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Doctor Matthew Brown
1. Ear Health For Life
A national approach to ear and hearing health
Matthew Brown
Director,
Deadly Ears Program
Brisbane
Associate Professor Kelvin Kong
University of NSW
Consultant Ear Nose and Throat Surgeon
Newcastle
3. 2. Ears and hearing
Kelvin and I share two great passions…
4. Characterised by:
•Earlier onset: first weeks of life;
•High frequency: more often and
repeatedly;
•Greater severity: more likely to
manifest severely;
•Greater persistency: lasts for longer.
•the highest rates of middle ear disease / hearing loss in the
world.
Why is ear health important?
6. • Speech and language
• Family relationships
• Social skills
• School readiness
• Listening and learning
• Educational outcomes
• Friendships
• Employment prospects
• Earning capacity
• Social engagement
• Criminal justice system
Why is ear health important?
7. EFFECTIVE PRIMARY CARE IS CRITICAL
• Targeting 0-4 year olds
• Early identification – child health checks
• Early intervention – clinical assessments
• Clinical management – Recommendations for Clinical Care
Guidelines on the Management of Otitis Media in Aboriginal
and Torres Strait Islander Populations
• Prevention and health promotion
What is important?
9. Measuring What Matters
This is a national problem!
• Ministers have agreed to
explore potential for a
more coordinated
approach
• Measurements of results
will be central
10. Measuring What Matters
• The incidence and prevalence
o especially for 0-4 yrs
• Where the burden of disease is the
greatest (community level)
o high / complex needs
o association with local risk factors
• How effective service coverage is
o eg how many kids receive Child
Health Checks
• What are the most effective
interventions
At present we don’t
know…
11. What do we need?
1. Consistent practice
• especially in primary health settings;
• alignment to national OM guidelines.
Who uses these? (no shame if you don’t!)
2. Consistent data collection
• to identify areas of need;
• to understand what works;
• to prioritise resources.
Sydney Morning Herald, 18 December 2016.
12. Measuring What Matters
Develop KPIs for primary health providers on ear and
hearing health.
These have to be
•Meaningful: capturing information that is useful to
• communities – eg in understanding need
• clinicians – eg improving the value of patient records
• service providers – eg for planning services, and
• policy makers – eg for prioritising resources
• Practical:
• Minimal data entry requirements
• Working with existing EMR systems
14. #earhealthforlife - Where are we up to?
Recent History
Throughout 2017:
- Roundtable catchups / briefings at
conferences.
-RACS, Kelvin and others meeting with
Commonwealth parliamentarians.
V supportive.
15. #earhealthforlife - Where are we up to?
Key next steps
Nov 2017:
Paper to AHMAC to recommend national
approach, which includes:
- Development of national data set / KPIs;
- Support to providers to deliver services
and collect/report data.
16. #earhealthforlife - Where to next?
If this is supported:
Stage 1:
•Form ministerial working group to develop nKPIs and options for
national framework.
Membership
•NACCHO, hearing health program reps and coordinators, ASOHNS,
PHNs, Aust Hearing, Menzies, AIHW, others as required.
Report: potentially within 12 months.
17. #earhealthforlife - Where to next?
Stage 2:
Development and implementation of national framework:
o Reporting structures developed,
o Deliver training,
o Identify difficulties in continuum of care and systems,
o Guide investment.
Funding: Forward estimates, longer term proposition.
22. Measuring What Matters
Simple Detailed
• Number and proportion of Aboriginal clients aged
between 3 months and 5 years who have ear
discharge.
• (Health promotion activity also reported)
Northern Territory Health - Aboriginal Health KPI
23. Measuring What Matters
Simple Detailed
Number and proportion of Indigenous regular clients (age-
specific cohorts) who, in the last 12 mnths:
1. Received otoscopy
2. Received tympanometry
3. Had a recorded episode of:
• Acute OM with or without perforation
• OM with effusion
• Chronic suppurative OM or persistent dry perforation
4. Were prescribed an appropriate antibiotic
5. Received an audiological test
6. Had a current care plan
7. Had a recorded clinical encounter
Sibthorpe, Agostino et al (2017)
24. Measuring What Matters
Simple Detailed
Potential ‘middle ground’?
Number and proportion of Indigenous regular clients (age- specific
cohorts) who, in the last 12 mnths:
1. ‘Did not pass’ a hearing health check comprising
(with otoscopy, tympanometry and audiometry at
appropriate ages) due to ?OM
2. Received the above ear and hearing health check
Numerator
Denominator
3. ‘Were subsequently diagnosed as having :
• Acute OM with or without perforation, or
• OM with effusion, or
• Chronic suppurative OM or persistent dry
perforation
25. Measuring What Matters
Simple Detailed
Potential ‘middle ground’?
Number and proportion of Indigenous regular clients (age- specific
cohorts) who, in the last 12 mnths:
1. ‘Did not pass’ a hearing health check comprising
(with otoscopy, tympanometry and audiometry at
appropriate ages) due to ?OM
2. Received the above ear and hearing health check
3. ‘Were subsequently diagnosed as having :
• Acute OM with or without perforation, or
• OM with effusion, or
• Chronic suppurative OM or persistent dry
perforation
‘Surveillance’
Clinical
assessment
