title: Development of a progressive audiologic tinnitus management program for Veterans with tinnitus.
abstract: Tinnitus is the most prevalent service-connected disability awarded to Veterans. However, clinical protocols for management of tinnitus have been inconsistent across Department of Veterans Affairs (VA) medical centers. A study was funded to develop and pilot test a protocol to provide tinnitus services consistently across VA audiology clinics. Drawing on a series of prior VA and external research projects, a clinical model was formulated, supporting materials in multimedia were developed, and a pilot study was conducted. Five hierarchical levels of care were defined and labeled the Progressive Audiologic Tinnitus Management (PATM) model. The model facilitates access to medical services for tinnitus and includes detailed protocols for evaluation, education, and counseling of patients. Patients at each level of care have the option to "progress" to the next level of PATM if further services are required. Clinical procedures were defined for each level and materials were produced for audiologists and patients. The PATM model was then piloted with clinical patients at the James A. Haley Veterans' Hospital (JAHVH) in Tampa, Florida. Throughout the pilot study, feedback from patients and clinicians was carefully noted. Training materials for audiologists, incorporation of the protocol into clinic activities, and patient outcomes were evaluated. The model was implemented within the JAHVH Audiology Clinic and to assist Veterans with tinnitus management. The most notable finding was how little tinnitus-specific intervention was required for the majority of patients. This finding supports a clinical model that offers stepped-care ("progressive") levels of care until tinnitus management is achieved by the patient.
authors.affiliation: James A. Haley Veterans' Hospital, Audiology Clinic, 14020 N 46th St, Tampa, FL 33613. paula.myers@va.gov.
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Myers
authors.forename: Susan
authors.initials: S
authors.lastname: Griest
authors.forename: Christine
authors.initials: C
authors.lastname: Kaelin
authors.forename: Marcia W
authors.initials: MW
authors.lastname: Legro
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Schmidt
authors.forename: Tara L
authors.initials: TL
authors.lastname: Zaugg
authors.forename: James A
authors.initials: JA
authors.lastname: Henry
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001298:Audiology / Q000193:education / Q000379:methods* / Q000458:organization & administration; D037001:Directive Counseling; D005260:Female; D006297:Health Services Accessibility; D006320:Hearing Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D010865:Pilot Projects; D011795:Surveys and Questionnaires; D014012:Tinnitus / Q000534:rehabilitation*; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: Progressive Audiologic Tinnitus Management; VA audiology; Veterans; auditory disorders; hearing disorders; outcome 
  and process assessment (health care); pilot projects; tinnitus; tinnitus intervention; treatment outcome