New Research From the BHI (Part 1)Best Practices = Good Outcomes Sergei Kochkin, PhD.
Agenda • Detailed look at the impact of the audiologist on hearing aid user success (4/2010 HR). • Updated with new data on benefit and quality of life changes associated with hearing aid usage (6/2011 HJ) • First summarize MarkeTrak VIII trends: • 25 year trends in the hearing health market (10/2009 HR) • Customer satisfaction with hearing aids (1/2010 HJ)
25 Year Trends in The Hearing Aid Market October 2009 Hearing Review
Are we really on the fast track? • Original cover for the first MarkeTrak VIII publication • Changed to “Headed for the Fast Track?”
Led to funny editorial“…or Slow Train Coming?” and some alternate titles • Are we on the right track? • Are we on the track at all? • Are we headed for derailment? • Throw Mama on the train! • Why isn't there anyone under 70 on this train? • The train has left the station leaving behind three-quarters of its passengers • People are in denial about their need to get on the train; it takes them 3 to 8 years just to get aboard • Why are train rides so expensive? Why can't we deduct them from our taxes? • Some still believe the train is too big and noisy—and the whistle drives them crazy! • My family doctor told me trains don't work • One of my friends told me that the train ride stinks
Method • National family opinion panel • 80,000 households • Balanced to 9 key census variables • Used since 1984 starting with HIA survey. • Does not include institutional settings. • Screening questions–Phase I(11-12 /2008) • Hearing loss • Hearing aids • Tinnitus • Physician screening for hearing loss • Detailed employment status beyond NFO panel data • Traffic accident data
Method • Screening survey: • Returns – 46,843 households • Identified 14,623 people with hearing loss and or tinnitus • Response rate: 59% • Detailed survey - Phase II (1/2009) • 7 page legal size survey • 3,779 hearing aid owners (total population) • 5,500 adult non-owners (random sample) • Response rate 84% & 79% respectively • $1 incentive
Incidence of hearing loss per thousand householdsThere is no hearing loss epidemic only the aging of America
For more than a generation the incidence of HL has been about one in 10 people HIA* * Adjusted by +.7% to account for multiple hearing-impaired per household
Key HL population data • Incidence of HL in U.S. population = 11.3% • Up from 10.7% (2004) • Admitted HL population = 34.25 million people • Up from 31.5 million people (2004) • 6 out of 10 are male • 60% are below retirement age
Key hearing aid owner population data • Current hearing aid owners = 8.41 million people • Up from 7.8 million (2004) • HA adoption now 24.6% primarily due to VA and direct mail growth.
Hearing aid adoption rates are now in 1 in 4 people with admitted hearing lossGrowth primarily VA and direct mail
What’s the REAL market for hearing aids? • Used subjective measures to segment market • Number of ears impaired • Subjective view of HL • Gallaudet scale • BHI quick hearing check (based on revised AAO-HNS 5 minute hearing loss screener) • Difficulty hearing in noise • Created single HL index (factor analysis) • Divided total HL population into 10% HL segments called deciles • Decile 1 = Lower 10% of HL – mild • Decile 10 – Top 10% of HL – severe to profound
Hearing aid adoption heavily dependent on degree of hearing loss Decile 5-10= 83% hearing aid owners 43% non-adopters
Hearing aid opportunity by age group. The viable hearing aid market in the U.S. is about 11 million more people with untreated hearing loss Deciles 5-10= 6.98 Mil. HA owners 11.1 Mil. non-adopters
Hearing aid adoption rates redefined • One in four people with admitted hearing loss own hearing aids. • 40% of people with moderate to severe hearing loss • 9% of people with milder hearing losses
We are at the right place at the right time • The hearing loss population is growing at the rate of 1.6 times the general population growth– primarily aging population. • Digital technology and the supporting software is superb – and it will get better. • We have the capability of meeting the needs of the vast majority of people with hearing loss.
So why are we on a such a slow moving train? • Explore customer satisfaction with hearing aids • Explore audiologist’s role in user success
Customer Satisfaction with Hearing Aids 2008 January 2010 Hearing Journal
Satisfied & very satisfied customers have not grown during the digital revolution
Dissatisfaction has dropped to 14% but…. 8% of new hearing aids are in the drawer
Hearing aids in the drawer • Varied between 11.7% and 17.9% historically. • More than half are <= 5 years of age • Current rate: 12.4% • New hearing aids (</=4 years) : 7.5% • Brand new HA: 5.2% • 1,040,000 customers never use their hearing aids. • Why do so many people spend $2000-$6000 for a product that does not meet their needs?
Causes for hearing aids in drawer • Poor benefit • Poor fit and comfort • Poor performance in noise
Customer satisfaction with hearing aid signal processing and sound qualityhearing aids are <= 4 years old.
Customer satisfaction with hearing aids in various listening situations hearing aids are <= 4 years old.
