Post Test Phase
Sample size:
Sixty-six contributors from Cranford area, one hundred and twelve contributors from Elizabeth site
Statistics Used:
Both nominal and scale data have been used. The graphic statistics such as frequency, percentages and crosstabs, parametric one-sample T-test with a 95% confidence interval to examine the quantitative values (detailed store) and non-parametric tests were employed to castoff the “null” hypothesis.
“Null” hypothesis at the substantial level 0.05:
- The dissemination of the diverse values across scored and denoted are correspondingly prospective (reject; not likely).
- The dispersal of the detailed score (raw store) is alike across classifications of stated (rejected; not the same)
On the other hand, the null hypothesis describes that “Dexa scan recommended rates would be similar; had no variances after ORAI”. In one case, T-test is utilized to assist to reject the null set and search out whether ORAI is adequate enough to utilize in the primary care medical offices. It is significant enough to alert primary care providers that practice of ORAI intensifies DEXA scan referral rates in prime care medical offices and outpatient clinics.
Age, gender and ethnicity are the qualitative and nominal data variables are entered into the IBM SPSS Statistics data analysis program. It is utilized for collaborative statistical data analysis. Such software program has been investigated data sets (labeled variables without quantitative worth) by expending categories like frequency, percentage, and crosstabs to decide whether or not there are any variations, comparisons or other interactions between variables.
This project has gathered qualitative-nominal data – on a binary, yes/no matrix. It reflects that the patients questioned could only offer a yes or no response to the questions asked and were incapable to offer a value that varied by degree of force. For instance, one question in this study has been asked if patients have taken cortisol steroids “for a protracted period?” The patients were supposed to answer with just yes or no. The data collector and educational hand-outs helped the patient to define what “a protracted period” would be.
Labels/Names and Values
There are seventeen nominal data variables from the analysis such as complexion, gender race, weight, family history, dairy, height, and exercise. The score made by the contributors characterized as “scored” centered on whether or not they gathered twelve or more points. Only one quantitative variable (detailed score) and is deliberated by making use of the one-sample T-test with a 95 % confidence break of the variance. The outcomes identified are: centered on the substantial 2-tailed (lower and upper values), the sample size was 178, the mean was 9.02, t was 28.909, standard deviance was 4.2 and standard error mean was 0.31. This project separated referral rates. The referral rates were intended by separating them into 2 classes and characterized as to whether or not the contributors were referred.
Values:
The contributors were provided with the numerical value of “1” in order to decide the criteria or met with it like numeric value “1” is stated to white fair skin tone and “2” for all other contributors who are not capable of meeting the criteria. SPSS inevitably marked them with either number 1 or 2 contingent on the values being dignified.
Graphs
SPSS has a role in putting the outcomes into graphs, categorizing the patient loch by gender, height, ethnicity, diet, weight, exercise, family history, rest lifestyle elements, and discrete medical antiquity. It is not restrained to the former cracks, dental diseases, steroid usage, long-lasting diseases and whether the females are pre or post-menopausal.
Cross-tabs
Both qualitative and quantitative sores came from medical offices and were investigated in contradiction of Dexa Scan referrals by utilizing the crosstabs analysis methods in a duration of one month period. Cross tabulation is a part of the SPSS procedure which takes into account several variables, representing the relationship in the tabular form for the better ease of the analysis. This research has cross tabularized multiple variables to pursuit substantial statistical outcomes like investigating the recommendation rates of menopausal women in percentages who ingest dairy products with those that refrain from dairy.
Error Analysis
The report represented that there is no fault occurred at the time of data revolution from spread-sheets to the software and the contributors attained the most scores from the latter section of ORAI where the significance of long-lasting ailments, post-menopausal prominence, long term steroid usage played an excessive role.
The report reflected that data analysis defined the substantial variance between the anticipated values versus the experiential one. The pre and post-test and doctor’s office’s DEXA scan referral rates altogether. The data analysis concentrates on the procedures of central tendency comprising the mean, and median. It is more generally used frequencies versus measures of variable utilized only for rule data or measurable data at the time of the calculation of the “Detail Score” like variance, standard deviation, the kurtosis, skewness, minimum and maximum variables. On the other side, a numerical scale is intended by higher-level descriptive statistical technique than modestly using frequencies and percentages.
