of the family medicine department at the University of Michigan School of Medicine, and colleagues asked older patients (n = 14,877) at two Michigan health systems to complete the Hearing Handicap Inventory (HHI) before their appointments. Most of the patients were female and white. Faculty, residents and midlevel clinicians who did not have access to the patients’ HHI results received an EHR alert during the appointments, prompting them to ask: “Do you have difficulty with your hearing?”
The study, which lasted 31 months, showed that audiologist referrals increased from 2.2% to 10.7%. Specifically, the audiologist referral rates at one health system increased from 3.2% at baseline to 14.4%, and from 0.7% to 4.7% at the other system. Among a comparison group of patients aged 65 years and older who attended annual wellness visits, referrals increased from 3% to 3.3%.
Among 5,883 patients who completed the HHI, approximately one-quarter had scores suggestive of hearing loss. According to the researchers, 28% of patients with positive HHI scores were referred based on the screening question compared with only 9.2% of those with negative HHI scores.
“The 72% of participants with a positive HHI who were not referred is likely due to a combination of patients not admitting their hearing loss, clinicians too busy to address the alert and patients declining referrals,” Zazove and colleagues wrote in the Annals of Family Medicine. “Of note, our population hearing loss rates (using HHI data) were similar to other studies, suggesting that our outcomes are applicable to typical community populations.”
Also, among 717 of 1,660 patients referred to audiologists, 93.3% were “appropriately referred,” 85% had hearing loss (mostly mild) and 58.7% were considered candidates for hearing aids.
Researchers concluded the EHR alert helps “increase the chances that hearing loss patients ... will get better and earlier hearing health care with potentially fewer hospitalizations and improved quality of life.”
Perspective
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Cheng-Jung Wu,, MD
Hearing loss is relatively prevalent among the elderly. Though common screening tests can effectively identify patients with hearing loss, these tests are rarely applied in office settings. Possible reasons include clinicians being unfamiliar with associated counseling and referral approaches, limited time of visit, patients’ lack of insight and/or their reluctance to reveal sickness.
Non-otolaryngologist physicians may not be familiar with the diagnosis and treatment of hearing impairment. Zazove and colleagues mentioned that patients in their study were asked to, among other things, complete the Hearing Handicap Inventory for the Elderly by themselves. However, it should be noted that the patients in the study were aged older than 55 years. Vision problems and/or health illiteracy are common among this population. Therefore, patients may need assistance in filling out the HHI to increase its accuracy.
Asking a single question does not take much time, but it acts as a turning point for potential patients to receive adequate hearing care. In addition, my experience has shown that using a tuning fork, which is simple to use, can also efficiently screen for hearing impairment. Physicians’ increased awareness of hearing loss, together with other advances, will benefit more patients.
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