1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.
-
Upload
margery-harrell -
Category
Documents
-
view
216 -
download
0
Transcript of 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.
![Page 1: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/1.jpg)
1
HPM 214 Course Review
March 9, 2015 (9:00-11:50 am)
HPM 214 http://hpm214.med.ucla.edu/
911 Broxton Avenue
Los Angeles, CA 90024
![Page 2: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/2.jpg)
Where we are now in HPM214
1. Introduction
2. Profile Measures (SF-36 due)
3. Preference-Based Measures
4. Designing Measures
5. Evaluating Measures
6. PROMIS/IRT/Internet Panels
7. Reviews of Manuscripts
8. Course Review (Cognitive interviews due)
9. Final Exam (3/16/15)2
![Page 3: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/3.jpg)
HPM 214 Assignments
• Class participation (25%)
• Two class assignments (25%)– Complete the SF-36 v2 survey at
http://www.sf-36.org/demos/SF-36v2.html – Conduct and summarize 5 cognitive interviews with
a self-administered HRQOL survey.
• Extra credit (2-page critique of published HRQOL article).
3
![Page 4: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/4.jpg)
U.S. Health Care Issues
• Access to care – ~ 50 million people without health insurance
• Costs of care– Expenditures ~ $ 2.7 Trillion
• Effectiveness (quality) of care4
![Page 5: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/5.jpg)
How Do We Know If Care Is Effective?
• Effective care maximizes probability of
desired health outcomes
– Health outcome measures indicate whether
care is effective
Cost ↓
Effectiveness ↑
5
![Page 6: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/6.jpg)
What Are Health Outcomes?
• Traditional clinical endpoints– Death, disease occurrence, other adverse events
– Clinical measures/biological indicators• Blood pressure• Blood hemoglobin level• Symptoms (e.g. fever)
• Health-Related Quality of Life
![Page 7: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/7.jpg)
7
HRQOL is Multi-Dimensional
HRQOL
Physical Mental Social
![Page 8: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/8.jpg)
8
Health-Related Quality of Life (HRQOL)
How the person FEELs (well-being)• Emotional well-being• Pain• Energy
What the person can DO (functioning)• Self-care • Role • Social
![Page 9: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/9.jpg)
9
HRQOL is Not
Quality of environment
Type of housing
Level of income
Social Support
![Page 10: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/10.jpg)
Patient-Reported Outcomes (PROs)
“Any report coming from patients about a health condition and its treatment”(U.S. FDA, 2006)
Including• Health-related quality of life (HRQOL)• Satisfaction with treatment• Patient reports about care• Needs assessment• Adherence to treatment
![Page 11: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/11.jpg)
Patient-Reported Outcomes (PROs)
“Any report coming from patients about a health condition and its treatment”(U.S. FDA, 2006)
Including• Health-related quality of life (HRQOL)• Satisfaction with treatment• Patient reports about care• Needs assessment• Adherence to treatment
![Page 12: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/12.jpg)
Patient-Reported Measures (PRMs)
• Background characteristics– Age, education, income
• Health care experiences– Reports about care (e.g., communication)
• Behavior– Adherence to physician recommendations
• Outcomes– Satisfaction with care– HRQOL
![Page 13: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/13.jpg)
Uses of HRQOL Measures
• Monitoring population (and subgroups)
• Observational studiesObservational studies
• Clinical trials Clinical trials
• Clinical practiceClinical practice
![Page 14: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/14.jpg)
HS 214, Winter 01·11·10
![Page 15: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/15.jpg)
Behavioral Risk Factor Surveillance System (BRFSS)
• Telephone interview (random digit dialing) of nationwide survey of U.S. adults
• % reporting poor or fair health about 16%
![Page 16: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/16.jpg)
Greater % of fair or poor health reported Greater % of fair or poor health reported by older adults (33% for 75+ vs. 9% for 18-24)by older adults (33% for 75+ vs. 9% for 18-24)
Greater % of fair or poor health reported Greater % of fair or poor health reported by older adults (33% for 75+ vs. 9% for 18-24)by older adults (33% for 75+ vs. 9% for 18-24)
![Page 17: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/17.jpg)
