Presentation on theme: "Health and Wellness Outcome Measures Kathi Kemper, MD, MPH; Gregg Gascon, PhD, MPA."— Presentation transcript:
Health and Wellness Outcome Measures Kathi Kemper, MD, MPH; Gregg Gascon, PhD, MPA
Introductions Kathi – measuring outcomes of healing touch, meditation, and music Gregg- measuring health status, biometrics, health plan metrics and outcomes YOU 2
Overview Introduction: 15 minutes Outcomes research Models Large group activity: PROMIS/Mindfulness 20 minutes to complete 15 minute small group discussion 25 minute report out Break: 15 minutes How to know what’s a good measure: 15 Small group activity 20 min complete questionnaires 15 min small group discussion 25 min report to large group Summary, Resources, Next Steps: 10 min 3
Outcome Research and Integrative Medicine Goal: Understand, predict and improve health care results 4
Interest in Outcomes Research Outcome measurement in health care has increased for four reasons: 1.Scarcity 2.Increasing rates of chronic illness 3.Desire to improve quality and outcomes 4.Variations in medical practices by geography 5
Why Conduct an Outcome Analysis? To measure population health To predict health outcomes To address demands for accountability To improve the knowledge base of a practice or procedure To evaluate treatment intervention effectiveness To improve quality To market a practice, service or procedure 6 Kane, R.L. and Radosevich, D.M. (2011). Conducting health outcomes research. Sudbury, MA: Jones & Bartlett Learning. See pages 2-4 and 78.
Typical Outcome Measures in Health Care Generic/Global/Universal Condition-specific Symptom-specific Health-related quality of life Satisfaction with care Few focus on health and wellness assets 7
Why Measure Global Health (1) Assess population health comparability between comparison groups Compare different treatments, diseases, and patient populations Systematically and consistently measure patient health status in outpatient settings, e.g., Bravenet 8
Why Measure Global Health(2) Complement disease-specific outcome Clinical endpoint in an economic study Risk adjustment Measure for professional profiling Global interventions: global outcomes Kane, R.L. and Radosevich, D.M. (2011). Conducting health outcomes research. Sudbury, MA: Jones & Bartlett Learning. 9
Health Outcome Models - WHO 11 World Health Organization (WHO) definition of health: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Other recent dimensions of health include Behavioral Emotional Spiritual Ecological Educational Economic Preamble to the Constitution of the WHO as adopted by the International Health Conference, New York, 19-22 June, 1946. Signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
Health Outcome In this presentation we will use aspects of each of these models to address health and wellness outcomes that are of interest to integrative medicine and health. We will also emphasize the use of outcome measures of health rather than disease or disease indicators. 12
Health and Wellness Outcome Goals 13 Playing to WIN, not just to avoid losing
Offense and Defense: Specific and general 14 Treatment Specific Disease Treatment Whole Person Conventional: Diagnose and dispense Complementary: Discover and develop Integrative care is BOTH
Which Measures? Accessible Published Free 16
PROMIS GLOBAL HEALTH The Patient Reported Outcomes Measurement Information System (PROMIS) Funded by NIH Highly reliable, valid, flexible, precise, and responsive assessment tools Measure patient–reported health status Physical Mental Social http://www.nihpromis.org/ http://www.nihpromis.org/ 17
Reflections on the PROMIS® on Well- Being/Flourishing Scales Purpose of scale Clinical vs. research utility Screening vs. assessment Time of administration Ease of administration Interpretability Pretest effects Communication Patient insight 19
Large Group Activity: Complete Measures (20 minutes) GLOBAL HEALTH (complete one or both) PROMIS 10 PROMIS 29 Global well-being or flourishing scales (complete at least 3) Diener – 5 item PWB – 8 item IWB – 9 item WHO-5 – 5 items Short Flourishing Scale – 8 item THEN, discuss pros and cons as small group for 15 minutes 20
Pros and Cons (large group: 20 minutes) GLOBAL HEALTH (complete one or both) PROMIS 10 PROMIS 29 Global well-being or flourishing scales Diener, SWL – 5 item PWBS – 8 item IWB – 9 item WHO-5 WBI – 5 items Short Flourishing Scale – 8 item 21
How do know which outcome measure to use to answer our research questions? Choose the outcome measure that best represents what you want to measure. If it can’t be measured, it can’t be studied quantitatively. Furr, R.M. and Bacharach, V.R. (2014). Psychometrics: An introduction (2 nd Ed.). Thousand Oaks, CA: Sage Publications. 23
Standardized Measures “A measure is standardized to the extent that (1)Its rules are clear (2)It is practical to apply (3)It does not demand great skill of administrators beyond that necessary for their initial training (4)Its results do not depend upon the specific administrator.” 24 Nunnally, J.C. and Bernstein, I.H. (1994). Psychometric theory (3 rd Ed.). New York, NY: McGraw- Hill, Inc.
Selecting Outcome Measures Does it make sense? Is it reliable? Is it valid? Is it responsive to meaningful change? Do resources for measurement exceed the burden/cost? Does it fit the study design and question? 27
Sensibility Does the measure make sense? The term ‘sensibility’ means the application of common sense and clinical understanding to the decision of whether or not to use a measure in a study of a given construct. 28
Responsiveness Can it detect clinically important changes? 30
Resources and Burden Do available resources exceed the burden for using the measure? Burden for patient and clinician: Patient: time, aggravation, and discomfort Clinician/Researcher: time, costs, and efficiency 31
Design and Study question Once the properties of an outcome measure have been thoroughly investigated, the measure must be evaluated in light of the Research design Analytical plan 32
Health and Wellness Goals 33 PHYSICALEMOTIONALMENTALSPIRITUALSOCIAL Comfort and sense of ease CheerfulnessClarity, insightWisdom Nurturing fellowship Vigor and vitality Calm, confidence Focus and awareness Compassion, love Generosity Strong immunity Resilience to stress Good memoryForgiveness Harmonious relationships
Selected Health and Wellness Measures 34 PHYSICALEMOTIONALMENTALSPIRITUALSOCIAL PROMIS Global EmpathyMindfulness Compassion, Gratitude Social Support SleepCopingResilience Meaning in life Hope VigorAffectSelf-efficacy Hope, Serenity
5 Groups 35 Each group completes measures in one domain Discuss when it might be useful to measure in this domain Discuss pros and cons of the measure(s) 1 volunteer to share with larger group Timing 20 minutes to complete measures 15 minutes for small group Physical Emotional Mental Spiritual Social
Discussion (25 minutes): What Measure, When, Why and with Whom? Physical Emotional Mental Spiritual Social 36
Research Implications 38 What are we studying? - Conditions/ people - Interventions What outcome measures of HEALTH and WELLNESS? Can we agree on shared measures to facilitate collaboration?
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