Patient-centered technology selection in ACHIEVE: What improved our outcomes?

A secondary analysis of ACHIEVE reinforces the importance of matching hearing technology and support to each patient’s real-world listening goals and communication needs.

The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study findings should influence how hearing care professionals think about hearing loss treatment in older adults.

While the primary ACHIEVE outcomes demonstrated that hearing intervention can slow cognitive decline in high-risk older adults, our recent publication1 takes a closer look at a question many clinicians face regularly:

How much does hearing aid technology level matter?

This secondary analysis examined the outcomes for the ACHIEVE hearing intervention participants to determine whether hearing aid technology level and hearing-assistive technology (HAT) selection were associated with individualized listening-goal achievement and daily hours of hearing aid use.

What was included in the intervention?

Participants in the hearing intervention received a 4-session, comprehensive, best-practice audiologic intervention.2

The ACHIEVE Hearing Intervention model included:

  • Goal-setting using the Client-Oriented Scale of Improvement3
  • Hearing aid technology level and HAT selection driven by COSI goals and unaided speech-in-noise performance4
  • Fitting including real-ear verification and device orientation
  • Counseling and self-management support

Study audiologists selected hearing aid technology and HATs using a structured, individualized process. During this study, which began in 2018, participants received Phonak Audéo Belong rechargeable hearing aids at one of three technology levels:

  • Standard (B-R 50)
  • Advanced (B-R 70)
  • Premium (B-R 90)

and provided at least one HAT, with options including:

  • ComPilot II/ ComPilot Air II
  • RemoteMic
  • TVLink
  • Roger™ Easy Pen

Selection recommendations, applied

To better understand the application of these recommendations, two example cases are provided:

Participant A:

COSI goalsAudiometric findingsQuickSIN
1. To hear the television show “West Wing” better when watching with my wife, without turning up the volume.

2. To understand my wife easier when eating dinner together at the table at home nightly.

3. To hear weekly conversations with grandchildren on the phone.		Bilateral mild sloping to moderate SNHL; PTA= 32 dB HLMild SNR loss

>> Technology selected: Standard hearing aids (Phonak Audéo B50-R), and TV Streamer (TVLink II with Compilot Air II; recall, TVLink required intermediate device, Compilot, to receive signal and send to hearing aids)

Participant B:

COSI goalsAudiometric findingsQuickSIN
1. To understand conversations easier during Sunday school.

2. To understand easier when with my family at our weekly dinners at a local Mexican restaurant.

3. To hear my daughter better when she takes me shopping at the grocery store.		Bilateral moderate sensorineural hearing loss; PTA = 52 dB HLMild SNR loss

>> Technology selected: Premium hearing aids (Phonak Audéo B90-R), FM System (Roger Easy Pen and Compilot II)

What did we find?

High amount of hearing aid use

Mean daily use across all participants was approximately 9 hours per day, measured objectively through datalogging.

Even more importantly:

  • Daily hearing aid use did not differ significantly across technology levels.
  • HAT type also did not predict greater hearing aid use.

Consistent hearing aid use was observed across all technology tiers when technology was appropriately matched to individual needs.

COSI goals achieved

According to the two COSI outcome questions (“Rate the degree of change in your hearing ability since your first visit for this goal”; and “Rate your ability to hear now for the first hearing situation”):

  • Almost all participants (>95%) had at least some improvement in their top listening goal and over 70% said their final listening ability was “much better”
  • More than 80% reported that they could hear in their highest prioritized listening situation “most of the time” or “almost always.”

Positive goal outcomes were achieved across technology tiers when technology selection was individualized to the participant’s listening goals and needs.

Further, after considering factors such as hearing loss severity, unaided speech in noise performance, demographics, and HAT use, there were no statistically significant differences between technology levels in:

  • COSI goal improvement
  • Final hearing ability ratings
  • Daily hours of hearing aid use

Putting it all together

So, this leads to an important question: if strong outcomes were achieved across technology levels, does technology tier have a role in patient-centered care?

Our answer is yes – absolutely! These findings do not diminish the value of advanced technology features. Rather, they demonstrate that strong outcomes can be achieved across technology levels when technology is thoughtfully selected to match patient needs, listening goals, and real-world environments.

The success of the ACHIEVE intervention was driven by careful, patient-centered consideration and individualized technology recommendations. The lack of outcome differences across tiers reinforces the value of thoughtful clinical decision-making:

When clinicians thoughtfully match technology and support to the patient, strong outcomes can be achieved while ensuring patients receive the level of technology best suited to their communication needs and lifestyle.

What does this mean for clinicians?

These findings highlight the importance of patient-centered care at technology selection and beyond.

The ACHIEVE protocol emphasized individualized assessment and matching technology to needs. For hearing healthcare providers, these findings highlight a clinical approach that focuses on a wholistic view of the patient, including their needs, goals, and speech-in-noise abilities, not just their audiograms.

When clinicians thoughtfully match technology to individual needs and provide comprehensive care, excellent outcomes are achievable across technology levels.

Final takeaway

The ACHIEVE hearing intervention participants succeeded after receiving individualized, evidence-based care.