Greater % of fair or poor health Greater % of fair or poor health reported reported
by females (17%) than males (15%) by females (17%) than males (15%)
Greater % of fair or poor health Greater % of fair or poor health reported reported
by females (17%) than males (15%) by females (17%) than males (15%)
![Page 18: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/18.jpg)
Uses of HRQOL Measures
• Monitoring population (and subgroups)Monitoring population (and subgroups)
• Observational studies
• Clinical trials Clinical trials
• Clinical practiceClinical practice
![Page 19: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/19.jpg)
Observational Study
•Observation of groups •(non-random assignment)
Outcomes
•Survival•Clinical•HRQOL
Casemix adjustment needed• + Conditions/comorbidity • + Severity• + Demographics•
![Page 20: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/20.jpg)
Uses of HRQOL Measures
• Monitoring population (and subgroups)Monitoring population (and subgroups)
• Observational studiesObservational studies
• Clinical trialsClinical trials
• Clinical practice Clinical practice
![Page 21: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/21.jpg)
Randomized Trial Design• Outcomes
– Survival
– Clinical
– HRQOL
• Control for case-mix may not be required
StudyPopulation
RandomizeRandomize
Intervention Group
Control Group
![Page 22: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/22.jpg)
Uses of HRQOL Measures
• Monitoring population (and subgroups)Monitoring population (and subgroups)
• Observational studiesObservational studies
• Clinical trials Clinical trials
• Clinical practice
![Page 23: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/23.jpg)
HRQOL Assessment by Providers May
• Facilitate patient-physician communication• Improve clinician understanding of patients’ problems
(particularly those of a psychosocial nature)
Detmar SB, Aaronson NK. Quality of life assessment in daily clinical oncology practice: a feasibility study. Eur J Cancer. 1998;34(8):1181-6.
Detmar SB, Muller MJ, Schornagel JH, Wever LD, Aaronson NK. Health-related quality-of-life assessments and patient-physician communication: a randomized controlled trial. J Am Med Assoc. 2002;288(23):3027-34.
Hess R, Tindle H, Conroy MB, et al. A randomized controlled pilot trial of the Functional Assessment Screening Tablet to engage patients at the point of care. JGIM. 2014; 29(12):1641-1649.
Velikova G, Brown JM, Smith AB, Selby PJ. Computer-based quality of life questionnaires may contribute to doctor-patient interactions in oncology. Br J Cancer. 2002;86(1):51-9.
Velikova G, Booth L, Smith AB, et al. Measuring quality of life in routine oncologypractice improves communication and patient well-being: a randomized controlled trial. JClin Oncol. 2004;22(4):714-24.
![Page 24: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/24.jpg)
24
In general, how would you rate your health?
Excellent
Very Good
Good
Fair
Poor
![Page 25: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/25.jpg)
25
Does your health now limit you inwalking more than a mile?
(If so, how much?)
Yes, limited a lotYes, limited a littleNo, not limited at all
![Page 26: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/26.jpg)
26
How much of the time during the past 4 weeks have you been happy?
None of the time
A little of the time
Some of the time
Most of the time
All of the time
![Page 27: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/27.jpg)
27
- Profile: Targeted vs. Generic
- Preference
Types of HRQOL Measures
![Page 28: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/28.jpg)
28
Targeted HRQOL Measures
• Designed to be relevant to particular group.• Sensitive to small, but clinically-important
changes.• More familiar and actionable for clinicians.• Enhance respondent cooperation.
![Page 29: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/29.jpg)
29
Kidney-Disease Targeted Items
During the last 30 days, to what extent were you bothered by cramps during dialysis?
Not at all bothered
Somewhat bothered
Moderately bothered
Very much bothered
Extremely bothered
![Page 30: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/30.jpg)
30
SF-36 Generic Profile Measure • Physical functioning (10 items)
• Role limitations/physical (4 items)
• Role limitations/emotional (3 items)
• Social functioning (2 items)
• Emotional well-being (5 items)
• Energy/fatigue (4 items)
• Pain (2 items)
• General health perceptions (5 items)
![Page 31: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/31.jpg)
31
Scoring HRQOL Profile Scales• Average or sum all items in the same scale.
