Abstract：
BACKGROUND: Pathway innovation using smartphone otoscopy and tablet-based audiometry technologies to deliver ear and hearing services via trained audiologists may improve efficiency of the service. An ENT-integrated-community-ear service (ENTICES-combining community audiology management, remote ENT review and novel technologies) was piloted. We aimed to assess the efficiency and safety of ENTICES.
METHODS: ENTICES was a community-based and audiologist-led pathway. Patients with otological symptoms were self-referred to this service. Smartphone otoscopy and tablet-based audiograms were performed. Two otologists reviewed all decisions made in the community by audiologists based on video-otoscopy, hearing tests and chart reviews. Data on the first 50 consecutive new patients attending either consultant-led hospital otology clinics (HOC), audiologist-led hospital advanced audiology diagnostics (AAD) or ENTICES clinics were collected between 1 August 2021 and 31 December 2021. Data were collected through chart reviews and questionnaires to compare the three pathways with respect to efficiency, patient satisfaction, technology utility and safety.
RESULTS: No audiology-led ENTICES decisions were amended by hospital otologists following remote review. Remote review of video-otoscopy with history was sufficient for a diagnosis in 80% of cases. Adding hearing tests and standardised history increased the diagnostic yield to 98%. Patient satisfaction scores showed 100% service recommendation. The cost per patient, per visit, was £83.36, £99.07 and £69.72 for AAD, HOC or ENTICES, respectively.
CONCLUSIONS: ENTICES provides a safe ear and hearing service that patients rated highly. Thirty-two per cent of hospital otology patients were eligible for this service. For those patients, ENTICES is 20% more cost-effective and can reduce the number of clinic visits by up to 60% compared with HOC.
METHODS: ENTICES was a community-based and audiologist-led pathway. Patients with otological symptoms were self-referred to this service. Smartphone otoscopy and tablet-based audiograms were performed. Two otologists reviewed all decisions made in the community by audiologists based on video-otoscopy, hearing tests and chart reviews. Data on the first 50 consecutive new patients attending either consultant-led hospital otology clinics (HOC), audiologist-led hospital advanced audiology diagnostics (AAD) or ENTICES clinics were collected between 1 August 2021 and 31 December 2021. Data were collected through chart reviews and questionnaires to compare the three pathways with respect to efficiency, patient satisfaction, technology utility and safety.
RESULTS: No audiology-led ENTICES decisions were amended by hospital otologists following remote review. Remote review of video-otoscopy with history was sufficient for a diagnosis in 80% of cases. Adding hearing tests and standardised history increased the diagnostic yield to 98%. Patient satisfaction scores showed 100% service recommendation. The cost per patient, per visit, was £83.36, £99.07 and £69.72 for AAD, HOC or ENTICES, respectively.
CONCLUSIONS: ENTICES provides a safe ear and hearing service that patients rated highly. Thirty-two per cent of hospital otology patients were eligible for this service. For those patients, ENTICES is 20% more cost-effective and can reduce the number of clinic visits by up to 60% compared with HOC.
摘要：
背景：使用智能手机耳镜检查和基于平板电脑的测听技术通过经过训练的听力学家提供耳朵和听力服务的途径创新可能会提高服务效率。耳鼻喉科综合社区耳部服务(结合社区听力学管理，远程耳鼻喉科审查和新技术)进行了试点。我们旨在评估实体的效率和安全性。
方法：实体是以社区为基础和听力学家为主导的途径。有耳科症状的患者自行转诊。进行了智能手机耳镜检查和基于平板电脑的听力图。两名耳科医师根据视频耳镜检查审查了社区中听力学家做出的所有决定，听力测试和图表审查。在由顾问领导的医院耳科诊所（HOC）就诊的前50名连续新患者的数据，在2021年8月1日至2021年12月31日期间收集了听力学家主导的医院高级听力学诊断（AAD）或鉴定诊所。通过图表回顾和问卷调查收集数据，比较三种途径的效率，患者满意度,技术实用性和安全性。
结果：医院的耳科医师在远程审查后没有修改听力学主导的决定。在80％的病例中，对具有病史的视频耳镜进行远程检查足以进行诊断。加上听力测试和标准化病史，诊断率提高到98%。患者满意度评分显示100%服务推荐。每个病人的费用，每次访问，AAD分别为83.36英镑、99.07英镑和69.72英镑，HOC或实体，分别。
结论：实体提供了安全的耳朵和听力服务，患者评价很高。32%的医院耳科患者有资格享受这项服务。对那些病人来说,与HOC相比，ENITCES的成本效益高20％，可将诊所就诊次数减少多达60％。
方法：实体是以社区为基础和听力学家为主导的途径。有耳科症状的患者自行转诊。进行了智能手机耳镜检查和基于平板电脑的听力图。两名耳科医师根据视频耳镜检查审查了社区中听力学家做出的所有决定，听力测试和图表审查。在由顾问领导的医院耳科诊所（HOC）就诊的前50名连续新患者的数据，在2021年8月1日至2021年12月31日期间收集了听力学家主导的医院高级听力学诊断（AAD）或鉴定诊所。通过图表回顾和问卷调查收集数据，比较三种途径的效率，患者满意度,技术实用性和安全性。
结果：医院的耳科医师在远程审查后没有修改听力学主导的决定。在80％的病例中，对具有病史的视频耳镜进行远程检查足以进行诊断。加上听力测试和标准化病史，诊断率提高到98%。患者满意度评分显示100%服务推荐。每个病人的费用，每次访问，AAD分别为83.36英镑、99.07英镑和69.72英镑，HOC或实体，分别。
结论：实体提供了安全的耳朵和听力服务，患者评价很高。32%的医院耳科患者有资格享受这项服务。对那些病人来说,与HOC相比，ENITCES的成本效益高20％，可将诊所就诊次数减少多达60％。
