Download - Outcome measures
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Outcome measures
Let’s choose one!
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What is the deal with outcome measures?
It’s more than a phab cozi coat to be worn on a sadl
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Outcome measures
Hearing aid outcome Self assessment Self report
For the purpose of determining patient perceived benefit in order to:
Know how to adjust hearing aids Change to another hearing aid Determine what counseling is needed
Validate
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What is Validation?
Validation of my feelings
Validation – the act of validating – finding or testing the truth of something, the cognitive process of establishing proof
Confirmation that something (application, experiment, equipment) consistently fulfills the requirements for specific use
Making or declaring valid; proof; confirmation
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VALIDATION of HEARING AIDS
Confirm that the hearing aid is providing benefit
We give patients hearing aids and we want to be sure they’re helping
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Is anyone validating?
Majority of dispensers do not administer self assessment outcomes (Lindley, 2006)
Report from an AuD class study said that 80% of practitioners use outcome measures
Subjective outcomes seem to have become the “gold standard” (Mendel, 2009)
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Informal Survey of 41 Offices in NY and NJ
Hospital22%
Priv Prac44%
ENT34%
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Investigation of 41 offices
Do you use any formal standardized outcome measures?
If so, which one(s)?If not, do you have your own that you’ve
developed?Or, do you use a more “informal”
interview method?
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Embarrassed
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Are they being used?
<5% (2 out of 41) use outcome measures
>95% DO NOT!
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Typical responses
I know we should…We’ve talked about it at meetingsI want to…We used to but…Use them with difficult casesUse real earUse pre and post testingUse intake questionnaire Use data logging or diaries
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Verification
17% (7 out of 41) use some type of verification as validation
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Validation vs. Verification
Verification is measurement to see if the gain/output is matching proposed targets
Real-ear measurementAided vs. unaided testing
speech discrimination aided/aided
speech in noise
VERIFICATION
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Other findings:
4 of 41 offices developed their own measure – one of those 4 developed one that looks at the ease of use
2 people in survey were involved in developing measures and are NOT using them
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Validation
Are matched targets appropriate? Treatment effectivenessTreatment efficiency Treatment effect
Weinstein, 1997
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ICF
The ICF is the World Health Organization's International Classification of Function (Disability and Health) The three main areas of the ICF are:
Structure and Function (relating to the actual hearing impairment)
Activities and activity limitations (previously referred to as disability)
Participation and participation restrictions (previously referred to as handicap)
(WHO-DAS)
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What is Validation of Hearing Aids looking at?
reduction of handicap acceptance benefit satisfaction
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Acceptance
If they provide benefitIf they are satisfiedIf they reduce handicapIf they can physically use them
Data logging
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Three different types of measures
Outcome measuresPre-fitting measurementSatisfaction measures
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Satisfaction Measures
SADL – Satisfaction with Amplification in Daily Life – by Cox and Alexander – 15 items in 4 areas – with 7 possible ratings
Marke Trac – by Kochkin – examines 5 areas, multiple questions under each – with 5 possible ratings
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What are we left with?
Pre-fitting measuresOutcome measures
Often accomplished with one tool
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Importance of patient perception
First looked at in 1947 (Davis and Silverman)Aided speech testing doesn’t work
One of the first printed assessments 1964 (High, Fairbanks, and Glorig)
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Why look at self report measures?
Healthcare is customer drivenReal world performance cannot be
simulated in the officeUsing evidence based assessmentNeed to some how justify the use of
technology like directional microphone advancements
For insurance purposes
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Other reasons to consider
New graduates
High frequency hearing loss
Counseling and realistic expectations
Reduced return rates
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Reduction of Returns
Study by Peterson and Bell (2004)
5 year study
return rate = 15.2% (includes all returns and previous vs. experienced users)
NO mention of use of formal standardized outcome measures
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Objective vs. Subjective measures
Subjective – formal questionnaire or interview
Objective – formal questionnaire – multiple choice – rating system
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Choosing the right tool for you
Prioritizing goals – your goals might be to: evaluate benefit of hearing aid fitting diagnose fitting problems predict fitting success compare fitting to similar fittings compare different hearing aids address the patient’s real life concerns
(Cox, 2005)
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Specifying Essential Features
Based upon your specifications:goalspopulationsetting
(Cox, 2005)
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Limit your choices
4 to 6 possible measuresObtain a copy of eachReview the items and instructions
(Cox, 2005)
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Appreciating the Fundamentals(looking at the features of the measurement you’re considering)
Learning to administer the testThe patient’s burdenScoring the testIs the test validIs the test sensitive enough
(Cox, 2005)
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Choose the best compromise
Nothing is a perfect fitLearn about the questionnaireBecome familiar with itDecide whether or not it is for you after
20 to 30 uses.
(Cox, 2005)
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Readily Available
COSI – in Phonak software
APHAB – in Noah
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Susan’s Quick Guide
Review choicesEliminatedNarrow down choicesGet copiesReview testAdministerChoose
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APHAB (Abbreviated Profile of Hearing Aid Benefit) Cox
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HHIE (Hearing Handicap Inventory)Weinstein
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COSI (Client Oriented Scale of Improvement) Dillon
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What tests may not address
PersonalityCognitive ability
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Suggestions
Evaluate return rateTry using an outcome measure
Open ended in an interviewClosed ended administered by dispenserPromote communication
Begin using outcome measuresRe-evaluate return rateEvaluate time difference
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Thank you