Making Measurements Meaningful Brian J. Zikmund-Fisher, PhD - PowerPoint PPT Presentation

Making Measurements Meaningful Brian J. Zikmund-Fisher, PhD University of Michigan Department of Health Behavior & Health Education Department of Internal Medicine Center for Bioethics & Social Sciences in Medicine Health Informatics Program @bzikmundfisher

Assumptions In Science Communication Assumption: People Lack Information (The Deficit Model) Assumed Solution: Give them more!

Language Numeracy Literacy Barriers Emotionality of Volume of Health Relevant Situations Information

More ≠ Better!

Evaluability

Good or Bad? Amend B. Welcome to Jasorassic Park, 1998, p.36.

Evaluability of Risk Information

Imagine Robert

Imagine Robert Your 10-year risk of cardiovascular disease is: 11.22%

“Am I at high risk, or not?”

Evaluability of Laboratory Test Results

Can Patients Use This?

What Is Out of Range?

Evaluability of Exposure Information

Buying a Home… Radon: 6 pCi/L

Drinking Water… Lead: 7 ppb

Problem #1: Numbers

Problem #2: Lack of Meaning

So now what? What can we do to help?

Step 1: Visual information

Robert’s Risk Created at iconarray.com

Tables Zikmund-Fisher BJ, et al. Graphics help patients distinguish between urgent and non-urgent deviations in laboratory test results. Journal of the American Medical Informatics Association 2017;24(3):520-528.

Table vs. Number Line Zikmund-Fisher BJ, et al. Graphics help patients distinguish between urgent and non-urgent deviations in laboratory test results. Journal of the American Medical Informatics Association 2017;24(3):520-528.

Lines with More Meaning Zikmund-Fisher BJ, et al. Graphics help patients distinguish between urgent and non-urgent deviations in laboratory test results. Journal of the American Medical Informatics Association 2017;24(3):520-528.

Near-Normal Results vs. Extreme Results Near-Normal Extreme Zikmund-Fisher BJ, et al. Graphics help patients distinguish between urgent and non-urgent deviations in laboratory test results. Journal of the American Medical Informatics Association 2017;24(3):520-528.

% with No Difference in Perceived Urgency Platelets ALT Creatinine (135 vs 25 x10 9 /L) (80 vs 360 U/L) (2.2 vs 3.4 mg/dl) Table 26.5 56.3 43.7 Simple Line 17.5 21.3 27.7 Block Line 19.0 20.2 28.7 Gradient 15.8 14.8 24.0 Line Zikmund-Fisher BJ, et al. Graphics help patients distinguish between urgent and non-urgent deviations in laboratory test results. Journal of the American Medical Informatics Association 2017;24(3):520-528.

Step 2: Gist-full information

Fuzzy Trace Theory (Brainerd and Reyna, 1995) Verbatim Gist vs memory

Fuzzy Trace Theory (Brainerd and Reyna, 1995) Verbatim Gist vs memory What the heck is “gist”?

Know Your “Commander’s Intent” Heath & Heath, Made to Stick , 2007

Cancer Screening Test Decisions

Colorectal Cancer Screening

Colorectal Cancer Screening … at age 50

Colorectal Cancer Screening … at age 50 … vs. at age 75 (with multiple comorbidities)

Benefits vs. Harms Image from study materials for “Promoting Veteran-Centered Colorectal Cancer Screening” (I01 HX001278-01); SD Saini, PI.

Gist Processing Image from study materials for “Promoting Veteran-Centered Colorectal Cancer Screening” (I01 HX001278-01); SD Saini, PI.

Setting the Context in Visual Displays

Hemoglobin A1c Unpublished graphic from 1 R01 HS021681, BJ Zikmund-Fisher, Principal Investigator.

Same (?!?) Result Unpublished graphic from 1 R01 HS021681, BJ Zikmund-Fisher, Principal Investigator.

Scale Matters Unpublished graphics from 1 R01 HS021681, BJ Zikmund-Fisher, Principal Investigator.

Test Results for Diagnosed Patients

Goals for Test Results Scherer AM, Witteman HO, Solomon J, Fagerlin A, Exe NL, Zikmund-Fisher BJ. Improving understanding of test results by substituting (not adding) goal ranges. Poster presentation to the Society for Medical Decision Making, Vancouver, BC, Canada, October 23, 2016.

