Voices From the Field: A Quality Improvement Project for Progressive Tinnitus Management 2.0

Purpose: Tinnitus is a common health condition in the general population, with increased prevalence among military Veterans. Tinnitus is, in fact, the most prevalent military service–connected disability. There is no cure for tinnitus, but interventions are available to help patients manage their reactions to tinnitus and reduce its functional impact. Progressive tinnitus management (PTM) is a stepped-care protocol that involves coordinated audiological and behavioral health clinical services. PTM was endorsed by national Veterans Affairs (VA) audiology leadership in 2009. Given new clinical insights and research findings since the initial rollout of PTM, it remains necessary to improve and update the protocol in response to feedback from clinicians and patients. Method: This two-phase quality improvement project captured quantitative and qualitative feedback from VA and Department of Defense (DOD) clinicians and patients concerning PTM materials. A convergent parallel mixed-methods design was used to integrate the quantitative and qualitative data, and a con-sensus method was used to adjudicate any discrepant findings. Results: In Phase 1, 21 VAs and DOD clinicians and patients completed semi-structured interviews and quantitative measures on the PTM handbook and work-book revisions. Phase 1 findings were recommendations to modify content, format, and adaptations of content (e.g., electronicformats with aclickable index).In Phase 2, six non-Veteran patients assisted in pilot testing PTM PowerPoint slides used by clinicians for PTM skills education sessions. Phase 2 findings indicated that the revised PTM PowerPoint slides were useful and clinically acceptable. Conclusions: Findings from this study are being used to revise and update materials in the PTM skills education sessions. More generally, the study demon-strates the necessity of end-user input to inform and implement clinical updates.