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Interprofessional Collaboration

How Audiologists Contribute to Population Health

Nunez, Loretta MA, AuD; Koehnke, Janet PhD; Williams, A. Lynn PhD

doi: 10.1097/01.HJ.0000575356.37456.6c
Practice Management
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From left: Dr. Nunez is the director of academic affairs and research education for the American Speech-Language-Hearing Association (ASHA). She's directing ASHA's 10-year (2015-2025) strategic objective to advance interprofessional education and collaborative practice. Dr. Koehnke is a professor and the chair of the department of communication sciences and disorders at Montclair State University. She serves as ASHA's vice president for academic affairs in audiology, and represents ASHA on the Interprofessional Education Collaborative (IPEC) Council. Dr. Williams is the associate dean for academic affairs in the college of clinical and rehabilitative health sciences at East Tennessee State University (ETSU), where she works to implement interprofessional education and interprofessional collaborative practice at ETSU's Academic Health Sciences Center.

Audiologists play a vital role in contributing to health care teams to address conditions associated with hearing and/or balance disorders;1 including treatment of chronic conditions such as diabetes,2 depression,3 cognitive decline,4 dizziness with falling, and ototoxicity. More than 90 percent of the U.S. annual health care spending is for people with chronic and mental health conditions.5 Chronic diseases (e.g., heart disease, diabetes, Alzheimer's disease) are defined as conditions that last one year or more, require ongoing medical attention, and/or limit activities of daily living (ADL).6 Communication disabilities (hearing, speech, language, and cognitive-communication disorders) are among the most prevalent handicaps in the world.7 Disability percentages increase with age, especially hearing loss. The ability to communicate effectively (speak, listen, and write) affects ADLs, including obtaining the highest quality of health care. Communication disabilities can increase the time, effort, and frustration associated with providing effective care. In addition, communication disabilities can lead to poor adherence to and/or inability to understand treatment recommendations; this, in turn, may affect clinical outcomes or even result in accidental injury or further medical difficulties.

Table 1

Table 1

Table 2

Table 2

Improving population health is a key component of the Institute for Health Improvement (IHI) Triple Aim (or Quadruple Aim). The Quadruple Aim is an approach to optimizing health system performance by improving the health of populations, enhancing the patient experience of care, reducing the per capita cost of health care, and improving the work conditions of health care clinicians and staff.8 These aims connect interprofessional health care teams, leading to the provision of better health care services that should result in improved health outcomes.9 As such, interprofessional education is based on the concept that health professional students are best trained on the skills, knowledge, and attitudes that promote population health when they learn with, from, and about others from diverse health science fields.10

In 2018, the American Speech-Language-Hearing Association's (ASHA) Audiology Advisory Council was surveyed to examine the role of audiologists in collaboration with other health professionals who serve to improve population health through interprofessional education, collaborative practice, and/or research (i.e., IPECP) endeavors.

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METHODS

Survey participants included 104 members of ASHA's Advisory Councils (52 members from the Audiology Advisory Council [AAC] and 52 from the SLP Advisory Council [SLPAC]). A 20-question online survey on interprofessional activity11 was sent between July 6-23, 2018. Respondents were first asked if they had engaged in any IPECP activities in the past 18 months (e.g., January 2017-July 2018). For those who indicated engagement in IPECP endeavors, additional information was collected about interprofessional activity, including the objectives and description of the activity, interprofessional partnerships, Interprofessional Education Collaborative (IPEC)12 core competencies that were targeted, and the outcome(s) of the activity. The online survey was fielded to ASHA's Advisory Councils on behalf of the vice president for academic affairs in audiology and the vice president for academic affairs in speech-language pathology to learn about the members’ involvement in these interprofessional activities. Respondents were informed that the aggregate results would be shared with other health professions to enhance efforts in increasing engagement in interprofessional activities. However, their responses would remain anonymous.

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RESULTS

Of the 104 surveys fielded, 63 responses were obtained (60.6% response rate). A total of 43 (69.4%) respondents indicated engaging in interprofessional activity within the past 18 months (22 [78.6%] AAC and 21 [61.8%] SLPAC members). The primary place of employment of respondents was college/university, followed by hospitals and health care facilities.

