the Session Slides - Integrative Medicine & Health

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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
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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
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Outcome Research and Integrative Medicine
Goal:
Understand, predict and improve health care results
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Interest in Outcomes Research
Outcome measurement in health care has increased for
four reasons:
1.
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4.
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Scarcity
Increasing rates of chronic illness
Desire to improve quality and outcomes
Variations in medical practices by geography
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
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Kane, R.L. and Radosevich, D.M. (2011). Conducting health outcomes research. Sudbury, MA: Jones
& Bartlett Learning. See pages 2-4 and 78.
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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
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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
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Why Measure Global Health(2)
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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.
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Health Outcome Models – IN-CAM
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Health Outcome Models - WHO
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.
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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.
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Health and Wellness Outcome Goals
Playing
to WIN,
not just
to avoid
losing
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Offense and Defense: Specific and general
 Conventional: Diagnose and dispense
Treatment
Specific
Disease
 Complementary: Discover and develop
Treatment
 Integrative care is BOTH
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Whole
Person
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Which Measures?
 Accessible
 Published
 Free
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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/
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PROMIS Adult Health Domain Framework
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Reflections on the PROMIS® on WellBeing/Flourishing Scales
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Purpose of scale
Clinical vs. research utility
Screening vs. assessment
Time of administration
Ease of administration
Interpretability
Pretest effects
Communication
Patient insight
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
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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
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BREAK or No Break?
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 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 (2nd Ed.). Thousand Oaks, CA:
Sage Publications.
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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.”
Nunnally, J.C. and Bernstein, I.H. (1994). Psychometric theory (3rd Ed.). New York, NY: McGrawHill, Inc.
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Outcome Measures in Outpatient Settings
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Outcome Measures in Research
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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?
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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.
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Validity and Reliability
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Responsiveness
Can it detect clinically important
changes?
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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
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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
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Health and Wellness Goals
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PHYSICAL
EMOTIONAL
MENTAL
SPIRITUAL
SOCIAL
Comfort and
sense of ease
Cheerfulness
Clarity, insight
Wisdom
Nurturing
fellowship
Vigor and
vitality
Calm,
confidence
Focus and
awareness
Compassion,
love
Generosity
Strong
immunity
Resilience to
stress
Good memory
Forgiveness
Harmonious
relationships
Selected Health and Wellness Measures
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PHYSICAL
EMOTIONAL
MENTAL
SPIRITUAL
SOCIAL
PROMIS
Global
Empathy
Mindfulness
Compassion,
Gratitude
Social
Support
Sleep
Coping
Resilience
Meaning in life
Hope
Vigor
Affect
Self-efficacy
Hope,
Serenity
5 Groups
 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
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Physical
Emotional
Mental
Spiritual
Social
Discussion (25 minutes): What Measure,
When, Why and with Whom?
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Physical
Emotional
Mental
Spiritual
Social
Online Resources
 http://www.nihpromis.org/
 http://www.outcomesdatabase.
org/
 http://www.cochrane.org/cochrane-reviews
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Research Implications
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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Next steps
Talk with colleagues here about collaboration on PCOR
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