Clark Khaya, Lovelace Suheily, Moring John C, Thielman Emily J, Thompson Kassander A, Henry James A, Zaugg Tara
National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, OR.
Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland.
Am J Audiol. 2024 Dec 2;33(4):1077-1091. doi: 10.1044/2024_AJA-23-00167. Epub 2024 Oct 8.
Tinnitus is a common health condition in the general population, with increased prevalence among military Veterans. Tinnitus is, in fact, the most prevalent military service-connected disability. There is no cure for tinnitus, but interventions are available to help patients manage their reactions to tinnitus and reduce its functional impact. Progressive tinnitus management (PTM) is a stepped-care protocol that involves coordinated audiological and behavioral health clinical services. PTM was endorsed by national Veterans Affairs (VA) audiology leadership in 2009. Given new clinical insights and research findings since the initial rollout of PTM, it remains necessary to improve and update the protocol in response to feedback from clinicians and patients.
This two-phase quality improvement project captured quantitative and qualitative feedback from VA and Department of Defense (DOD) clinicians and patients concerning PTM materials. A convergent parallel mixed-methods design was used to integrate the quantitative and qualitative data, and a consensus method was used to adjudicate any discrepant findings.
In Phase 1, 21 VAs and DOD clinicians and patients completed semistructured interviews and quantitative measures on the PTM handbook and workbook revisions. Phase 1 findings were recommendations to modify content, format, and adaptations of content (e.g., electronic formats with a clickable index). In Phase 2, six non-Veteran patients assisted in pilot testing PTM PowerPoint slides used by clinicians for PTM skills education sessions. Phase 2 findings indicated that the revised PTM PowerPoint slides were useful and clinically acceptable.
Findings from this study are being used to revise and update materials in the PTM skills education sessions. More generally, the study demonstrates the necessity of end-user input to inform and implement clinical updates.
耳鸣是普通人群中的常见健康问题，在退伍军人中患病率更高。事实上，耳鸣是与军事服役相关的最普遍残疾。耳鸣无法治愈，但有干预措施可帮助患者应对耳鸣反应并减轻其功能影响。渐进性耳鸣管理（PTM）是一种分级护理方案，涉及协调的听力学和行为健康临床服务。PTM于2009年得到美国退伍军人事务部（VA）听力学领导层的认可。鉴于自PTM首次推出以来有了新的临床见解和研究发现，仍有必要根据临床医生和患者的反馈改进和更新该方案。
这个两阶段的质量改进项目收集了来自VA和国防部（DOD）临床医生及患者关于PTM材料的定量和定性反馈。采用了收敛平行混合方法设计来整合定量和定性数据，并使用了一种共识方法来裁决任何不一致的发现。
在第1阶段，21名VA和DOD临床医生及患者完成了关于PTM手册和工作手册修订的半结构化访谈及定量测量。第1阶段的发现是关于修改内容、格式以及内容改编（例如带有可点击索引的电子格式）的建议。在第2阶段，6名非退伍军人患者协助对临床医生用于PTM技能教育课程的PTM PowerPoint幻灯片进行了试点测试。第2阶段的发现表明，修订后的PTM PowerPoint幻灯片是有用的且在临床上是可接受的。
本研究的结果正被用于修订和更新PTM技能教育课程中的材料。更广泛地说，该研究证明了终端用户输入对于告知和实施临床更新的必要性。
