Validation Measures Flashcards
Why is validation important?
To demonstrate the value of audiological services
To improve clinical practice and patient outcomes
To justify reimbursement for services (increasingly stakeholders are making decisions based on healthcare analytics to drive better treatment outcomes, to identify and differentiate quality providers from those with less effective plans of care, and to determine reimbursement rates
Who are stakeholders?
Regulatory bodies (Food and Drug Administration, Federal Trade Commission)
Health insurance industry
Consumers
What are healthcare analytics used for?
Provides data to insurers, HMOs, state and federal government entities, and other 3rd party payers to determine if money is well spent
Documents Audiology services effectively reduce restrictions/improve quality of life to accrediting agencies
Shows patients and families that professional intervention was beneficial
Validates an audiologists clinical decision for hearing aid selection and fitting practices
Data may be used to support marketing services to the community
When are validation measures taken?
After the patient has adjusted to the newly returned audibility (4-6 weeks after fitting)
Assessment is tailored to determine if an individual’s goals were achieved
What are validation measures?
Compares aided objective and subjective assessments to pre-fitting performance
Demonstrates benefit (reduced activity limitation, increased participations), satisfaction, and improved quality of life
What do post-fitting outcome assessments include?
Assessment of treatment usage/adherence
Measurement of objective aided performance
Self-report measurements of subjective benefit
Self-report measurement of subjective satisfaction
What is the SII?
Speech Intelligibility Index (SII)
The percentage of total speech information available to the listener’s ear for a given speech material
There is considerable individual variability in relating the SII to speech recognition, especially amongst impaired listeners
Validation measure
What is root mean square error (RMSE)?
Mostly used in peds
Automatic calculation to tell us how close we are to the prescriptive target
The difference b/w the probe measured output and prescriptive targets (500 Hz, 1k HZ, 2k Hz, 4k Hz)
The goal is to be within 5 dB of the targets (RMSE of 5 dB or less) - attainable for most mild to severe hearing losses
Aided audibility has been found to be significantly predicted by the proximity to prescriptive targets for a hearing aid fitting
How do you assess usage and treatment adherence?
Review datalogging to determine patterns of daily use
Does usage match your recommendations?
Does the patient reset start up volume?
Analyze environmental variations
Analyze manual program changes
Ask patients to submit a diary of use/experiences
Address any unexpected deviations
If program modification or significant counseling is needed reschedule validation assessment
How do you conduct aided speech assessments in the soundfield?
Materials: syllables, words, sentences (recommended)
Presentation level is typically 50 to 60 dBA (70 dBA for severe losses)
Measure aided performance in quiet and in noise
Compare results to unaided performance for each test condition
Objective assessment
Is the aided QuickSIN also an object assessment?
Yes
Tracks 24-35 allow multi-channel control of the test (channel 1 contains sentence lists, channel 2 contains four-talker babble)
Can be assessed binaurally or monaurally (set up is different depending on this)
Presentation level: 50 to 60 dB HL
Manually increase CH 2 (noise) in 5 dB steps (+25 dB to 0 dB SNR)
Start at 25 dB SNR, then go up to 20 dB SNR, keep going until you reach 0 dB SNR (with each sentence)
What are we looking for when we do aided performance measurements?
Confirm improved audibility of speech signal
Confirm SNR loss did not degrade with omnidirectional microphones
Confirm improved SNR loss with directional microphones enabled
Confirm improved speech understanding with frequency lowering enabled
Confirm Audio-visual integration benefit (optional)
Discuss any residual performance limitations in noise for the purpose of realistic expectations
What are subjective assessments of benefit?
Aided self-report measures
Purpose is to identify improvement of activity limitations and participation restrictions
Assessments allow pre/post-fitting measurements of improvement
Examples: Hearing Handicap Inventory for adults or elderly (HHIA; HHIE)
Abbreviated Profile of Hearing Aid Benefit (APHAB)
Glasgow Hearing Aid Benefit Profile (GHABP)
The Speech, Spatial and Qualities of Hearing Scale (SSQ)
Profile Questionnaire for Rating Communication Performance in Home and Social Environment
York Binaural Hearing-Related Quality of Life Questionnaire
Client oriented scale of improvement (COSI)
What does the post-fitting COSI measure?
Relative benefit - assesses degree of improvement experienced for each COSI goal
Absolute benefit - assesses percentage of time patient hears satisfactorily for each COSI goal (select a percentage representing how much you hear)
What are some subjective assessments of satisfaction?
Device oriented subjective outcome scale (DOSO)
Hearing Aid Skills and Knowledge Inventory - Self-administered (HASKI-self)
International Outcome
Inventory for Hearing Aids (IOI-HA)
SADL (Satisfaction with Amplification in Daily Life)
Shortened Hearing Aid Performance Inventory (SHAPI)
Hearing Aid Use and Satisfaction Measure
