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Highs, Lows of Developing a CI Clinic in an AuD Program

Hyfte, Shannon M. Van AuD, CCC-A

doi: 10.1097/01.HJ.0000527211.51688.75
Audiology Education
Free

Dr. Van Hyfte is a clinical associate professor at the Purdue University Department of Speech, Language, and Hearing Sciences and the director of the Purdue University Audiology Clinic. She provides audiologic services for all populations and supervises students.

Since the FDA approval of cochlear implants (CIs)—in 1985 for adults and 1990 for children—the eligibility standards for these devices have widened, resulting in growing rates of implantation and an increasing need for audiologists skilled to work with CI patients. In a 2003 study, Parisier concluded that university audiology programs must include CI education to keep up with the rising number of patients who could benefit from CI technology (Laryngoscope. 2003;113[9]:1470). Recent research has yet to reveal whether this shortcoming has been addressed. However, Windmill and Freeman found that while the demand for audiology services is projected to rise, the number of audiologists who graduate each year remains insufficient to meet the demand. Liebe suggested that this shortage could result in audiology services being provided by non-certified audiologists in an attempt to satisfy patient needs (HHTM, 2014). These studies do not specifically address audiologists working with CI, but in central Indiana, the concern of not having an adequate number of CI audiology providers has been anecdotally noted by patients, audiologists, and surgeons. This need is where the idea for developing a clinical CI program in Purdue University's Audiology Clinic began to take root, kicking off a roller coaster ride.

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WHY BRAVE THE RIDE

The clinical CI program was developed to take on the professional challenge of providing a new service, expand student education from the classroom to an in-house clinic, and improve patient care with expanded services. First, it is professionally rewarding to expand upon one's education, learn about technological updates, and provide patients with new services. Second, although the students in the university's four-year doctor of audiology (AuD) program are trained to work with CIs in the academic setting, they also gain clinical experience in this area through externships in their third year. Having on-campus clinical services exposes students to CI technology earlier in their education, allowing them to explore this as an area of interest and better prepare them for the third-year externship. Additionally, this lends itself to a team-teaching model to enhance classroom education. Finally, having the ability to evaluate for CI candidacy and map CIs enhances the clinic services, providing ongoing patient care instead of referring them to other clinics.

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HOW TO GET ON THE RIDE

The Purdue University Audiology Clinic is not connected with any medical facility, hospital, or surgeons, so the first issue to resolve was how to get on the roller coaster. To begin this endeavor, multiple areas were addressed. The goal of the CI program was developed, and other questions such as whether the program was needed and could be supported were discussed. Next, community connections were made. For the program to work, cooperation and support within the local CI community are necessary. Meetings were arranged with audiologists, surgeons, and CI manufacturer representatives to discuss the program details and how a partnership might look for all parties. These meetings resulted in an agreement that the CI clinic could provide candidacy evaluations for pediatric and adult patients, as well as device selection and counseling services. Follow-up mapping/programming could also be completed with the assistance of a manufacturer-trained audiologist.

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RIDESHARING

Provider education and mentorship were also central to the program. To ensure the welfare of the patients, the clinical audiologists involved in the program must be skilled and competent to provide CI services. Before the program began, the CI audiologist went through arduous education and training, including staying up-to-date with readings on current research, observing an experienced CI audiologist in the area, and training with a CI manufacturer. The knowledge gained from these trainings was then shared with the students in the program.

The value of mentors in the CI clinic cannot be overstated. The development of this program was largely on account of the significant support, guidance, and encouragement of many skilled audiologists who mentored and assisted the next generation of CI audiologists at the university level.

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THE SLOW CLIMB (AND INEVITABLE LOWS)

The journey of implementing a CI program in a university that is not linked to a hospital has its highs and lows. A remarkable high is the enthusiastic response of local surgeons and audiologists to our plan of providing the local community and surrounding rural areas with clinical CI services. In addition, the AuD students expressed excitement about expanding the clinical services and engaging in opportunities for researcher-clinician teamwork. The location of the clinic meets the needs of local CI patients, with several CI surgeons in the area. The clinic is also is run by an industry-trained audiology clinician from Purdue University. Building a CI patient base at a moderate pace allows for ongoing mentoring opportunities. Having too few patients halts learning, while having too many would compromise the ability to provide optimal care.

A notable low is the clinic's inability to directly bill insurance companies at this time. At present, one or two patients are scheduled each month for CI candidacy evaluations. Patients found to be CI candidates are referred to a surgeon, and if the surgeon agrees with the recommendation for a CI, the surgery is billed through the surgeon's office. Patients understand that payments for evaluation and mapping/programming services at the clinic are out-of-pocket and that they can submit the bill to their insurance for possible reimbursement. While this limitation has curbed the growth of the CI program, there remains a lot of optimism. Moving forward, the next goals are to increase the patient intake to two to three patients each month, reassess the clinic's ability to maintain its growth, and address billing issues affecting this challenging but motivating roller coaster ride.

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