Health and Wellness Outcome Measures

Kathi Kemper, MD, MPH; Gregg Gascon, PhD, MPA

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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 ResearchOutcome measurement in health care has increased for four reasons:  

1. Scarcity2. Increasing rates of chronic illness 3. Desire to improve quality and outcomes4. Variations in medical practices by geography

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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

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) 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 - WHOWorld 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• EconomicPreamble 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

Treatment Specific Disease

Treatment Whole Person

Conventional: Diagnose and dispense

Complementary: Discover and develop

Integrative care is BOTH

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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 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

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Large Group Activity: Complete Measures (20 minutes)GLOBAL HEALTH (complete one or both) PROMIS 10 PROMIS 29Global 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 itemTHEN, 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 29Global 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: McGraw-Hill, 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 questionOnce 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

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

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Selected Health and Wellness Measures

PHYSICAL EMOTIONAL MENTAL SPIRITUAL SOCIAL

PROMIS Global Empathy Mindfulness Compassion,

GratitudeSocial

Support

Sleep Coping Resilience Meaning in lifeHope

Vigor Affect Self-efficacy Hope, Serenity

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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

Physical Emotional Mental Spiritual Social

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Discussion (25 minutes): What Measure, When, Why and with Whom?

Physical Emotional Mental Spiritual Social

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Online Resources

http://www.nihpromis.org/ http://www.outcomesdatabase.org

/

http://www.cochrane.org/cochrane-reviews

Research Implications

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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 stepsTalk with colleagues here about collaboration on

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