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Outcome measures

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Title: Outcome measures


1
Outcome measures
  • Lets choose one!

2
What is the deal with outcome measures?
  • Its more than a phab cozi coat to be worn on a
    sadl

3
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

4
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

5
VALIDATION of HEARING AIDS
  • Confirm that the hearing aid is providing benefit
  • We give patients hearing aids and we want to be
    sure theyre helping

6
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)

7
Informal Survey of 41 Offices in NY and NJ
8
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 youve
    developed?
  • Or, do you use a more informal interview
    method?

9
Embarrassed
10
Are they being used?
  • lt5 (2 out of 41) use outcome measures
  • gt95 DO NOT!

11
Typical responses
  • I know we should
  • Weve talked about it at meetings
  • I want to
  • We used to but
  • Use them with difficult cases
  • Use real ear
  • Use pre and post testing
  • Use intake questionnaire
  • Use data logging or diaries

12
Verification
  • 17 (7 out of 41) use some type of verification
    as validation

13
Validation vs. Verification
  • Verification is measurement to see if the
    gain/output is matching proposed targets
  • Real-ear measurement
  • Aided vs. unaided testing
  • speech discrimination
  • aided/aided
  • speech in noise
  • VERIFICATION

14
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

15
Validation
  • Are matched targets appropriate?
  • Treatment effectiveness
  • Treatment efficiency
  • Treatment effect
  • Weinstein, 1997

16
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)

17
What is Validation of Hearing Aids looking at?
  • reduction of handicap
  • acceptance
  • benefit
  • satisfaction

18
Acceptance
  • If they provide benefit
  • If they are satisfied
  • If they reduce handicap
  • If they can physically use them
  • Data logging

19
Three different types of measures
  • Outcome measures
  • Pre-fitting measurement
  • Satisfaction measures

20
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

21
What are we left with?
  • Pre-fitting measures
  • Outcome measures
  • Often accomplished with one tool

22
Importance of patient perception
  • First looked at in 1947 (Davis and Silverman)
  • Aided speech testing doesnt work
  • One of the first printed assessments 1964 (High,
    Fairbanks, and Glorig)

23
Why look at self report measures?
  • Healthcare is customer driven
  • Real world performance cannot be simulated in the
    office
  • Using evidence based assessment
  • Need to some how justify the use of technology
    like directional microphone advancements
  • For insurance purposes

24
Other reasons to consider
  • New graduates
  • High frequency hearing loss
  • Counseling and realistic expectations
  • Reduced return rates

25
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

26
Objective vs. Subjective measures
  • Subjective formal questionnaire or interview
  • Objective formal questionnaire multiple
    choice rating system

27
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 patients real life concerns
  • (Cox, 2005)

28
Specifying Essential Features
  • Based upon your specifications
  • goals
  • population
  • setting
  • (Cox, 2005)

29
Limit your choices
  • 4 to 6 possible measures
  • Obtain a copy of each
  • Review the items and instructions
  • (Cox, 2005)

30
Appreciating the Fundamentals(looking at the
features of the measurement youre considering)
  • Learning to administer the test
  • The patients burden
  • Scoring the test
  • Is the test valid
  • Is the test sensitive enough
  • (Cox, 2005)

31
Choose the best compromise
  • Nothing is a perfect fit
  • Learn about the questionnaire
  • Become familiar with it
  • Decide whether or not it is for you after 20 to
    30 uses.
  • (Cox, 2005)

32
Readily Available
  • COSI in Phonak software
  • APHAB in Noah

33
Susans Quick Guide
  • Review choices
  • Eliminated
  • Narrow down choices
  • Get copies
  • Review test
  • Administer
  • Choose

34
APHAB (Abbreviated Profile of Hearing Aid
Benefit) Cox
35
HHIE (Hearing Handicap Inventory)Weinstein
36
COSI (Client Oriented Scale of Improvement) Dillon
37
What tests may not address
  • Personality
  • Cognitive ability

38
Suggestions
  • Evaluate return rate
  • Try using an outcome measure
  • Open ended in an interview
  • Closed ended administered by dispenser
  • Promote communication
  • Begin using outcome measures
  • Re-evaluate return rate
  • Evaluate time difference

39
  • Thank you
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