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

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

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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

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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

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Assumptions In Science Communication

Assumption: People Lack Information

(The Deficit Model)

Assumed Solution: Give them more!

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Barriers

Language Literacy Numeracy Emotionality of Health Situations Volume of Relevant Information

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More ≠ Better!

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Evaluability

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Good or Bad?

Amend B. Welcome to Jasorassic Park, 1998, p.36.

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Good or Bad?

Amend B. Welcome to Jasorassic Park, 1998, p.36.

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Evaluability

  • f Risk Information
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Imagine Robert

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Imagine Robert

Your 10-year risk of cardiovascular disease is:

11.22%

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“Am I at high risk,

  • r not?”
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Evaluability

  • f Laboratory

Test Results

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Can Patients Use This?

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What Is Out of Range?

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What Is Out of Range?

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“Am I at high risk,

  • r not?”
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Evaluability

  • f Exposure

Information

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Buying a Home…

Radon: 6 pCi/L

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Drinking Water…

Lead: 7 ppb

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“Am I at high risk,

  • r not?”
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Problem #1: Numbers

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Problem #2: Lack of Meaning

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So now what?

What can we do to help?

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Step 1: Visual information

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Robert’s Risk

Created at iconarray.com

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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.

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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.

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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.

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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.

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% with No Difference in Perceived Urgency

Platelets

(135 vs 25 x109/L)

ALT

(80 vs 360 U/L)

Creatinine

(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 Line 15.8 14.8 24.0

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.

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Step 2: Gist-full information

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Fuzzy Trace Theory

(Brainerd and Reyna, 1995)

Verbatim memory Gist

vs

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Fuzzy Trace Theory

(Brainerd and Reyna, 1995)

Verbatim memory Gist

What the heck is “gist”?

vs

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Know Your “Commander’s Intent”

Heath & Heath, Made to Stick, 2007

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Cancer Screening Test Decisions

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Colorectal Cancer Screening

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Colorectal Cancer Screening

… at age 50

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Colorectal Cancer Screening

… at age 50 … vs. at age 75

(with multiple comorbidities)

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Benefits vs. Harms

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

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Gist Processing

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

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Setting the Context in Visual Displays

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Hemoglobin A1c

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

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Same (?!?) Result

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

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Scale Matters

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

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Test Results for Diagnosed Patients

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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.

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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.

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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.

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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.

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Test Results for Monitoring

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Harms

Alanine Aminotransferase (ALT):

80 IU/L

Standard Range: 10-40

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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.

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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.

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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.

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Increased Sensitivity with Harm Anchors

1 2 3 4 5 6

Near Value Extreme Value

Perceived Alarm 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.

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One Last Example

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7 7.1 7.2 7.3 7.4 7.5 7.6 7.7 5 10 15 20

Hemoglobin A1c

Percent Months

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7 7.1 7.2 7.3 7.4 7.5 7.6 7.7 5 10 15 20

Hemoglobin A1c

Percent Months

Central Message: Varies

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7 7.1 7.2 7.3 7.4 7.5 7.6 7.7 10 20

Months Percent

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7 7.1 7.2 7.3 7.4 7.5 7.6 7.7 10 20 4 6 8 10 12 10 20

=

?

Months Months Percent Percent

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7 7.1 7.2 7.3 7.4 7.5 7.6 7.7 10 20 4 6 8 10 12 10 20 2 4 6 8 10 20

=

?

Months Months Months Percent Percent Percent

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7 7.1 7.2 7.3 7.4 7.5 7.6 7.7 10 20 4 6 8 10 12 10 20 2 4 6 8 10 20

=

?

Months Months Months Percent Percent Percent

Varies!

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7 7.1 7.2 7.3 7.4 7.5 7.6 7.7 10 20 4 6 8 10 12 10 20 2 4 6 8 10 20

=

?

Months Months Months Percent Percent Percent

Varies! Stable!

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7 7.1 7.2 7.3 7.4 7.5 7.6 7.7 10 20 4 6 8 10 12 10 20 2 4 6 8 10 20

=

?

Months Months Months Percent Percent Percent

Varies! Stable! High!

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7 7.1 7.2 7.3 7.4 7.5 7.6 7.7 10 20 4 6 8 10 12 10 20 2 4 6 8 10 20

=

? Scaled to data variations

Months Months Months Percent Percent Percent

Varies! Stable! High!

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7 7.1 7.2 7.3 7.4 7.5 7.6 7.7 10 20 4 6 8 10 12 10 20 2 4 6 8 10 20

=

? Scaled to data variations Scaled to population variations

Months Months Months Percent Percent Percent

Varies! Stable! High!

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7 7.1 7.2 7.3 7.4 7.5 7.6 7.7 10 20 4 6 8 10 12 10 20 2 4 6 8 10 20

=

? Scaled to data variations Scaled to population variations Scaled to zero

Months Months Months Percent Percent Percent

Varies! Stable! High!

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4 5 6 7 8 9 10 11 12 5 10 15 20

Good

  • r

Bad?

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4 5 6 7 8 9 10 11 12 5 10 15 20

Standard Range

Good

  • r

Bad?

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4 5 6 7 8 9 10 11 12 5 10 15 20

Good

  • r

Bad?

Target Range for Patients with Type 2 Diabetes

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My Commander’s Intent

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“We need to design for the way people ARE, not the way we wish they were”

  • Holly O. Witteman
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People only process or remember

  • ne thing
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You can’t change this fact!

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BUT…

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BUT… You get to choose!

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Use context to create ONE message based on THEIR needs

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Thank You!

bzikmund@umich.edu @bzikmundfisher