Hearing health information from primary care data: how to capture hearing aid uptake

BACKGROUND: To improve outcomes and reduce health inequalities, we propose a unique and comprehensive NHS telehealth program grant to evaluate case finding of adult hearing loss in primary care via online assessment with remotely delivered intervention.

Our application embraces the NHS long-term plan by using: digital solutions, innovations, technology supported self-management, and remote care to better support people with long-term conditions.

To conduct the planned evaluation of this intervention, a reliable measure of hearing aid (HA) uptake is required that can be used at primary care level.

Although primary care data can index treatment uptake for many health conditions, coding of hearing loss and hearing loss treatments is variable.

NHS HA services communicate with referring GPs and Clinical Commissioning Groups (CCG) through letters or bills of service, respectively, but no communication or coding standards exist.

AIM: To identify and evaluate candidate measures of HA uptake in an adult primary care population, based on routine clinical data, to inform development of an efficient and inexpensive long-term outcome measure for clinical trials.

OBJECTIVES: Audit recording of HA provision in primary care against NHS HA service records to characterise how HA uptake is communicated, coded, and billed. Determine sensitivity of primary care records and CCG billing at identifying first HA provision.

Identify what information is required by GPs, what HA services can provide, and barriers/facilitators to communication between HA services and primary care. Develop, implement, and evaluate a primary care coding scheme for first-time HA provision.

METHODS: We will audit primary care coding and CCG billing data to identify first time adult HA recipients across NHS HA services (NHS Trusts and Any Qualified Provider) and trace these cases to the relevant primary care provider in order to characterise communication of HA provision (objective 1&2).

We will interview audiologists and GPs to determine: (i) what information GPs want from HA services; (ii) what constraints/facilitators there are for coding information; (iii) what information HA services can provide; and (iv) what constraints/facilitators there are on providing that information to GPs (objective 3).

This work will inform development of a communication strategy from HA services to primary care and a coding scheme for HA fittings.

We will implement the coding scheme and evaluate the degree to which first-time HA fittings are captured in GP records over 3-months post-implementation in a sample of 6 practices in two geographic areas (North West and London), varying in size and deprivation.

Implementation and access to routine data will be facilitated by tools developed by PRIMIS (primary care health informatics: https://www.nottingham.ac.uk/primis/) (objective 4).

TIMELINES: Audit and interviews will run concurrently in the first 6 months of the project; development and implementation of the coding scheme in the final 6 months.

IMPACT AND DISSEMINATION: Developing reliable communication and overcoming barriers to coding of HA uptake information in primary care will: i) facilitate indices for future trials to improve hearing health and, ii) promote good communication and record keeping between primary care and HA services, enabling better clinical outcomes for people with hearing loss.