Effective hearing loss screening in primary care: The early auditory referral-primary care study

Philip Zazove, University of Michigan, Ann Arbor
Melissa A. Plegue, University of Michigan, Ann Arbor
Michael M. McKee, University of Michigan, Ann Arbor
Melissa Dejonckheere, University of Michigan, Ann Arbor
Paul R. Kileny, University of Michigan, Ann Arbor
Lauren S. Schleicher, University of Michigan, Ann Arbor
Lee A. Green, University of Alberta
Ananda Sen, University of Michigan, Ann Arbor
Mary E. Rapai, University of Michigan, Ann Arbor
Elie Mulhem, Oakland University William Beaumont School of Medicine


© 2020, Annals of Family Medicine, Inc. All rights reserved. PURPOSE Hearing loss, the second most common disability in the United States, is under-diagnosed and under-treated. Identifying it in early stages could prevent its known substantial adverse outcomes. METHODS A multiple baseline design was implemented to assess a screening paradigm for identifying and referring patients aged ≥55 years with hearing loss at 10 family medicine clinics in 2 health systems. Patients completed a consent form and the Hearing Handicap Inventory for the Elderly (HHI). An electronic alert prompted clinicians to screen for hearing loss during visits. RESULTS The 14,877 eligible patients during the study period had 36,701 encounters. Referral rates in the family medicine clinics increased from a baseline rate of 3.2% to 14.4% in 1 health system and from a baseline rate of 0.7% to 4.7% in the other. A general medicine comparison group showed referral rate increase from the 3.0% baseline rate to 3.3%. Of the 5,883 study patients who completed the HHI 25.2% (n = 1,484) had HHI scores suggestive of hearing loss; those patients had higher referral rates, 28% vs 9.2% (P <001). Of 1,660 patients referred for hearing testing, 717 had audiology data available for analysis: 669 (93.3%) were rated appropriately referred and 421 (58.7%) were considered hearing aid candi-dates. Overall, 71.5% of patients contacted felt their referral was appropriate. CONCLUSION An electronic alert used to remind clinicians to ask patients aged ≥55 years about hearing loss significantly increased audiology referrals for at-risk patients. Audiologic and audiogram data support the effectiveness of the prompt. Clinicians should consider adopting this method to identify patients with hearing loss to reduce its known and adverse sequelae.