• Transform average or sum to• 0 (worse) to 100 (best) possible range• z-score (mean = 0, SD = 1)• T-score (mean = 50, SD = 10)
![Page 32: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/32.jpg)
32
HRQOL in HIV Compared to otherChronic Illnesses and General Population
0 10 20 30 40 50 60
Asymptomatic
Symptomatic
AIDS
General Pop
Epilepsy
GERD
Prostate disease
Depression
Diabetes
ESRD
MSEmot.Phy func
Hays et al. (2000), American Journal of MedicineT-score metric
![Page 33: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/33.jpg)
33
HRQOL in HIV Compared to otherChronic Illnesses and General Population
0 10 20 30 40 50 60
Asymptomatic
Symptomatic
AIDS
General Pop
Epilepsy
GERD
Prostate disease
Depression
Diabetes
ESRD
MSEmot.Phy func
Hays et al. (2000), American Journal of MedicineT-score metric
![Page 34: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/34.jpg)
34
HRQOL in HIV Compared to otherChronic Illnesses and General Population
0 10 20 30 40 50 60
Asymptomatic
Symptomatic
AIDS
General Pop
Epilepsy
GERD
Prostate disease
Depression
Diabetes
ESRD
MSEmot.Phy func
Hays et al. (2000), American Journal of MedicineT-score metric
![Page 35: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/35.jpg)
35
Hypertension
Diabetes
Current Depression
Stewart, A.L., Hays, R.D., Wells, K.B., Rogers, W.H., Spritzer, K.L., & Greenfield, S. (1994). Long-termfunctioning and well-being outcomes associated with physical activity and exercise in patients withchronic conditions in the Medical Outcomes Study. Journal of Clinical Epidemiology, 47, 719-730.
Physical Functioning in Relation to Time
Spent Exercising 2-years Before
Low High
Total Time Spent Exercising
84
82
80
78
76
74
72
70
68
66
64
62
0-100 range
![Page 36: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/36.jpg)
36
SF-36 PCS and MCSPCS_z = (PF_Z * 0.42) + (RP_Z * 0.35) +
(BP_Z * 0.32) + (GH_Z * 0.25) + (EF_Z * 0.03) + (SF_Z * -.01) + (RE_Z * -.19) + (EW_Z * -.22)
MCS_z = (PF_Z * -.23) + (RP_Z * -.12) + (BP_Z * -.10) + (GH_Z * -.02) + (EF_Z * 0.24) + (SF_Z * 0.27) + (RE_Z * 0.43) + (EW_Z * 0.49)
PCS = (PCS_z*10) + 50MCS = (MCS_z*10) + 50
![Page 37: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/37.jpg)
SF-12
• Items by Scale– General health (1)– Physical functioning (3b, 3d)– Role-Physical (4b, 4c)– Role-Emotional (5b, 5c)– Bodily pain (8)– Emotional well-being (9d, 9f)– Energy/fatigue (9e)– Social functioning (10)
37
![Page 38: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/38.jpg)
38
Debate About Summary Scores
•Taft, C., Karlsson, J., & Sullivan, M. (2001). Do SF-36 component score accurately summarize subscale scores? Quality of Life Research, 10, 395-404.•Ware, J. E., & Kosinski, M. (2001). Interpreting SF-36 summary health measures: A response. Quality of Life Research, 10, 405-413.•Taft, C., Karlsson, J., & Sullivan, M. (2001). Reply to Drs Ware and Kosinski. Quality of Life Research, 10, 415-420.
![Page 39: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/39.jpg)
39
Farivar et al. alternative weights
PCS_z = (PF_z * .20) + (RP_z * .31) + (BP_z * .23) +
(GH_z * .20) + (EF_z * .13) + (SF_z * .11) +
(RE_z * .03) + (EW_z * -.03)
MCS_z = (PF_z * -.02) + (RP_z * .03) + (BP_z * .04) + (GH_z * .10) + (EF_z * .29) + (SF_z * .14) +
(RE_z * .20) + (EW_z * .35)
•Farivar, S. S., Cunningham, W. E., & Hays, R. D. (2007). Correlated physical and mental health summary scores •for the SF-36 and SF-12 health survey, V. 1. Health and Quality of Life Outcomes, 5: 54. [PMCID: PMC2065865]
![Page 40: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/40.jpg)
40
Is Complementary and Alternative Medicine (CAM) Better than Standard Care (SC)?
0
10
20
30
40
50
60
70
80
90
100
CAMCAM
SCSCCAMCAM
SCSC
PhysicalHealth
CAM > SC
Mental Health
SC > CAM
![Page 41: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/41.jpg)
41
Does Taking Medicine for HIV Lead to Worse HRQOL?
