. 2022 Mar 29;37(Suppl 1):22–32. doi: 10.1007/s11606-021-07076-x

Table 3.

GRECC Initiatives Promoting Patient-Centered Care Among Veterans with Hearing Loss, OVET Feedback, and Impact 2018–2020

Initiatives (guest)	OVET feedback, response, and current status
Expanding hearing health resources (Director of RMR VAMC Audiology Department and training supervisor) January 2018	• OVET feedback: simplify name of new, proposed walk-in clinic, provide reminders for annual appointments, expand services to long-term care facilities serving Veterans • Response: Changed name of clinic and started providing reminders to schedule annual appointments. Was doing hearing aid checks and maintenance in a post-acute and long-term care facility prior to COVID-19. • Related outcome: Average of 34 Veterans served in audiology walk-in clinic per day
Skills building support for Veterans newly fitted for hearing aids (Audiology trainee) November 2019	• OVET feedback: Took part in a hands-on demonstration of skills-building component using different kinds of hearing aids. Informed the development of a guide for new hearing aid wearers. OVET provided feedback on visuals to include and recommended a “Tips and Tricks” section, offering their own tried-and-true methods. OVET informed questions used during phone follow-up with new hearing aid wearers. • Response: Guide and follow-up incorporated all feedback. Suggestion to hold regular group skills-building workshops is on hold due to COVID-19. • Related outcomes: See case example featured in text.
Assistive Listening Device Project (Audiology trainee) April 2020	• OVET feedback: provided anecdotes highlighting the value of this project, which were featured in proposal used to garner support from medical center director and funding from the regional office. OVET raised concerns about sanitation of devices between use. OVET provided feedback that simplified and clarified questions used to collect Veteran and caregiver feedback. • Response: Project was approved in Summer 2020 with VISN funding support ($3560). Disposable headset covers were purchased; devices are included in cleaning protocols implemented between patient visits. • Related outcomes: 40 devices are available in various clinic rooms associated with resident clinics, Geriatric Specialty Care clinics and Geriatric ED. Salience within context of COVID-19: masks make hearing and understanding what is said more challenging; assistive listening devices can help overcome this barrier. Anecdote from resident caring for patient who had forgotten hearing aids: “The Veteran loved it, understood how to use it. It took 20 seconds to put it on, adjust the volume to a comfortable level. That 20 seconds saved 10 minutes.”
Incorporating audiologic best practices into residents and Geriatric Medicine Fellows' practice (Audiology trainee) December 2020	• OVET feedback: Brainstormed screening questions providers could use to assess hearing loss indirectly (e.g., in case Veteran is reticent to admit hearing loss). Also noted key signs, such as a Veteran turning his/her head a particular way to hear. Recommended signs in clinic rooms: Over 60? Have a hearing screen every two years. • Response: Educate providers about objective signs of hearing loss during team huddles before residents and Geriatric Medicine Fellows see patients. Added flyers advertising classes on tinnitus and communication to mailings as OVET members noted that they had benefited from these classes and strongly encouraged broader advertising. • Related outcomes: Geriatric Medicine Fellows have reported greater awareness of hearing loss in Veteran patient populations.

Initiatives (guest)

OVET feedback, response, and current status

Expanding hearing health resources (Director of RMR VAMC Audiology Department and training supervisor)

January 2018

• OVET feedback: simplify name of new, proposed walk-in clinic, provide reminders for annual appointments, expand services to long-term care facilities serving Veterans

• Response: Changed name of clinic and started providing reminders to schedule annual appointments. Was doing hearing aid checks and maintenance in a post-acute and long-term care facility prior to COVID-19.

• Related outcome: Average of 34 Veterans served in audiology walk-in clinic per day

Skills building support for Veterans newly fitted for hearing aids (Audiology trainee)

November 2019

• OVET feedback: Took part in a hands-on demonstration of skills-building component using different kinds of hearing aids. Informed the development of a guide for new hearing aid wearers. OVET provided feedback on visuals to include and recommended a “Tips and Tricks” section, offering their own tried-and-true methods. OVET informed questions used during phone follow-up with new hearing aid wearers.

• Response: Guide and follow-up incorporated all feedback. Suggestion to hold regular group skills-building workshops is on hold due to COVID-19.

• Related outcomes: See case example featured in text.

Assistive Listening Device Project (Audiology trainee)

April 2020

• OVET feedback: provided anecdotes highlighting the value of this project, which were featured in proposal used to garner support from medical center director and funding from the regional office. OVET raised concerns about sanitation of devices between use. OVET provided feedback that simplified and clarified questions used to collect Veteran and caregiver feedback.

• Response: Project was approved in Summer 2020 with VISN funding support ($3560). Disposable headset covers were purchased; devices are included in cleaning protocols implemented between patient visits.

• Related outcomes: 40 devices are available in various clinic rooms associated with resident clinics, Geriatric Specialty Care clinics and Geriatric ED. Salience within context of COVID-19: masks make hearing and understanding what is said more challenging; assistive listening devices can help overcome this barrier. Anecdote from resident caring for patient who had forgotten hearing aids: “The Veteran loved it, understood how to use it. It took 20 seconds to put it on, adjust the volume to a comfortable level. That 20 seconds saved 10 minutes.”

Incorporating audiologic best practices into residents and Geriatric Medicine Fellows' practice (Audiology trainee)

December 2020

• OVET feedback: Brainstormed screening questions providers could use to assess hearing loss indirectly (e.g., in case Veteran is reticent to admit hearing loss). Also noted key signs, such as a Veteran turning his/her head a particular way to hear. Recommended signs in clinic rooms: Over 60? Have a hearing screen every two years.

• Response: Educate providers about objective signs of hearing loss during team huddles before residents and Geriatric Medicine Fellows see patients. Added flyers advertising classes on tinnitus and communication to mailings as OVET members noted that they had benefited from these classes and strongly encouraged broader advertising.

• Related outcomes: Geriatric Medicine Fellows have reported greater awareness of hearing loss in Veteran patient populations.