outcomes Flashcards
Define clinical accountability
Procedures and processes by which one party that carries out an action justifies and is held responsible for its actions by another interested party
Assessing outcomes for a particular patient - circumstances and possible measures
Circumstance - patient oriented enablement
Measures - COSI; visual analogue scales; significant other measures; personalised satisfaction measures
Assessing effectiveness of a particular service - circumstances and measures
Circumstances - comparison of different audiological centres
Measures - SADL (Satisfcation with Amplification in Daily Life); GHABP (Glasgow Hearing Aid Benefit Profile); Changes in other measure; IOI international outcome inventories
What can we measure?
Benefit - Decreased disability/increases activity; decreased handicap/increased participation; quality of sound
Satisfaction
Usage
QOL
How can we measure benefits?
Performance based measures (aided speech testing)
Questionnaires
—-> self administered
—-> administered by clinician
Why do we use speech tests?
1) Measure initial or remaining disability/activity limitation (not restriction)
2) Decide if a program/aid has had the desired effect
3) Compare hearing aids or rehabilitation programs
Aided speech test conclusion
Must be aware score will differ depending on testing conditions and generalisation is not always appropriate
High face validity
Demonstrate utility of lip reading and context
Verifying
Informing further rehab pathways
Issues with questionnaires
Low face validity
Illiteracy
Participant bias
Benefits of COSI
Client specific - high relevance
Relatively short
Good test-retest reliability and validity
Problem - not standardised, can’t look at it in comparison to other clinics etc
What is satisfaction?
The clients reaction to salient aspects of the context, process and results of the service experience
What is QOL?
General - physical health, psychological health, social relation, education, material wealth, recreation/leisure time, and environment
Health related
SPIN
Speech Perception in Noise
List of high and low predictability sentences
Most don’t do it in noise, to either show improvement in scores with contextual cues
Quick SIN
1 min test , aims to measure SNR a listener requires to understand ~50% of key words in sentences in background babble
Whole word scoring
5 key words in each sentence
Vary SNR from 25-0
HAUQ
Measures Usage, benefit and satisfaction
HHIE
Pre-Post measure
Health related QOL measure as it relates to aural rehab
2 subscales: emotional and social/situational
Nice and simple
Should be done face to face/improves reliability
WHO DAS II
WHO Disability Assessment Schedule II looking at QOL
Specific questions on communication
Said to be more sensitive to communication interventions
APHAB
4 Subscales
- Ease of communication
- Reverberation
- BGN
- Aversiveness of sounds
IOI
3 versions for HAs, alternative interventions (group programs etc), and significant other
Single, short post intervention
Quick
Only 1 or 2 questions per measurement
Although standardised questions, they are personalised by wording so can invalidate again
Benefit
Usage
Satisfaction
QOL
GHABP
Glasgow Hearing Aid Benefit Profile
Focussed on disability/handicap (benefit), but also aid use, satisfaction.
Bit long
Post measure only
SADL
Satisfaction with Amplification in Daily Life 4 subscales - positive effect - service and cost - negative features - personal image
QDS
Quantified Denver Scale Some quite confronting Better Face to Face Pre and Post measure used as outcome Not HA specific
SF-36
General QoL measure
Physical health
Mental health
Not very sensitive to impact of amplification, not really a clinical tool (more for research)
Why measure outcomes?
1) WE want to ensure that we are doing the best for our patients; know where to focus future efforts
2) OTHERS make sure we are providing services which are useful/efficacious and cost effective (accountability)
3) OURSELVES keep ourselves accountable, how is your service going
How might you change your approach to speech testing with CI users?
CI may get floor effect for normal free field testing so might be better to do something like detection test, or a closed set test
Make it easier to avoid getting a floor effect/ceiling effect
Functional performance test
What outcome would we use for unilateral snhl with cros aid
Only way to show is to show benefit signal to cros (dead ear) noise to other
Have to add noise
Don’t expect to see benefit when directly from the front
Artificial but shows benefit plausibility
Need to double check this at 2:18