1 No deaddead2 No deaddead
3 No 50 4 No 75 5 No 100 6 Yes 0 7 Yes 25 8 Yes 50 9 Yes 75 10 Yes 100
Subject Antiretrovirals HRQOL (0-100)
No Antiretroviral 3 75Yes Antiretoviral 5 50
Group n HRQOL
![Page 42: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/42.jpg)
42
Cost-Effectiveness of Health Care
Cost ↓
Effectiveness (“Utility”) ↑
![Page 43: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/43.jpg)
http://www.ukmi.nhs.uk/Research/pharma_res.asp
![Page 44: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/44.jpg)
Preference Elicitation• Standard gamble (SG)• Time trade-off (TTO)• Rating scale (RS)
– http://araw.mede.uic.edu/cgi-bin/utility.cgi
SG > TTO > RS SG = TTOa
SG = RSb (Where a and b are less than 1)
• Also discrete choice experiments44
![Page 45: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/45.jpg)
45
![Page 46: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/46.jpg)
46
SF-6D
Brazier et al. (1998, 2002)— 6-dimensional classification
(collapsed role scales, dropped general health)
— Uses 12 SF-36 items (PF: 3a, b, j; R: 4c, 5b; SF: 10; BP: 7, 8; MH: 9b, f; EN: 9e)
--- About 18,000 possible states-— 249 states rated by sample of 836
from UK general populationhttp://www.shef.ac.uk/scharr/sections/heds/mvh/sf-6d
![Page 47: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/47.jpg)
SF-6D Example
• Mean = 0.73 (SD = 0.14)
• Adjusted R-squared of 39% for 43 dfs
• Only 2 of 23 conditions had non-significant associations (melanoma, endometrial cancer)
![Page 48: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/48.jpg)
48
HRQOL in SEER-Medicare Health Outcomes Study (n = 126,366)
0.73
0.74
0.75
0.76
0.77
0.78
0.79
0.8
0.81
0.82
No Condition Hypertension Arthritis-Hand Stroke COPD Arthritis-Hip
SF-6D (range = 0.30-1.00; SD = 0.14) by Condition
Controlling for age, gender, race/ethnicity, education, income, and marital status.
![Page 49: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/49.jpg)
Summary of SF-6D Example
• Unique associations of multiple chronic conditions on health-related quality of life are generally similar and additive, not interactive
• The largest unique associations of chronic conditions with health-related quality of life among Medicare managed care beneficiaries was observed for four chronic medical conditions– Stroke, COPD/asthma, sciatica, arthritis of the hip
• Advanced stage of cancer is associated with noteworthy decrement in health-related quality of life for four “big” cancers (breast, prostate, colorectal, lung)
![Page 50: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/50.jpg)
50
End goal is measure that is “Psychometrically Sound”
• Same people get same scores
• Different people get different scores and differ in the way you expect
• Measure works the same way for different groups (age, gender, race/ethnicity)
• Measure is practical
![Page 51: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/51.jpg)
51
First law of survey development:
Only do it when necessary
![Page 52: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/52.jpg)
52
Second law: Know thy respondent
![Page 53: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/53.jpg)
53
Third law: Practice before you play
“Cut and try, see how it looks and sounds, see how people react to it, and then cut again, and try again” Converse & Presser (1986, p. 78)
Identify problems with
– Comprehension of items (stem/response options)– Retrieval of information– Skip patterns– Response burden
![Page 54: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/54.jpg)
54
Fourth law: Keep it simple and short
![Page 55: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/55.jpg)
55
Fifth law: Believe the survey respondent, but only so much
![Page 56: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/56.jpg)
Four Levels of Measurement
• Nominal (categorical)
• Ordinal (rank)
• Interval (numerical)
• Ratio (numerical)
![Page 57: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/57.jpg)
Levels of Measurement and Their Properties
PropertyProperty
Level Level Magnitude Magnitude Equal Equal
IntervalInterval Absolute 0Absolute 0
Nominal Nominal NoNo NoNo NoNo
Ordinal Ordinal YesYes NoNo NoNo
Interval Interval YesYes YesYes No No
Ratio Ratio YesYes YesYes YesYes
![Page 58: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/58.jpg)
Measurement Range for HRQOL Measures
NominalNominal OrdinalOrdinal IntervalInterval RatioRatio
![Page 59: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/59.jpg)
Variability• Responses fall in each response category
• Distribution approximates bell-shaped “normal” curve (68.2%, 95.4%, and 99.6%)
![Page 60: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/60.jpg)
Reliability
Reliability is the degree to which the same score is obtained for thing being measured (person, plant or whatever) when that thing hasn’t changed.