Test Results for Monitoring

Harms Alanine Aminotransferase (ALT): 80 IU/L Standard Range: 10-40

Showing the Possible Range Zikmund-Fisher BJ, Scherer AM, Witteman HO, Solomon J, Exe NL, Fagerlin A. Providing harm anchors in visual displays of test results can mitigate patient perceptions of urgency about near-normal values. Journal of Medical Internet Research, 2018.

Harm Anchors Zikmund-Fisher BJ, Scherer AM, Witteman HO, Solomon J, Exe NL, Fagerlin A. Providing harm anchors in visual displays of test results can mitigate patient perceptions of urgency about near-normal values. Journal of Medical Internet Research, 2018.

Harm Anchors “Many doctors are not concerned until here” Zikmund-Fisher BJ, Scherer AM, Witteman HO, Solomon J, Exe NL, Fagerlin A. Providing harm anchors in visual displays of test results can mitigate patient perceptions of urgency about near-normal values. Journal of Medical Internet Research, 2018.

Increased Sensitivity with Harm Anchors 6 5 Perceived Alarm 4 3 2 1 Near Value Extreme Value Simple Harm Anchor Zikmund-Fisher BJ, Scherer AM, Witteman HO, Solomon J, Exe NL, Fagerlin A. Providing harm anchors in visual displays of test results can mitigate patient perceptions of urgency about near-normal values. Journal of Medical Internet Research, 2018.

One Last Example

Hemoglobin A1c 7.7 7.6 7.5 7.4 Percent 7.3 7.2 7.1 7 0 5 10 15 20 Months

Hemoglobin A1c 7.7 7.6 Central 7.5 Message: 7.4 Percent Varies 7.3 7.2 7.1 7 0 5 10 15 20 Months

7.7 7.6 7.5 Percent 7.4 7.3 7.2 7.1 7 0 10 20 Months

12 10 Percent 8 6 7.7 7.6 = ? 4 7.5 0 10 20 Percent 7.4 Months 7.3 7.2 7.1 7 0 10 20 Months

12 10 Percent 8 6 7.7 7.6 = ? 4 7.5 0 10 20 Percent 7.4 Months 7.3 7.2 7.1 8 7 0 10 20 6 Percent Months 4 2 0 0 10 20 Months

12 10 Percent 8 Varies! 6 7.7 7.6 = ? 4 7.5 0 10 20 Percent 7.4 Months 7.3 7.2 7.1 8 7 0 10 20 6 Percent Months 4 2 0 0 10 20 Months

12 Stable! 10 Percent 8 Varies! 6 7.7 7.6 = ? 4 7.5 0 10 20 Percent 7.4 Months 7.3 7.2 7.1 8 7 0 10 20 6 Percent Months 4 2 0 0 10 20 Months

12 Stable! 10 Percent 8 Varies! 6 7.7 7.6 = ? 4 7.5 0 10 20 Percent 7.4 Months 7.3 7.2 7.1 8 7 0 10 20 6 High! Percent Months 4 2 0 0 10 20 Months

12 Stable! 10 Percent 8 Varies! 6 7.7 7.6 = ? 4 7.5 0 10 20 Percent 7.4 Months 7.3 7.2 7.1 8 7 0 10 20 6 High! Percent Months 4 Scaled to data variations 2 0 0 10 20 Months

Scaled to 12 population Stable! variations 10 Percent 8 Varies! 6 7.7 7.6 = ? 4 7.5 0 10 20 Percent 7.4 Months 7.3 7.2 7.1 8 7 0 10 20 6 High! Percent Months 4 Scaled to data variations 2 0 0 10 20 Months

Scaled to 12 population Stable! variations 10 Percent 8 Varies! 6 7.7 7.6 = ? 4 7.5 0 10 20 Percent 7.4 Months 7.3 7.2 7.1 8 7 0 10 20 6 High! Percent Months 4 Scaled to data variations 2 Scaled to zero 0 0 10 20 Months

12 11 10 Good 9 or 8 Bad? 7 6 5 4 0 5 10 15 20

12 11 10 Good 9 or 8 Bad? 7 6 5 Standard Range 4 0 5 10 15 20

12 11 10 Good 9 or 8 Bad? 7 Target Range for Patients with Type 2 Diabetes 6 5 4 0 5 10 15 20

My Commander’s Intent

“We need to design for the way people ARE, not the way we wish they were” - Holly O. Witteman

People only process or remember one thing

You can’t change this fact!