The null hypothesis has been disproved by data analysis means that there is no statistical consequence (same or likely) between DEXA scan referral rates along with the execution of ORAI instruments. It demonstrates a statistically substantial relationship between the two variables. The null hypothesis should be prohibited and a substitute should be used reflecting that there are implications demonstrated between the scores and the referral rates. They are not dispersed similarly or they are not similar.
Statistical Data
Demographics
The demographics of the project represent that 52.8 percent of the populace was women whereas male represented 47.2%. Among these, 42.1 % were fair toned and 57. 9 percent were other rivalries. It was viewed that 44.9 % had white skin color and the remaining had a suntanned or dark skin color. The outcome was received in 6.7% of the populace was under 125 pounds and 93.3 percent was overhead 125 pounds on the measure. Afterward, only 14.6 % of the populace said yes to family antiquity of breakages. On the other side, more than 53.9 % confesses sighted their seniors at home with a deformed back look.
Chronic Illnesses Data Analysis
It was viewed that populace had generally long-lasting diseases irrespective of the demographics and lifestyle.
¾ of the female contributors had menopause.
Just 27% scored sufficient to be referred among all these populace to be stated and among them just 23.6% stated.
Findings
The project views whether the contributor score over prearranged cut-off points or not, whether they had immediate osteopenia or OP analysis and whether there are subordinate clauses. The final result was analyzed after all the data was gathered. It proved that one of the objectives was clearly met and surpassed by a substantial degree at the statistical p-value .02 which is lesser than the alfa substantial value at .05. I assisted to enhance DEXA scan recommendation rates. On the other side, in the Cranford office, before the origination of the study, there were just six referrals within the twenty-four-month duration. After the study conducted, data was exposed that there were three referrals in 1-month duration along with the statistical increase of 1200 %. There were six referrals in the six month period before the study commencement at Elizabeth office. Once the study was concluded, recommendations rise to ten recommendations in one month period along with the statistical rate increased to 1000%.
The second goal of the project indicated instant OP/osteopenia diagnosis and also met because of over 70% of the contributors had long-lasting diseases which were deliberated as the ancillary causes of OP and osteopenia. According to the scores, individuals have some other causes like epilepsy, RA, DM type II, thyroid problems, and long-lasting liver ailments other than the genuine bone thickness mineral deficiencies. The above discussion meant that the persons who arise to primary care workplaces are more apprehensive about their long-lasting diseases than OP or osteopenia. It was found that the care providers had no phase to monitor people as they mostly recommend medication along with taking care of the people with further diseases. Though, the foremost objective and the ancillary causes of OP/osteopenia are encountered along with the instant analysis of OP/ osteopenia was not dignified. It was because of the project scope which is not enabled the investigator to go back into the charts and to potential data analysis. It necessitates an additional proposal to IRB to encompass the latitude of the project along with further analysis of the outcomes.
The investigator learned that the older patients having the highest scores on the ORAI scale were preferred less commonly than the fresher ones. This learning was offered by Crosstabulation. For instance, 50 contributors out of 178 contributors scored over 12 points on ORAI. 27 of these were stated which means 23.6% were stated. It has been identified to be the acute conclusion to decide to comprise Chi-square. It represents that present screening process for elderly people is ineffective. It leads to much fewer recommendations than what is essential. It has been identified by comparing to the late middle age or younger. The consequence is realized in the form that added health establishments should utilize the Fracture Risk Assessment Tool (FRAX), mentioned by The WTO (World Health Organization), to make sure an added suitable rate of recommendation for DEXA images and precise fracture deterrence techniques for aged patients.
