Glasgow hearing aid benefit and difference profiles

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Glasgow hearing aid benefit and difference
profiles

• MHAS TRAINING TEAM

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Outline

• Outcome measures why ? which?
• Glasgow Benefit and Difference profiles
• How to administer
• Profiles and how to interpret

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Why measure outcomes?

• Patient orientated
• to assess patients needs
• to assess effectiveness of rehabilitation and
  need for further help
• Service orientated
• to evaluate service
• to evaluate changes to service

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Which outcome measures?

• Audibility
• Speech tests
• Technical outcomes
• Self report questionnaires (QoL, social, meeting
  needs, hearing aid benefit, satisfaction with
  services and aids)
• COSI, IOI-HA

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Self report questionnaires

• Some have lists of situations - many will be
  irrelevant to individual
• Patient nominates own situations
• Which dimensions to ask about ?
• satisfaction and benefit are different

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An absolute requisite

• Administration of outcome measures MUST be
  robustly embedded in IT infrastructure
• PMS now make routine use realistic

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Glasgow profiles
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Glasgow Profiles

• Glasgow Hearing Aid Benefit Profile (GHABP)
• new hearing aid users
• Glasgow Hearing Aid Difference Profile (GHADiffP)
• existing hearing aid users
• Patient-centred, situation-specific

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GHABP dimensions

• Initial disability
• Handicap
• Use
• Benefit
• Residual disability
• Satisfaction

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Procedure

• Carried out on 2 sessions
• initial assessment
• follow-up appointment, after intervention

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GHABP
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GHABP Part 1

• Does this situation happen in your life?
• How much difficulty do you have in this
  situation?
• How much does any difficulty in this situation
  worry annoy or upset you?

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4 pre-specified situations
LISTENING TO THE TELEVISION WITH OTHER FAMILY OR
FRIENDS WHEN THE VOLUME IS ADJUSTED TO SUIT OTHER
PEOPLE
HAVING A CONVERSATION WITH ONE OTHER PERSON WHEN
THERE IS NO BACKGROUND NOISE
CARRYING ON A CONVERSATION IN A BUSY STREET OR
SHOP
HAVING A CONVERSATION WITH SEVERAL PEOPLE IN A
GROUP
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Up to 4 user-defined situations

• We have dealt with some of the situations which
  in our experience can lead to difficulty with
  hearing. What we would now like you to do is to
  nominate up to four new situations in which it is
  important for you to hear as well as possible.

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User-defined situations
HEARING WHEN MY FRIENDS ASK IF I WANT ANOTHER
DRINK IN THE PUB
LISTENING TO WHAT MY FAMILY ARE SAYING ABOUT ME
WHEN IM IN THE NEXT ROOM
LISTENING FOR APPROACHING POLICE SIRENS WHEN IM
STEALING FROM THE RICH OF SHERWOOD
Note These examples are entirely fictional and
any resemblance between any person alive or
otherwise is purely coincidental
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Demo on PMS
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Practical 1

• Split into small groups
• Demonstrator acts as the patient
• Delegates conduct Glasgow HABP Pt 1 interview
  with a new patient
• Discussion

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Pre-specified situations

• Four pre-specified situations
• Set scene for how interview will take place
• Show the choice of answers
• Use wording on questionnaire to prevent altering
  the meaning
• If situation could apply in different ways,
  investigate further with user-defined situations

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User-defined situations

• Open-ended
• Communication needs important to you to be
  able to hear as well as possible
• Many will say nothing
• Avoid suggesting situations leave them to think
• Be as specific as possible

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User-defined situations

• These give GHABP its power
• What situations occurred last week?
• Relevant to hobbies, interests?
• Examples
• Playing with grandchildren
• At a concert
• At committee meetings
• Refereeing football match

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Practical 1
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GHABP Part 2

• For each situation
• ...what proportion of the time do you wear your
  hearing aid?
• ...how much does your HA help you?
• ...with your HA how much difficulty do you now
  have?
• ...how satisfied are you with your HA?