Customer satisfaction with hearing aids in various listening situations (continued) hearing aids are <= 4 years old.
Hearing aid multiple environment listening utility (MELU) is not impressive.
Multiple environment listening utility (MELU) is highly related to brand repurchase and positive word of mouth advertising.
Satisfaction with benefit is highly dependent on the number of listening situations hearing aids work…and Somewhat satisfied is hardly an endorsement
Changes since MarkeTrak VII (2004) • Practical (at least 5% point increase)and statistically significant improvements (p<.001 or better): • Whistling and feedback (12% points) • Sound of chewing and swallowing (9% points) • Wind noise (7% points) • Use in noisy situations (7% points) • Comfort with loud sounds (5% points)
The Impact of the Audiologist on Hearing Aid User Success Co-authors Sergei Kochkin, PhD (BHI) Douglas L. Beck, AuD (Oticon) Laurel A. Christensen, PhD (GN ReSound) Cynthia Compton-Conley (Gallaudet U) Brian J. Fligor, ScD (Harvard) Pat B. Kricos, PhD (U of Florida) Jay McSpaden, PhD (Retired audiologist - Oregon) H. Gustav Mueller, PhD (Vanderbilt) Michael Nilsson, PhD (Sonic Innovations) Jerry Northern, PhD (Starkey) Thomas A. Powers, PhD (Siemens) Robert W. Sweetow, PhD (U of C) Brian Taylor, AuD (Unitron) Robert G. Turner, PhD (LSU) Reviewers Harvey B. Abrams, PhD (VA) Ruth Bentler, PhD (U of Iowa) Vic S. Gladstone, PhD (ASHA) Larry Humes, PhD (Indiana U) Michael Valente, PhD (Washington U)
THESIS Audiologist has Direct Control Over Hearing Aid User Success • Hearing aid quality control prior to fit • Fit and comfort of hearing aid • Verification • Validation • Optimal amplification within the residual auditory area of the consumer given current technology & software • Vast array of counseling tools • Measureable BENEFIT GUARANTEE Best Practices Benefit Life Changes
Method • Measured 17 items of the hearing aid fitting protocol. • Measured 7 real-world success measures • Related use of protocol items to real-world success. • Related total weighted protocol to success • Related unweighted protocol to success (e.g. simple counting of steps performed)
Protocol items measured • Hearing tested in sound booth • Real ear measurement verification • Subjective benefit measurement • Objective benefit measurement • Patient satisfaction measurement • Loudness discomfort measurement • Auditory retraining software therapy • Aural rehabilitation group • Received self-help book • Received self-help video • Referred to self-help group
Protocol items measured • Fit and comfort of the hearing aid (single Likert scale item) • Achieved sound quality : • clearness of tone/sound • whistling and feedback • use in noisy situations • natural sounding • sound of voice • ability to hear soft sounds • comfort with loud sounds • single index from Factor analysis. Proxy for: • Optimal amplification of residual auditory area of patient • Functionality of hearing aid (quality control pre-fit)
Protocol items measured • Attributes of the audiologist: • knowledge • professionalism • empathy • creation of realistic expectations • explained care and maintenance of hearing aids • quality of service during the fitting process • quality of service after the hearing aid fitting • all measured on a 7 point Likert scale • single index from Factor analysis
Protocol items measured • Attributes of the hearing healthcare office: • front office staff • hours of operation • attractiveness and comfort of the office • ease of access to the office • convenient location • all measured on a 7 point Likert scale • single index from Factor analysis.
Protocol items measured • Counseling: • the amount of time spent in hours explaining care and maintenance of the hearing aids and • the hours spent in aural rehabilitation • total counseling hours spent in the first 2 months of the new hearing aid fitting. • The number of visits to get the hearing aid working just right for the patient.
Success measures • Hearing aids in the drawer and hearing aid usage in hours. • Benefit. • Satisfaction with benefit (7 point Likert scale) • Perception of % hearing handicap reduction in 10 listening situations. • Multiple Environmental Listening Utility (MELU). The percent of 19 listening situations in which the patient was satisfied or very satisfied. • Quantified Client Oriented Scale of Improvement (COSI) measure. • Only situations for which patient had need to hear.
Success measures • Patient recommendations • Would recommend the audiologist • Would recommend hearing aids to friends • Would repurchase current hearing aid brand • Overall success. • A composite measure of success derived from factor analyzing the above variables • Converting to factor scores and standardizing to a mean of 5 and standard deviation of 2 (stanine scores).
Consumer perceptions of hearing aid fitting protocol received comparing new and experienced users.
Summary of statistically significant relationships between outcome measures and protocol items for new and experienced users
High-low analysis • Compare patients experiencing below average (-1 std) and above average (+1 std) real-world success. • Let’s look at the patients’ experience during the hearing aid fitting process!
A comparison of above average (+1 std) and below average (-1 std) hearing aid success as measured by subjective real-world outcomes showing protocol received based on consumer perceptions.