Considering the circumstance in the elderly, the project consequence represented remarkable upsurge of DEXA scan recommendations in four weeks at these 2 primary care offices. The risk factors have been identified by the findings such as long-lasting ailment and post-menopausal generally found in women more than the age of 50, specific lifestyle like inactive lifestyle, drinking soda, alcohol and carbonic beverages. Such risk elements have assisted care establishments to form an instant analysis of OP or osteopenia. The elements also represented DEXA scans recommendations unconditionally assisted the investigator to detect secondary causes of OP within and between the files of 2 doctors. The project even underscored the risk evaluation by DM type II, HTN and thyroid glitches of the OP in spite of the contributor’s other risk factors are not confined to the demographic data and assured lifestyles.
The mass elements distinguished both clinics which could responsible for the major variation in the increased rates. Such elements comprise variations in the socio-cultural makeup of the patient crowds for locations comprising income level, civilization, health attention status, and probability to use or abuse drugs. None of these factors were deliberated at this moment. Although, irrespective of these elements which could transform the findings represent a substantial increase in the referral rates for both locations validates that this project encountered at least 2 out of 3 of its purposes and consequences.
Limitation
Type I & II Errors
Untrue Positive OP Risk Valuation with ORAI
The statistical assessment offers to mean to the worthless variables and breathes life into the unconscious data. Another aspect of the project was to interpret the findings. The lowest level of the descriptive analysis method comprising mode, frequencies and percentages helped investigator to came across with some unfamiliar responses among the contributors concerning the question. For instance, some contributor’s parent died very young and they were not even able to see those dropping substantial height or having ruptures before 45 years of age. Such type of replies to the questions documented as “No! Fractures” due to constrained picks to response each question which upsurges type II errors (misleadingly kept null hypothesis).
Some other situations have been also been met by the investigator. For instance, sometimes it happens that the contributors reflect that they used to exercise but are not doing at present. In such a situation, their replies were recorded again under the group of “No! I do not exercise” to be reliable with data analysis and to deliberate their greatest existing level of exercise.
At the time of revising such sort of vague information, the investigators are likely to choose answers which assist the concept of OP risk influences than the data lowering the risk factors of the contributors. Though Cohen’s kappa coefficient (κ) is a figure which processes inter-rater agreement for qualitative and these cannot be calculated because the project does not have a two-way table along with the variable of the alike type. Each of the variables come from a changed researcher. Other than this, the investigator reviewed the data appropriately for any missing values. The further step identified was to appraisal all data along with deliberating the cogency of each and every entry in SPSS. Afterward, data from responses have been associated with the formerly gathered data which presented a statistically substantial augmented referral rate. The risk factors have been established as the secondary long-lasting disease with high percentages.
Demographic Data
A perception bias has been identified among the people who think that losing height is quite normal whereas aging versus those think that there is a hunchback look. It is required to comprehend that one has to lose weight rapidly and at an early age. In such a case, the perception of the contributors is obligatory to be elucidated regarding the fact that a normal human loses 1 inch of height in every 10 years. It becomes quite important if a person is losing 3 inches in 6 months. On the other side, old people after attaining the age of 70, loses more than 3 inches in rare cases is anticipated. Therefore, such percentages can be a fault or invalid findings. The projects should be assisted on the reason like why doctors do hesitate to state populace to DEXA scan due to what is irregular in those who are young converts normal after definite age. Such findings can reduce the efficiency of standard screening tools which could have been castoff in a variety of backgrounds irrespective of ages.it is required to make clear that age connected OP risk assessment tools should be used or ORAI can be used in order to be individualized.
The Lifestyle Data Analysis
The section of populace lifestyles, chi-square and cross tables significances represented the points mentioned:
The persons who ingest sufficient dairy products do not use steroids
The persons who ingest sufficient dairy products do not consume alcohol and do not smoke. The gum disease and tooth decay rates are found comparatively less in both cases and in both the genders.
The project revealed that one-third of the populace do not even exercise required and this same data has been found in the people who drink more than five cups of coffee, soda, and tea.
On the other side, it has been observed that persons who do not have a good lifestyle comprising exercise and ingestion of dairy products admit suffering from one of the long-lasting ailments that can cause OP.
