1 US Army Center for Health Promotion and Preventive Medicine, Edgewood, MD
2 Naval Reserve Readiness Center, Kansas City, KS
3 Army Audiology and Speech Center, Washington, DC
In health care, an increasing interest in accountability for outcomes, proof of quality care, and cost effectiveness is forcing many practitioners, including audiologists, in the direction of using outcomes analysis to provide proof of performance in their practices. Critical to the conduct of outcomes analysis are the selection of valid outcomes metrics and application of appropriate statistical processes.
Modeling of clinical protocols is a useful exercise for developing outcomes data and data management standards. The authors describe the implications for wider use of outcomes modeling once the Health Insurance Portability and Accountability Act (HIPAA) administrative simplification law is implemented. This legislation will set up a wholly new administrative data set that has strong potential to provide outcomes metrics to a variety of Audiology practices. The modeling exercise described here was originally intended to derive assessment outcomes for evaluating hearing conservation program effectiveness in military populations from an administrative database implemented within the Military Health System starting in 1997. The outcomes modelers, however, soon realized the broader applicability of modeling techniques for other special populations and Audiology practices, particularly with the oncoming startup of HIPAA legislative mandates.
The modeling exercise demonstrates a process of structuring standard health-care codes to produce outcomes data for epidemiologic and cost analyses, thereby providing better information to guide health-care practices toward improving quality and cost effectiveness. This information in time series should also provide a record of continuous quality improvement. The authors present a general hearing surveillance protocol for evaluating occupational hearing loss. The protocol is used as a specific instance to demonstrate the shaping of an outcomes metrics model. This same process can be applied more generally when used to model outcomes data from other audiology practices. Implementation of the administrative data model described here began at more than 400 Department of Defense (DOD) medical treatment facilities worldwide as of October 1, 1999. The exercise of developing similar outcomes metrics for newborn hearing screening programs, school hearing conservation programs, and other clinical and rehabilitative audiology practices in the civilian sector remains to be done.
Key Words: hearing conservation, outcomes analysis, evidence-based practice, clinical practice guidelines, audiometric surveillance
Submitted on April 25, 1999
Accepted on May 17, 2000
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