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)

Informal Survey of 41 Offices in NY and NJ

Hospital22%

Priv Prac44%

ENT34%

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?

Embarrassed

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 meetingsI want to…We used to but…Use them with difficult casesUse real earUse pre and post testingUse 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 measurementAided 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 effectivenessTreatment 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 benefitIf they are satisfiedIf they reduce handicapIf they can physically use them

Data logging

Three different types of measures

Outcome measuresPre-fitting measurementSatisfaction 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 measuresOutcome 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 drivenReal world performance cannot be

simulated in the officeUsing evidence based assessmentNeed 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:goalspopulationsetting

(Cox, 2005)

Limit your choices

4 to 6 possible measuresObtain a copy of eachReview the items and instructions

(Cox, 2005)

Appreciating the Fundamentals(looking at the features of the measurement you’re considering)

Learning to administer the testThe patient’s burdenScoring the testIs the test validIs the test sensitive enough

(Cox, 2005)

Choose the best compromise

Nothing is a perfect fitLearn about the questionnaireBecome familiar with itDecide 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 choicesEliminatedNarrow down choicesGet copiesReview testAdministerChoose

APHAB (Abbreviated Profile of Hearing Aid Benefit) Cox

HHIE (Hearing Handicap Inventory)Weinstein

COSI (Client Oriented Scale of Improvement) Dillon

What tests may not address

PersonalityCognitive ability

Suggestions

Evaluate return rateTry using an outcome measure

Open ended in an interviewClosed ended administered by dispenserPromote communication

Begin using outcome measuresRe-evaluate return rateEvaluate time difference

Thank you