Provision and Fitting of New Technology Hearing Aids: Implications from a Survey of Some 'Good Practice Services' in UK and USA

In the delivery of heath care services there is increasing focus on quality of provision and quality assurance mechanisms. Thus, consensus statements, guidelines, standards, protocols and audit are now concepts familiar to those providing services. The aim of quality assurance is, obviously, to improve quality, but also to reduce practice variability and its corollary, inequity of provision. The extent of variability in the quality of paediatric audiology services has been highlighted previously as a cause for concern (e.g., Bamford et al. 2001). Currently, the two major advances in paediatric audiology, which arguably carry the greatest potential for significant improvement in outcomes are the introduction of newborn hearing screening, leading to early identification and early intervention, and the provision of Digital Signal Processing (DSP) hearing aids. The attraction of the latter over analog aids is that in general they offer the possibility of using advanced processing features (for those likely to benefit from them; which groups of users are likely to benefit from which features is still a matter for research (see Gatehouse 2001). One way of helping the process of service development and quality enhancement is to monitor activity at the better end of the quality distribution. This may help to enhance quality in one or both of two ways: it may show other services what can be done, and thus encourage emulation; and it may point up general gaps in or barriers to development that have to be addressed at levels other than individual