Title: Outcome measures
1Outcome measures
2What is the deal with outcome measures?
- Its more than a phab cozi coat to be worn on a
sadl
3Outcome 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
4What 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
5VALIDATION of HEARING AIDS
- Confirm that the hearing aid is providing benefit
- We give patients hearing aids and we want to be
sure theyre helping
6Is 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)
7Informal Survey of 41 Offices in NY and NJ
8Investigation 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?
9Embarrassed
10Are they being used?
- lt5 (2 out of 41) use outcome measures
- gt95 DO NOT!
11Typical 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
12Verification
- 17 (7 out of 41) use some type of verification
as validation
13Validation 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
14Other 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
15Validation
- Are matched targets appropriate?
- Treatment effectiveness
- Treatment efficiency
- Treatment effect
- Weinstein, 1997
16ICF
- 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)
17What is Validation of Hearing Aids looking at?
- reduction of handicap
- acceptance
- benefit
- satisfaction
18Acceptance
- If they provide benefit
- If they are satisfied
- If they reduce handicap
- If they can physically use them
- Data logging
19Three different types of measures
- Outcome measures
- Pre-fitting measurement
- Satisfaction measures
20Satisfaction 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
21What are we left with?
- Pre-fitting measures
- Outcome measures
- Often accomplished with one tool
22Importance 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)
23Why 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
24Other reasons to consider
- New graduates
- High frequency hearing loss
- Counseling and realistic expectations
- Reduced return rates
25Reduction 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
26Objective vs. Subjective measures
- Subjective formal questionnaire or interview
- Objective formal questionnaire multiple
choice rating system
27Choosing 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)
28Specifying Essential Features
- Based upon your specifications
- goals
- population
- setting
- (Cox, 2005)
-
29Limit your choices
- 4 to 6 possible measures
- Obtain a copy of each
- Review the items and instructions
- (Cox, 2005)
30Appreciating 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)
31Choose 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)
32Readily Available
- COSI in Phonak software
- APHAB in Noah
33Susans Quick Guide
- Review choices
- Eliminated
- Narrow down choices
- Get copies
- Review test
- Administer
- Choose
34APHAB (Abbreviated Profile of Hearing Aid
Benefit) Cox
35HHIE (Hearing Handicap Inventory)Weinstein
36COSI (Client Oriented Scale of Improvement) Dillon
37What tests may not address
- Personality
- Cognitive ability
38Suggestions
- 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