NASEM Releases Report on Meaningful Outcomes in Adult Hearing Health Care

The National Academies of Science, Engineering, and Medicine recently released the report “Measuring Meaningful Outcomes for Adult Hearing Health Outcomes.” The report includes the committee’s recommendations in the key areas related to a core outcome set, standardized outcome measures, future research on outcomes, measure development and refinement, and update of the core outcome set and measures. NASEM will offer a public webinar about the report on Monday, May 12 at 3:00 pm ET with a recording also available for future viewing. The report and webinar information are available on the project page.  

NASEM formed the 13-member Committee on Meaningful Outcomes in Adult Hearing Health Care in late 2023 to examine outcome research for interventions in adult hearing-health care (excluding surgically placed prosthetic devices). The committee had the charges to determine a core set of existing standard outcome measures, define the core outcome domains (including hearing, communication, and other domains) that should be measured, and develop strategies and a set of recommendations to guide the development of standardized and meaningful measures that are fit for use in different settings. The committee included individuals with a range of perspectives, including hearing-health care, primary care, outcome measurement, epidemiology, public health, disability and rehabilitation, and etiology of and interventions for hearing loss and difficulties. The committee also engaged other stakeholders.

The committee primarily focused on acquired adult-onset hearing loss (and hearing difficulties) and relied on evidence-based review and synthesis of the literature in developing its recommendations:

Core Outcome Set

Recommendation 5-1:  Individuals and organizations engaged in hearing health interventions should adopt the following outcomes as a core outcome set in both research and clinical settings:

• Understanding speech in complex listening situations
• Hearing-related psycho-social health

Standardized Outcome Measures

Recommendation 6-1: When assessing outcomes in hearing health, clinicians, researchers, and individuals should use the following outcome measures for each of the outcomes in the core outcome set:

1. Understanding speech in complex listening situations
   1. Abbreviated Profile of Hearing Aid Benefit test (global score)
   1. Words in Noise (WIN) test
2. Hearing-related psychosocial health
   1. Revised Hearing Handicap Inventory (HHI)

Future Research on Outcomes

Recommendation 4-1: Sponsors of hearing health research should fund additional research to engage adults with hearing difficulties, their communication partners, and clinicians to determine the most meaningful outcomes based on direct evidence from adults with hearing difficulties.

Recommendation 5-2: Sponsors of hearing health research should fund research to build the evidence base on the clinical effect of hearing health interventions on key outcomes that are meaningful to adults with hearing difficulties and clinicians.

Measure Development and Refinement

Recommendation 6-2: Sponsors of hearing health research should fund further psychometric evaluation of the measures recommended for the core outcome set. Specific areas of research include the following:

1. Development of links and crosswalks
   1. WIN test versus Quick Speech in Noise (Quick-SIN) test
   1. Among different variations of the HHI
2. Establishment of the sensitivity to change relative to intervention (including minimal detectable change and minimal clinically important difference) for the WIN, the global score from the Abbreviated Profile of Hearing Aid Benefit (APHAB-global), the Revised HHI (RHHI), and the screening (RHHI-S)
3. Development of WIN (and QuickSIN) in other languages
4. Assessment of associations among the set of core outcomes to further establish the independence and uniqueness of each measure.
5. Application of item response theory to further develop and refine the recommended outcome measures.

Recommendation 6-3:  Sponsors of hearing health research should fund research to develop and refine hearing health outcome measures beyond the currently recommended measures, including:

1. Broader psychometric development of the QuickSIN test;
2. Exploration of the use of the digits-in-noise test as an outcome measure; and
3. Exploration of the usefulness of the high-quality language agnostic tests for sound processing in complex listening situations.

Uptake of Core Outcome Set and Measures

Recommendation 7-1: Health academic organizations and programs, professional organizations, researchers, and consumer groups should disseminate information about the importance of the core outcome set to clinicians of first contact (e.g., primary care clinicians), hearing health clinicians (e.g., students, audiologists, otolaryngologists), and adults with hearing difficulties.

Recommendation 7-2: To create incentives for the use of the core outcome set and corresponding measures the following should occur:

1. Sponsors of research on hearing health interventions should require the use of the core outcome set and corresponding measures (at a minimum), unless scientifically justified for exclusion.
2. Electronic health record (EHR) vendors should incorporate the Abbreviated Profile of Hearing Aid Benefit and Revised Hearing Handicap Inventory into EHRs.
3. Insurers who require outcome measures should require the use of the recommended measures.

Recommendation 7-3: To facilitate big-data meta-analyses, the National Institutes of Health should develop a national database to allow clinicians and researchers to benchmark the use of the core outcome set and corresponding measures as well as their results.

Recommendation 7-4: After an adequate level of new research has been gathered, the National Institutes of Health, the Department of Defense, and the Veterans Administration should collaborate to revisit the core outcome set.

Recommendation 7-5: Sponsors of hearing health research should fund research on comprehensive implementation science approaches to identify additional key facilitators for and barriers to the uptake and use of the core outcome set and corresponding measures.

The Academy will continue to review the full report and share any further key highlights with the membership.