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Default responses -GHABP

• If situation doesnt happen in life, all columns
  are N/A AB ? PN ?
• If patient has no difficulty in a situation, all
  columns are N/A. 2004 res dis init dis AB ?
  PN ?
• If patient has never worn aid, then intervention
  is ineffective, so for part 2
• Benefit HA no use at all
• Residual disability that prior to HA fitting
• Satisfaction not satisfied at all AB ? PN ?
• If a situation has not occurred since the HA
  fitting, then part 2 is N/A 2004 res dis init
  dis. AB ? PN ?

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GHA Difference Profile

• There are 2 versions - original and MHAS
• MHAS version created to make layout and order
  more intuitive

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GHADiffP - MHAS
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GHADiffP - MHAS

• Part 1 - with old aid(s)
• Use
• Residual disability
• Part 2 - after new aids fitted (or any other
  change)
• Use
• Residual disability
• Benefit difference
• Satisfaction difference

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GHADiffP - residual disability

• the extent to which problems remain after the
  current hearing aid been given
• If patient wears aid, answer as though wearing
  aid
• If the patient never wears their aid, answer as
  though not wearing aid
• The fact that they never wear the aid will be
  documented in the use column (1).

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GHADiffP Follow up appointment

• Post hearing aid change (or change in settings or
  strategy)
• Part 2 (columns 3 - 6)
• relevant to new hearing aid
• Use the user-defined situations that were
  specified at initial assessment

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Default responses - GHADiffP

• If patient has never worn either aid in a
  situation at the 3 month review
• residual disability- new will be the same
  residual disability old
• use will be never
• benefit difference new aid will be the same as
  the old aid
• satisfaction difference will be equally
  satisfied AB ? PN ?

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Practical 2

• Conduct Glasgow HABP Pt 2 interview with a new
  patient
• Conduct Glasgow HADIffP Pt 1 2 interviews with
  an existing patient
• Discussion

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Practical 2
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Scoring

• For each domain, results are averaged across all
  situations
• scaled from 0 to 100

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What do raw scores tell us?
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Raw Score
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Percentiles
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Need for percentiles

• As the raw scores may give a misleading picture
  - 70 use is average (median)
• Need to compare results with those from similar
  patients
• Convert to percentile locations on the
  distribution of peers in the clinical population

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What are percentiles?

• Median is 50th percentile - middle person in a
  distribution (eg height)
• 5th percentile - only 5 are shorter
• 95th percentile - 95 are shorter, only 5
  are taller

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Relevant peer group to compare with?

• Those living in area
• Those with same hearing aid type
• Those with same degree of loss
• Those in same age band
• (National population data from MHAS First Wave
  sites available - can be entered into PMS)

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MHAS reference data for GHABP
Note these data are quite different to the
default data
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Use for Patient management
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Patient Management

• Information from interview
• in particular user-defined situations
• Use of patient profile
• raw scores
• percentiles

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• How might we interpret the GHABP profile?

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Percentiles
Further counselling/hearing therapy
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Percentiles
Different processing strategy/ DSP aid
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Percentiles
Cosmetic/ in-the-ear aid
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• Mis-matches can be informative
• But
• They provide prompts and do not give answers

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GHABP is not a sausage machine
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When to refer for more help?

• Look at centiles
• Look at person
• Rules of thumb - discussion

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GHABP

• Helps audiologist to really understand patients
  hearing needs and their lifestyle
• Separates disability from handicap
• Provides relevant measure of aid use
• Measures perceived benefit in key situations
• Residual disability measure guides need for
  further rehabilitative input

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Use for service evaluation
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Service evaluation- changes to rehab package

• Gatehouse and Brooks study of effect of
  pre-fitting counselling

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Use
Benefit
Satisfaction
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Policy, funding decisions and clinical
effectiveness beyond MHAS

• Continue to make the case for continued further
  investment in hardware, infrastructure, staff and
  rehabilitation
• based on clinical effectiveness
• ability to demonstrate to fundholders that a
  service change leads to better patients outcomes

(hopefully)
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Summary

• We must embed outcome measures in our routine
  services for future development and to help
  individual patient rehabilitation
• Modernising is about a process of hearing
  rehabilitation
• Time spent in understanding our patients needs
  and enabling better rehabilitation is time well
  spent