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Outcome measures


									Outcome measures
 Let’s choose one!
What is the deal with outcome
 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

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

 Confirm that the hearing aid is providing

 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

                      Priv Prac
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
  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

   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
                                          speech in noise

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

 Are matched targets appropriate?
  Treatment effectiveness
  Treatment efficiency
  Treatment effect

 Weinstein, 1997
 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
              Activities and activity limitations (previously referred to as
               Participation and participation restrictions (previously
               referred to as handicap)

What is Validation of Hearing Aids
looking at?

       reduction of handicap
       acceptance
       benefit
       satisfaction

  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
        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
  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
   NO mention of use of formal
   standardized outcome measures
Objective vs. Subjective measures

    Subjective – formal questionnaire or

    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:

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

  Personality
  Cognitive ability

  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
Thank you

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