– Ratio of signal to noise
![Page 61: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/61.jpg)
Kappa Coefficient of Agreement(Corrects for Chance)
kappa =(observed - chance)
(1 - chance)
“Quality Index”
![Page 62: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/62.jpg)
Reliability Minimum Standards
• 0.70 or above (for group comparisons)
• 0.90 or higher (for individual assessment)
SEM = SD (1- reliability)1/2 95% CI = true score +/- 1.96 x SEM
if z-score = 0, then CI: -.62 to +.62 when reliability = 0.90Width of CI is 1.24 z-score units
![Page 63: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/63.jpg)
63
Range of reliability estimates
0.80-0.90 for blood pressure
0.70-0.90 for multi-item self-report scales
Hahn, E. A., Cella, D., et al. (2007). Precision of health-related
quality-of-life data compared with other clinical measures.
Mayo Clin Proceedings, 82 (10), 1244-1254.
![Page 64: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/64.jpg)
Multitrait Scaling Analysis
• Internal consistency reliability– Item convergence
• Item discrimination
![Page 65: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/65.jpg)
65
Item-scale correlation matrix
Depress Anxiety Anger Item #1 0.50* 0.50 0.50 Item #2 0.50* 0.50 0.50 Item #3 0.50* 0.50 0.50 Item #4 0.50 0.50* 0.50 Item #5 0.50 0.50* 0.50 Item #6 0.50 0.50* 0.50 Item #7 0.50 0.50 0.50* Item #8 0.50 0.50 0.50* Item #9 0.50 0.50 0.50* *Item-scale correlation, corrected for overlap.
![Page 66: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/66.jpg)
Validity
• Does instrument measure what it is supposed to measure?
• Content Validity– Includes face validity
• Construct Validity– Many synonyms
![Page 67: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/67.jpg)
67
6
2
17
5
0
2
4
6
8
10
12
14
16
18
<35 35-44 45-54 >55
%
Dead
(n=676) (n=754) (n=1181) (n=609)
SF-36 Physical Health Component Score (PCS)—T scoreSF-36 Physical Health Component Score (PCS)—T score
Ware et al. (1994). SF-36 Physical and Mental Health Summary Scales: A User’s Manual.
Self-Reports of Physical Health Predict Five-Year Mortality
![Page 68: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/68.jpg)
Evaluating Construct ValidityScale Age Obesity ESRD Nursing
Home Resident
Physical Functioning
Medium (-). Small (-) Large (-) Large (-)
Depressive Symptoms
? Small (+) ? Medium (+)
Cohen effect size rules of thumb (d = 0.2, 0.5, and 0.8):Small correlation = 0.100Medium correlation = 0.243Large correlation = 0.371r = d / [(d2 + 4).5] = 0.8 / [(0.82 + 4).5] = 0.8 / [(0.64 + 4).5] = 0.8 / [( 4.64).5] = 0.8 / 2.154 = 0.371 (Beware r’s of 0.10, 0.30 and 0.50 are often cited as small, medium, and large.)
![Page 69: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/69.jpg)
Responsiveness to Change
• HRQOL measures should be responsive to interventions that changes HRQOL
• Need external indicators of change (Anchors)
![Page 70: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/70.jpg)
Minimally Important Difference (MID)
• External anchors– Self-report– Provider report– Clinical measure – Intervention
• Anchor correlated with change on target measure at 0.371 or higher
• Anchor indicates “minimal” change
![Page 71: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/71.jpg)
Listed below are a few statements about your relationships with others. How much is each statement TRUE or FALSE for you?
1. I am always courteous even to people who are disagreeable.2. There have been occasions when I took advantage of someone.3. I sometimes try to get even rather than forgive and forget.4. I sometimes feel resentful when I don’t get my way.5. No matter who I’m talking to, I’m always a good listener.
Definitely true; Mostly true; Don’t know; Mostly false; Definitely false
![Page 72: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/72.jpg)
72
0 10 20 30 40 50 60
General PopEpilepsy
GERDProstate disease
DepressionDiabetes
ESRDMS
AsymptomaticSymptomatic
AIDS
East-West
Physical Functioning and Emotional Well-Being at Baseline
for 54 Patients at UCLA-Center for East West Medicine
EWBPhysical
MS = multiple sclerosis; ESRD = end-stage renal disease; GERD = gastroesophageal reflux disease.
