Technology Update SessionSession 1B The Client Oriented Scale of Improvement (COSI; Dillon et al., 1997) has been a cornerstone of audiology best practices for decades. Its ease of use, proven validity for measuring benefit and satisfaction, and the active involvement of clients in establishing treatment goals and self-rating their progress have contributed to its widespread adoption (Crowhen & Turnbull, 2018). Although COSI remains a key outcome measure in audiology, a comprehensive review at National Acoustics Laboratories (NAL) revealed limitations. Specifically, COSI goals are frequently vague, seldom revisited, and rarely supported by clear strategies. These shortcomings are often attributed to time constraints, communication barriers, and the absence of structured tools to guide discussions. The evolving landscape of hearing healthcare—with remote and hybrid care models, self-fitted devices, and increasingly informed patients—necessitates a goal-setting process that is patient-driven, consistently applied, and easily integrated into diverse clinical environments. To address these needs, NAL developed COSI 2.0, an AI-powered digital tool designed to help patients articulate their hearing needs and assist clinicians in measuring progress without increasing clinical workloads.To compare the relative effectiveness of COSI 2.0 with the original COSI, NAL partnered with Jabra Enhance (JE), a leader in digital and remote hearing health care. JE combines high-quality hearing aids with a robust teleaudiology platform and has routinely incorporated COSI into its client journey since 2018. This presentation reviews findings from a two-phase study comparing client goals and outcomes in JE's commercial teleaudiology model with data from Hearing Australia’s (HA) traditional clinical network.Phase 1: The first phase involved a retrospective analysis of over 305,000 COSI-generated client goals from both JE’s and HA’s databases (2018–2025). The study examined and compared goal prioritization and intervention outcomes between JE and HA clients. Both models showed a strong convergence in primary patient needs, with "Speech in Noise" emerging as the most common goal category. Outcome distributions were statistically similar, with both care models exhibiting a positive skew toward "Better" and "Much Better" ratings, which supported the efficacy of telehealth. Phase 2: The second phase prospectively deployed COSI 2.0 within both JE and HA settings to address vague goal setting and potential clinician bias. Analyses revealed that 91% of participants reported positive usability. Importantly, self-reporting through COSI 2.0 led to a "realism shift" in outcome measures. The results of this two-phase investigation provided evidence that commercial telehealth models can yield outcomes comparable to traditional clinical care. Moreover, the integration of AI-driven tools enables the collection of highly personal, specific functional goals, moving beyond generic keywords to actionable communication contexts, and offers a more accurate, less biased measure of treatment success. References Crowhen, D., and Turnbull, B. (2018). FOCAS: Family Oriented Communication Assessment and Solutions. Hear Rev, 25(11), 20, 22, 24, 26. Retrieved 12/02/2025 from: https://hearingreview.com/practice-building/focas-family-oriented-communication-assessment-solutions Dillon, H., James, A., and Ginis, J.(1997). Client Oriented Scale of Improvement (COSI) and its Relationship to Several other Measures of Benefit and Satisfaction Provided by Hearing Aids. J Am Acad Audiol, 8(1), 27-43.
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