BUT…

BUT… You get to choose!

Use context to create ONE message based on THEIR needs

Thank You! bzikmund@umich.edu @bzikmundfisher

Making Measurements Meaningful Brian J. Zikmund-Fisher, PhD - PowerPoint PPT Presentation

Making Measurements Meaningful Brian J. Zikmund-Fisher, PhD University of Michigan Department of Health Behavior & Health Education Department of Internal Medicine Center for Bioethics & Social Sciences in Medicine Health Informatics

Authority & Advocacy Professor Pat Buckley Dean of Graduate Studies Making meaningful &

Making Web Sites More Meaningful Tom Heath Knowledge Media Institute The Open University

Measurements - time Measurements - steps MASPAR MP-1 256 processors (Zimmermann, Kumm)

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HIE The Bridge to Interoperability Facilitating Meaningful Use and MACRA Meaningful Use Today

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What is a Meaningful Life? What is a Meaningful Life? The purpose of life, after all, is to

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Meaningful Use Eligible Professional Physician Office Breakfast April 13, 2011 Briggs

Meaningful Turning Assessment Into More Than Numbers David W. Marshall, PhD California State

Meaningful Use 2016 and Beyond Jack Millaway, MS, CPHQ Louisiana Public Health Institute LDH

Meaningful Use: a Primer Mary Mitchell Director of Meaningful Use A project of L.A. Care Health

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a) b) Stereo Camera Sonar Sensors IR Sensors c) Omnidirectional Camera IMU Inertial

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Making Measurements Meaningful Brian J. Zikmund-Fisher, PhD - PowerPoint PPT Presentation

Making Measurements Meaningful Brian J. Zikmund-Fisher, PhD University of Michigan Department of Health Behavior & Health Education Department of Internal Medicine Center for Bioethics & Social Sciences in Medicine Health Informatics

Authority &amp; Advocacy Professor Pat Buckley Dean of Graduate Studies Making meaningful &amp;

Making Web Sites More Meaningful Tom Heath Knowledge Media Institute The Open University

Measurements - time Measurements - steps MASPAR MP-1 256 processors (Zimmermann, Kumm)

Making Math 20 year math teacher Differentiate between a concept and a skills

Making Informed Consent More Meaningful in the Era of the Revised Common Rule Yvonne Lau, MBBS,

HIE The Bridge to Interoperability Facilitating Meaningful Use and MACRA Meaningful Use Today

Paths to Leadership Supporting Emerging Faculty Leaders in Making a Meaningful Difference

Agenda Overview of practice of facilitating meaningful mathematical discourse Standing

What is a Meaningful Life? What is a Meaningful Life? The purpose of life, after all, is to

Meaningful Use Stage 3 Brett Paepke, OD Why talk about Stage 3 now? Introduce the

Meaningful Measures November 28, 2017 Jean Moody-Williams, RN, MPP Pierre Yong, MD, MPH, MS

Meaningful Use Eligible Professional Physician Office Breakfast April 13, 2011 Briggs

Meaningful Turning Assessment Into More Than Numbers David W. Marshall, PhD California State

Meaningful Use 2016 and Beyond Jack Millaway, MS, CPHQ Louisiana Public Health Institute LDH

Meaningful Use: a Primer Mary Mitchell Director of Meaningful Use A project of L.A. Care Health

Facilitating Meaningful How do you promote meaningful Mathematical Discourse mathematical

a) b) Stereo Camera Sonar Sensors IR Sensors c) Omnidirectional Camera IMU Inertial

Vibration measurements on the final doublets Vibration measurements on the final doublets and the

Time series Decomposing a series into meaningful components R.W. Oldford Time series data -

What Magnetic Measurements tell us What Magnetic Measurements tell us about magnetism? about

Making a presentation The material included will help you develop and improve your skills in

Developing a Learning Progression for Scientific Modeling: Making Scientific Modeling Accessible

Office of the National Coordinator for Health Information Technology Supporting Meaningful Use

MEANINGFUL GUIDANCE (when job insecurity has been normalised) Dr. Petra Elftorp 7 th November

Authority & Advocacy Professor Pat Buckley Dean of Graduate Studies Making meaningful &