72
![Page 73: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/73.jpg)
73
Significant Improvement in all but 1 of SF-36 Scales (Change is in T-score metric)
Change t-test prob.
PF-10 1.7 2.38 .0208
RP-4 4.1 3.81 .0004
BP-2 3.6 2.59 .0125
GH-5 2.4 2.86 .0061
EN-4 5.1 4.33 .0001
SF-2 4.7 3.51 .0009
RE-3 1.5 0.96 .3400
EWB-5 4.3 3.20 .0023
PCS 2.8 3.23 .0021
MCS 3.9 2.82 .0067
![Page 74: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/74.jpg)
Effect Size
(Follow-up – Baseline)/ SDbaseline
Cohen’s Rule of Thumb:
ES = 0.20 Small
ES = 0.50 Medium
ES = 0.80 Large
74
![Page 75: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/75.jpg)
75
Effect Sizes for Changes in SF-36 Scores
0
5
10
15
20
25
30
35
40
45
50
PFI Role-P Pain Gen H Energy Social Role-E EWB PCS MCS
Baseline
Followup
0.13 0.35 0.35 0.21 0.53 0.36 0.11 0.41 0.24 0.30
Effect Size
PFI = Physical Functioning; Role-P = Role-Physical; Pain = Bodily Pain; Gen H=General Health; Energy = Energy/Fatigue; Social = Social Functioning; Role-E = Role-Emotional; EWB = Emotional Well-being; PCS = Physical Component Summary; MCS =Mental Component Summary.0.11 0.13 0.21 0.24 0.30 0.35 0.35 0.36 0.41 0.53
![Page 76: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/76.jpg)
76
Defining a Responder: Reliable Change Index
(RCI)
)( )2(12
SEM
XX
xxbl rSDSEM 1
Note: SDbl = standard deviation at baseline rxx = reliability
![Page 77: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/77.jpg)
77
7-31% Improve Significantly
% Improving % Declining Difference
PF-10 13% 2% + 11%
RP-4 31% 2% + 29%
BP-2 22% 7% + 15%
GH-5 7% 0% + 7%
EN-4 9% 2% + 7%
SF-2 17% 4% + 13%
RE-3 15% 15% 0%
EWB-5 19% 4% + 15%
PCS 24% 7% + 17%
MCS 22% 11% + 11%
![Page 78: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/78.jpg)
Item Responses and Trait Levels
Item 1 Item 2 Item 3
Person 1 Person 2Person 3
TraitContinuum
78
![Page 79: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/79.jpg)
Reliability Target for Use of Measures with Individuals
Reliability ranges from 0-1 0.90 or above is goal
SE = SD (1- reliability)1/2
Reliability = 1 – (SE/10)2
Reliability = 0.90 when SE = 3.2 95% CI = true score +/- 1.96 x SE
79
![Page 80: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/80.jpg)
Convenience Internet Panels• PROs
– Relatively inexpensive and faster– Able to get to low incidence subgroups
• CONs– Data integrity
• False answers• Answering too fast• Same answer repeatedly• Duplicate surveys from same person
– Respondents may differ from intended target on measured (more educated) and on unmeasured characteristics
![Page 81: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/81.jpg)
Probability Panels
• Selection probabilities known. – Need sampling frame (denominator)
• Get internet access for those without it.
81
![Page 82: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/82.jpg)
Example Questions
1) What is the difference between a profile and preference-based measure?
2) Name a profile measure.
3) Name a preference-based measure.
4) What is a quality-adjusted life year?
5) What does “ACE” stand for?
82
![Page 83: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/83.jpg)
Example Questions (2)1) What is the difference between a PRM and a
PRO?
2) What are the 3 underlying dimensions of HRQOL?
3) Is social support an indicator of HRQOL?
4) What is known about using HRQOL in clinical practice?
5) How much of the time during the last 4 weeks have you been happy?” is an item that measures what?
83
![Page 84: 1 HPM 214 Course Review March 9, 2015 (9:00-11:50 am) HPM 214 911 Broxton Avenue Los Angeles, CA.](https://reader036.fdocuments.in/reader036/viewer/2022062409/5697bf851a28abf838c879e5/html5/thumbnails/84.jpg)
Questions