Use of the Client Oriented Scale of Improvement as a Clinical Outcome Measure in the Veterans Affairs National Hearing Aid Program

In the present health care environment, there is an increased demand for audiologists to measure the outcomes of hearing aid intervention. In addition to the more traditional objective outcome measures, many subjective outcome measures have been developed in the last 20 years. Two such subjective outcome measures are the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Hearing Handicap Inventory for the Elderly (HHIE). These instruments consist of a series of pre-selected questions that may or may not be applicable to an individual. An alternative to the pre-selected question format is an open format design that allows the person with a hearing loss to designate areas of concern to them. One subjective outcome measure that uses this format is the Client Oriented Scale of Improvement (COSI) developed by Dillon and his colleagues in Australia. The COSI has been validated and may be useful for oversight with multi-clinician or for multi-clinic systems. The purpose of this study was to address tthe potential of the COSI for such oversight. Specifically, the study examined the inter-observer agreement of the classification of individually identified situations into general categories. The study also re-examined the clinical utility of the COSI as an outcome measure in individual hearing aid fittings. The results demonstrated very good inter-observer agreement for the classification of individually identified situations. In addition, the study supported the usefulness as a clinical outcome measure that had been found by Dillon and his colleagues in Australia. These results indicate that the COSI has potential for oversight of the outcomes of hearing aid intervention in hearing aid delivery organizations