Outcome measures

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Outcome measures

• Lets choose one!

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What is the deal with outcome measures?

• Its more than a phab cozi coat to be worn on a
  sadl

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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

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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

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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

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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)

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Informal Survey of 41 Offices in NY and NJ
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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?

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Embarrassed
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Are they being used?

• lt5 (2 out of 41) use outcome measures
• gt95 DO NOT!

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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

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Verification

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

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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

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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

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Validation

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

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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)

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What is Validation of Hearing Aids looking at?

• reduction of handicap
• acceptance
• benefit
• satisfaction

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Acceptance

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

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Three different types of measures

• Outcome measures
• Pre-fitting measurement
• Satisfaction measures

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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

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What are we left with?

• Pre-fitting measures
• Outcome measures
• Often accomplished with one tool

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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)

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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

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Other reasons to consider

• New graduates
• High frequency hearing loss
• Counseling and realistic expectations
• Reduced return rates

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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

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Objective vs. Subjective measures

• Subjective formal questionnaire or interview
• Objective formal questionnaire multiple
  choice rating system

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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)

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Specifying Essential Features

• Based upon your specifications
• goals
• population
• setting
• (Cox, 2005)

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Limit your choices

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

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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)

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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)

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Readily Available

• COSI in Phonak software
• APHAB in Noah

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Susans Quick Guide

• Review choices
• Eliminated
• Narrow down choices
• Get copies
• Review test
• Administer
• Choose

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APHAB (Abbreviated Profile of Hearing Aid
Benefit) Cox
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HHIE (Hearing Handicap Inventory)Weinstein
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COSI (Client Oriented Scale of Improvement) Dillon
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What tests may not address

• Personality
• Cognitive ability

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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

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• Thank you