Audiologists reported engaging in interprofessional practice (IPP; 59.1%) more often than in interprofessional education (IPE; 40.9%). Few respondents reported engaging in interprofessional research (13.6%). Audiologists most frequently reported serving as team members in interprofessional teams (40.9%). Some served as team leaders some of the time (31.8%) or team leaders all the time (9.1%).

Audiologists reported that they worked most frequently with otolaryngologists, nurses, social workers, and SLPs. They were also more likely to collaborate with other professionals such as athletic trainers, industrial hygienists, and surgeons. With regard to interprofessional collaboration activities, audiologists reported that they engaged in a variety of interprofessional team activities with a range of professionals that were related to specific care teams (Table 1).

The survey also included the IPEC core competency domains of Values & Ethics; Roles & Responsibilities; Interprofessional Communication; and Teams & Teamwork. Audiologists were asked to select those competencies within each of the four core domains that were addressed as an objective or outcome of the interprofessional activities in which they were engaged. Of the four core domains, audiologists reported a higher percentage of their interprofessional activities occurred within Roles & Responsibilities (68.2%), followed by Values & Ethics and Interprofessional Communication (tied at 63.6%), and Teams & Teamwork (59.1%). Table 2 summarizes the specific competencies that were addressed as an objective or outcome. The rating of these competency objectives can be examined within the primary roles and the types of interprofessional activities in which audiologists reported they were engaged. That is, across the core domains, the competency objectives reflected the primary role of a team member rather than that of a team leader. For example, “use unique and complimentary abilities of all members of the team to optimize health and patient care” was rated higher than “forge interdependent relationships with other professions within and outside of the health system to improve care and advance learning” (Roles & Responsibilities). Likewise, the higher-rated competency objectives may also be related to AAC members’ reporting more interprofessional practice activities than interprofessional education activities. For example, AAC members rated “engage health and other professionals in shared patient-centered and population-focused problem-solving” higher than “develop consensus on the ethical principles to guide all aspects of teamwork” (Teams & Teamwork).

Additionally, audiologists shared the general and specific value-added outcomes of their interprofessional team collaborations. The general outcomes were consensus building across professions for difficult treatment decisions, coordinated care for patients, and streamlined treatment planning for patients. The specific outcomes included conducting balance and hearing screenings that resulted in a broader view of the quality-of-life implications among health professionals on teams and recognizing the broad impact of familial hypercholesterolemia (FH).

IPECP endeavors that include audiologists contribute significantly to population health. For overall sustainability, audiologists need to be more engaged in interprofessional research to demonstrate the value-added of their services. Increased public awareness of the impact of communication disabilities on health and health care and the contribution of audiologists as communication specialists within health care teams is also needed. Leadership should be fostered among audiologists in interprofessional teams, and engagement needs to be facilitated among audiologists in IPECP research teams. Finally, a larger-scale study on the IPECP activities of audiologists across work settings should be conducted.

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REFERENCES

1. American Speech Language and Hearing Association (ASHA). (2013). The Value of Collaborating with Audiologists and Speech-Language Pathologists: What We Do. www.asha.org.
2. Bainbridge, KE, Hoffman, HJ, Cowie, CC. (2008). Diabetes and Hearing Impairment in the United States: Audiometric Evidence from the National Health and Nutrition Examination Survey, 1999 to 2004. Ann Intern Med. 2008; 149(1):1-10. DOI: 10.7326/0003-4819-149-1-200807010-00231. Retrieved from http://annals.org/aim/fullarticle/741394/diabetes-hearing-impairment-united-states-audiometric-evidence-from-national-health.
3. Li, C-M, Zhang, X, Hoffman, HJ, et al (2014). Hearing Impairment Associated With Depression in US Adults, National Health and Nutrition Examination Survey 2005-2010. JAMA Otolaryngol Head Neck Surg. 2014;140(4):293-302. doi:10.1001/jamaoto.2014.42. Retrieved from https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/1835392.
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