PubMed · 2190558
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R A Koenigsknecht. Learning from our consumers.. https://pubmed.ncbi.nlm.nih.gov/2190558/
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OBJECTIVES: To determine referral rates resulting from application of American Academy of Otolaryngology-Head and Neck Surgery audiometric referral criteria for occupational hearing conservation programs (HCPs) in a large industrial population and to estimate the efficacy of audiometric retesting in identifying false-positive referral flags. DESIGN: Retrospective, comparing referral rates between control and noncontrol HCPs from public domain data in the American National Standards Institute Draft American National Standard: Evaluating the Effectiveness of Hearing Conservation Programs. SETTING: Occupational HCPs from the United States and Canada. PATIENTS: A total of 45,055 baseline and 27,047 second chronologic audiograms were analyzed. A subset of 3958 employees who had baseline and seven subsequent tests were examined to confirm results. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Percent of employees meeting referral criteria was calculated for unconfirmed (ie, single test) and confirmed (two consecutive tests) audiometric findings. No a priori hypotheses were formulated for referral rates for control or noncontrol HCPs. RESULTS: Noncontrol HCP referral rates were typically two to three times that of control HCPs. Control and noncontrol HCPs had about half as many audiometric referral flags when retests were used to confirm initial results. CONCLUSIONS: Mature industrial populations are likely to yield higher baseline referral rates than younger populations. Retesting may identify up to 50% of audiometric referral flags as false-positive and significantly reduce costly overreferrals. Annual referral rates of 1% to 2% seem to be achievable in well-run HCPs in which retesting is performed to identify false-positive audiometric outcomes.
The value of audiometric database analysis (ADBA) procedures for evaluating the effectiveness of hearing conservation programs (HCPs) was studied in a population of 82,195 workers. We rated the HCP using four ADBA procedures. Results showed that the HCP ratings ran the gamut from "unacceptable" to "acceptable" from year to year and from procedure to procedure. A mere 7 percent of the total population was eligible for ADBA analysis. This drastically reduced sample size precludes subgroup analyses of even a large cohort and likely could not be applied to the HCPs of most small- and medium-sized businesses. The low levels of agreement observed (weighted kappa = 15%-25%) between the ADBA procedures reflect poor validity. Generalizability of these results would be inappropriate when so few nonrandomly selected individuals contribute to the evaluation. In view of these problems, acceptance of the ADBA method as a national standard may not be warranted.