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

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 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

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 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

Thank you