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Comparing the International Classification of Functioning, Disability, and Health Core Sets for Hearing Loss and Otorhinolaryngology/Audiology Intake Documentation at Mayo Clinic

Alfakir, Razan1,3; van Leeuwen, Lisette M.1,2,3; Pronk, Marieke2; Kramer, Sophia E.2; Zapala, David A.1

doi: 10.1097/AUD.0000000000000662
Research Article: PDF Only

Objectives: The International Classification of Functioning, Disability, and Health (ICF) Core Sets for Hearing Loss (CSHL) consists of short lists of categories from the entire ICF classification that are thought to be the most relevant for describing the functioning of persons with hearing loss. A comprehensive intake that covers all factors included in the ICF CSHL holds the promise of developing a tailored treatment plan that fully complements the patient’s needs. The Comprehensive CSHL contains 117 categories and serves as a guide for multiprofessional, comprehensive assessment. The Brief CSHL includes 27 of the 117 categories and represents the minimal spectrum of functioning of persons with HL for single-discipline encounters or clinical trials. The authors first sought to benchmark the extent to which Audiologist (AUD) and Otorhinolaryngologist (ORL) discipline-specific intake documentation, as well as Mayo Clinic’s multidisciplinary intake documentation, captures ICF CSHL categories.

Design: A retrospective study design including 168 patient records from the Department of Otorhinolaryngology/Audiology of Mayo Clinic in Jacksonville, Florida. Anonymized intake documentation forms and reports were selected from patient records filed between January 2016 and May 2017. Data were extracted from the intake documentation forms and reports and linked to ICF categories using pre-established linking rules. “Overlap,” defined as the percentage of ICF CSHL categories represented in the intake documentation, was calculated across document types. In addition, extra non–ICF CSHL categories (ICF categories that are not part of the CSHL) and extra constructs (constructs that are not part of the ICF classification) found in the patient records were described.

Results: The total overlap of multidisciplinary intake documentation with ICF CSHL categories was 100% for the Brief CSHL and 50% for the Comprehensive CSHL. Brief CSHL overlap for discipline-specific documentation fell short at 70% for both AUD and ORL. Important extra non–ICF CSHL categories were identified and included “sleep function” and “motor-related functions and activities,” which mostly were reported in relation to tinnitus and vestibular disorders.

Conclusion: The multidisciplinary intake documentation of Mayo Clinic showed 100% overlap with the Brief CSHL, while important areas of nonoverlap were identified in AUD- and ORL-specific reports. The ICF CSHL provides a framework for describing each hearing-impaired individual’s unique capabilities and needs in ways currently not documented by audiological and otological evaluations, potentially setting the stage for more effective individualized patient care. Efforts to further validate the ICF CSHL may require the involvement of multidisciplinary institutions with commonly shared electronic health records to adequately capture the breath of the ICF CSHL.

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1Department of Otorhinolaryngology, Mayo Clinic, Jacksonville, FL, USA;

2Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology- Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health Research Institute, De Boelelaan, Amsterdam, Netherlands;

3 These authors contributed equally to this work.

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ACKNOWLEDGMENTS: The study was financially supported by a Crawford Post-Doctoral Fellowship (R.A.), the Stichting Het Heinsius-Houbolt Foundation, and by an EMGO+ travel grant (to L. v. L.). The work presented in this article was completed in collaboration between all authors. The first two authors (R. A. and L. v. L.) contributed equally to this work, including data collection, analyses, and the writing process. All authors contributed to the conception and design of the work and reviewed, edited, and approved the final paper. The authors gratefully acknowledge the Mayo Clinic Research and Editing Services for their assistance in manuscript preparation.

The authors report no conflict of interest. The authors alone are responsible for the content and writing of this article.

Address for correspondence: Razan Alfakir, MD, PhD, Department of Otorhinolaryngology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224. E-mail:

Received October 23, 2017; accepted August 14, 2018.

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