Health and Wellness Outcome Measures

1. Health and Wellness Outcome Measures Kathi Kemper, MD, MPH; Gregg Gascon, PhD, MPA

2. Introductions • Kathi – measuring outcomes of healing touch, meditation, and music • Gregg- measuring health status, biometrics, health plan metrics and outcomes • YOU

3. 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

4. Outcome Research and Integrative Medicine Goal: Understand, predict and improve health care results

5. Interest in Outcomes Research Outcome measurement in health care has increased for four reasons:   • Scarcity • Increasing rates of chronic illness • Desire to improve quality and outcomes • Variations in medical practices by geography

6. 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.

7. 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

8. 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

9. 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.

10. Health Outcome Models – IN-CAM

11. 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.

12. 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.

13. Health and Wellness Outcome Goals Playing to WIN, not just to avoid losing

14. Offense and Defense: Specific and general • Conventional: Diagnose and dispense • Complementary: Discover and develop • Integrative care is BOTH

16. Which Measures? • Accessible • Published • Free

17. 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/

18. PROMIS Adult Health Domain Framework

19. 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

20. 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

21. 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

22. BREAK or No Break?

23. 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.

24. Standardized Measures • “A measure is standardized to the extent that • Its rules are clear • It is practical to apply • It does not demand great skill of administrators beyond that necessary for their initial training • 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.

25. Outcome Measures in Outpatient Settings

26. Outcome Measures in Research

27. 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?

28. 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.

29. Validity and Reliability

30. Responsiveness Can it detect clinically important changes?

31. 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

32. 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

33. Health and Wellness Goals

34. Selected Health and Wellness Measures

35. 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

36. Discussion (25 minutes): What Measure, When, Why and with Whom? • Physical • Emotional • Mental • Spiritual • Social

37. Online Resources • http://www.nihpromis.org/ • http://www.outcomesdatabase.org/ • http://www.cochrane.org/cochrane-reviews

38. 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?

39. Next steps Talk with colleagues here about collaboration on PCOR Thank you for completing session feedback! go.osu.edu/integrativehealth facebook.com/OSUCIHW twitter.com/OSUCIHW Get our e-newsletter: cihw@osumc.edu