Activity: Talk or presentation › Oral presentation
ABSTRACT: Background/Objective: Ear and hearing health care should focus on enhancing a patients‘ total functioning to facilitate optimal, patient-centered care. The Brief International Classification of Functioning, Disability and Health (ICF) Core Set for Hearing Loss (CSHL) provides a minimal standard for what aspects need to be measured in clinical encounters in adults with hearing loss. We developed an intake tool based on the ICF CSHL, by operationalizing its categories into a Patient Reported Outcome Measure (PROM). Besides careful development, strategies for the implementation of the ICF based intake tool in clinical practice are key for successful implementation of care innovations. These were investigated. Therefore, development and implemention plan of the ICF based e-intake tool in Dutch clinical oto-audiology practice will be outlined.
Method: For the development of the e-intake tool potential items that corresponded to the ICF categories of the CSHL were selected from existing PROMs. Via various consensus and feedback-rounds in the research team, the most suitable items were included and adapted in the first version of the intake tool. This version was reviewed by an expertpanel via a digital survey. Next, the intake tool was pilot-tested in patients using the three step test interview. For the implementation, the Behavioral Change Wheel guide was used for the development of an implementation plan. Firstly, barriers and enablers to use the intake tool from the perspectives of health care professionals (i.e., audiologists and otologists) and patients were identified via interviews. Based on this, implementation strategies for the successful adoption of the intake tool in clinical routine practice were developed.
Results: An intake tool containing 62 items was developed covering nine domains: general- and health information; location of the ear/hearing problem; medical background; physical and mental problems; hearing problems; ear problems; activities and participation; environmental factors; and personal factors. Professionals recognized the potential value of the intake tool but raised important concerns as well. Professonals‘ barriers to the implementation of the intake tool were: lack of time and the need to address all functioning topics that would arise from the tool. Enablers included integration into the electronic patient record system; a better preparation by the patient for the intake consult by using the tool; and providing a complete picture of the patient‘s functioning. Patients were generally positive and willing to use the intake tool, and raised little concerns. Patients‘ barriers related to fear of losing personal attention/contact with the professional. Enablers included knowledge on the aim and relevance of the intake tool; expectation of better preparation; and a more focused intake process. Implementation strategies to overcome barriers included enhancing professionals‘ knowledge, skills and motivation regarding the intake tool‘s relevance, and its clinical usefulness. To reinforce patients‘ motivation, providing clear and specific information on the purpose of the intake tool was recommended.
Conclusion: A digital ICF based intake tool has the potential to contribute to complete and efficient intake and a transparent care process for the oto/audiology patient. By making the outcomes on the patient‘s functioning profile available to both the professional and the patient prior to the intake consultation, the patient can be better involved in the choices made about his/her rehabilitation plan. The findings of the present work have implications for the further design of the e-intake tool and its implementation in the oto-audiology clinical practice and to make this a standard part of the (intake) care process.