Careful assessment, patient-centered goal setting, verification, counseling, and appropriate technology matching can provide hearing aid users with life-changing benefits while helping clinicians select the most appropriate technology level for each individual patient.

To learn more about this secondary analysis, find the full publication here.

References:

  1. Sanchez, V. A., Garcia Morales, E. E., Arnold, M. L., Neil Calloway, H. N., Faucette, S., Goman, A. M., … & Chisolm, T. H. (2026). Patient-Centered Hearing Intervention Leads to Positive Outcomes: The Association of Hearing Technology With Daily Hearing Aid Usage and Listening Goals in the Aging and Cognitive Health Evaluation in Elders Study. American Journal of Audiology, 1-18.
  2. Sanchez, V. A., Arnold, M. L., Reed, N. S., Oree, P. H., Matthews, C. R., Eddins, A. C., … & Chisolm, T. H. (2020). The hearing intervention for the Aging and Cognitive Health Evaluation in Elders randomized control trial: manualization and feasibility study. Ear and Hearing, 41(5), 1333-1348.
  3. Dillon, H., James, A., & Ginis, J. (1997). Client Oriented Scale of Improvement (COSI) and its relationship to several other measures of benefit and satisfaction provided by hearing aids. Journal of the American Academy of Audiology, 8(1). 
  4. Killion MC, Niquette PA, Gudmundsen GI, Revit LJ, Banerjee S (2004) Development of a quick speech-in-noise test for measuring signal-to-noise ratio loss in normal-hearing and hearing-impaired listeners. The Journal of the Acoustical Society of America 116(4):2395–2405

ACHIEVE study context
The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study was a large randomized controlled trial evaluating a best-practices hearing intervention versus a health education control and its relationship to cognitive outcomes over three years in older adults with untreated hearing loss. Learn more about the study design and participant characteristics here.

Source of Funding:
The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study is supported by the National Institute on Aging (NIA) grant R01AG055426, with magnetic brain resonance examination funded by NIA R01AG060502 and with previous pilot study support NIAR34AG046548 and the Eleanor Schwartz Charitable Foundation, in collaboration with the Atherosclerosis Risk in Communities (ARIC) Study, supported by National Heart, Lung and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C,HHSN268201100008C, HHSN268201100009C, HHSN268201100010C,HHSN268201100011C, and HHSN268201100012C). Neurocognitive data in ARIC is collected by U01 2U01HL096812, 2U01HL096814, 2U01HL096899, 2U01HL096902, 2U01HL096917 from the NIH (NHLBI, NINDS, NIA and NIDCD), and with previous brain MRI examinations funded by R01HL70825 from the NHLBI. Hearing aids, hearing assistive technologies, and related materials used in the ACHIEVE Study were provided at no cost to the researchers or the participants from Sonova/Phonak LLC. Neither the funders of the study, nor the sponsoring manufacturer, had no role in study design, data collection, data analysis, data interpretation, or writing of the report. 

Acknowledgments: Members of the ACHIEVE Collaborative Research Group are listed at achievestudy.org. The authors thank the staff and participants of the ACHIEVE and ARIC studies for their important contributions.

Authors:

Sarah Faucette, AuD, PhD, Associate Professor

Dr. Faucette is an Associate Professor at the University of Mississippi Medical Center. She serves at ACHIEVE’s Jackson site as the lead research audiologist. Faucette also teaches Audiological Management in the UMMC AuD program and works clinically in adult diagnostics and treatment.

Theresa Chisolm, PhD, Professor

Dr. Theresa (Terry) Chisolm is a Professor of Audiology in the Department of Communication Sciences and Disorders at the University of South Florida (USF). Dr. Chisolm specializes in rehabilitative audiology and is a licensed and certified audiologist, with over 40 years of clinical and research experience. Previous research examined the efficacy of a computer-based auditory training program for use post-hearing aid fitting, the benefits of group aural rehabilitation, approaches to auditory rehabilitation for veterans with mild traumatic brain injury, and systematic reviews of hearing-related quality of life outcomes from hearing aid use. Her current role as a co-investigator on the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Randomized Study has spanned from initial conceptualization to development of the manualized best-practices hearing intervention to implementation and fidelity monitoring with her co-PI colleagues at USF’s Audiology Rehabilitation Clinical Trial’s laboratory (ARCT), Drs. Victoria Sanchez and Michelle Arnold.

LinkedIn: https://www.linkedin.com/in/theresa-chisolm-4234366b/

Victoria Sanchez, AuD, PhD, Associate Professor

Dr. Sanchez is a clinician scientist at the University of South Florida where she provides patient care, teaches and mentors trainees, and conducts research in the Auditory Rehabilitation & Clinical Trials Laboratory. 

LinkedIn:  www.linkedin.com/in/victoria-sanchez-aud-phd-60009119a

Laura Sherry, AuD, Study Audiologist

Dr. Sherry is a research audiologist in the Department of Otolaryngology-Head & Neck Surgery, Division of Research at the Johns Hopkins University, School of Medicine. Her research interests include the correlation between hearing loss and cognitive decline, as well as improving accessibility to hearing healthcare. Sherry is the lead study audiologist at the Washington County field site for the ACHIEVE study.