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Outcome measures. Let’s choose one!. What is the deal with outcome measures?. It’s more than a phab cozi coat to be worn on a sadl. Outcome measures. Hearing aid outcome Self assessment Self report For the purpose of determining patient perceived benefit in order to:
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Outcome measures Let’s choose one!
What is the deal with outcome measures? It’s more than a phab cozi coat to be worn on a sadl
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
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
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
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)
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?
Are they being used? <5% (2 out of 41) use outcome measures >95% DO NOT!
Typical responses • I know we should… • We’ve 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
Verification 17% (7 out of 41) use some type of verification as validation
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
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
Validation Are matched targets appropriate? • Treatment effectiveness • Treatment efficiency • Treatment effect Weinstein, 1997
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)
What is Validation of Hearing Aids looking at? • reduction of handicap • acceptance • benefit • satisfaction
Acceptance • If they provide benefit • If they are satisfied • If they reduce handicap • If they can physically use them • Data logging
Three different types of measures • Outcome measures • Pre-fitting measurement • Satisfaction measures
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
What are we left with? • Pre-fitting measures • Outcome measures Often accomplished with one tool
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)
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
Other reasons to consider • New graduates • High frequency hearing loss • Counseling and realistic expectations • Reduced return rates
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
Objective vs. Subjective measures • Subjective – formal questionnaire or interview • Objective – formal questionnaire – multiple choice – rating system
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)
Specifying Essential Features Based upon your specifications: goals population setting (Cox, 2005)
Limit your choices • 4 to 6 possible measures • Obtain a copy of each • Review the items and instructions (Cox, 2005)
Appreciating the Fundamentals(looking at the features of the measurement you’re considering) • Learning to administer the test • The patient’s burden • Scoring the test • Is the test valid • Is the test sensitive enough (Cox, 2005)
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)
Readily Available • COSI – in Phonak software • APHAB – in Noah
Susan’s Quick Guide • Review choices • Eliminated • Narrow down choices • Get copies • Review test • Administer • Choose
What tests may not address • Personality • Cognitive ability
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