At this movement, PCP can be missing age concerning data which varies in each and every lifetime. Here unexposed risk factors seem to be normal and non-significant.
Place of Male versus Female in Data Analysis
The project represented that male populace over the age of fifty are deliberated to be of dark or tan skin, weighing over 125 pounds, repudiates record of family fractures along with generally witnessing folks lose height after the age of 45 years. Such people are even likely to confess consuming dairy products and practicing exercise without the consumption of the drinks and smoke. In such a case, persons denied gum ailments along with the consumption of the steroids. The consumption of steroid in the males was found more than females. Consequently, they judged less to DEXA scan than the female ones.
The findings of the project also represented that female in the stage of menopause drinks less tea, coffee and soda compared to 3 times more anticipate being referred in the males. It is because of the perception of women that these should be at the risk.
When both the genders are compared, males are not anticipated to score high even then they do not drink tea, coffee, and soda. The males are discovered to have fewer risk causes and score less than twelve points on ORAI if sufficient dairy products are consumed. The females in the menopause identified to do more exercise and use less of the steroids than younger ones. Both of the genders regardless of the age represented to have several long-lasting diseases and visit the family doctor for the medical issues than just taking OP defensive measurement principally.
Add on, the females not exercising and in menopause are prospective to have 4 times more recommendations than the male ones. The males who are not exercising are found to be scoring less than twelve points and mentioned almost three times less than the females who
are exercising in the relevant category.
The males and females are very improbable to consume steroids and drink dairy, tea, coffee, and soda in the same period of time. The females who are skinny and fair, do not drink and consume dairy products are more prospective to be in menopause and mentioned more than men in the same crowd. Both male and female who exercise and had no FH of fractures score fewer than twelve points and are less probable to be mentioned.
Limitations
The limitations have been revealed by the project like female contributors prefers to go to OBGYN and Rheumatologists or any other experts than coming to primary care offices for the long-lasting disease. Most of the contributors speak Spanish in Elizabeth site and the prescription is written in only English language. It creates to substantial loss of the information from this populace. Add on, the medical history comprising long-lasting diseases section does not comprise other sexually conveyed illnesses, HIV or are an illness which can capture the small percentage of the hidden populace.
Recommendations and Discussion
Economic/Cost Benefits of Your Project
This project has grabbed the attention of the age concerning OP risk influences which appears to be a well-organized measure. This project has discovered that using screening tools are unsuccessful after 65-70 years of ages. These are not even defensive at that stage of low bone mass volume and breakage rates become significant. These should be deliberated all together with secondary factors in its place broadcast for OP risk factors. Consequently, growing DEXA scans by least 20% should decrease significant vertebral along with the hip fracture rates in elderly males who are 65 years and more after exploiting extra FRAX scale moderately than ORAI instrument; occasioning in less nursing home care, and smaller hospital visits.
The persons with the injuries and fractures instigated by weak bones should be detached from other reasons of falls and fractures owed to trauma. As an additional approach, a person having good age and scoring high on any defensive OP risk valuation tool should be directly educated on the deterrence of falls and fractures. Some additional actions should be taken to visit orthopedics, podiatrists, eye doctor, neurologists, cardiologists if any kind of heart inactivity is felt, DM type II, glaucoma, gait and balance glitches, seizures, long-lasting diseases. Long-lasting diseases should be treated well. Their caregivers should be reinforced and cultivated in order to prevent the falls and fractures at home, comprising which type of measures should be undertaken to hygiene the hallways. The elder people are required to go for the physical therapy and reinforce the upper and lower body muscles mass along with the leg muscles in order to keep the body alignments balanced.
The persons at the risky stage and are younger than 65 years are required to be evaluated by a risk valuation tool. They can even state to DEXA scan which will bounce PCP a significant consequence.
Impact on healthcare quality and safety
The enhanced DEXA scans have resulted in a variation in the medical offices from what is presently suggested. It does not look to have any assistance for elder patients at all. Several times, it was mentioned that OP diagnosis assumed too late and not capable of preventing any major bones fractures in males along with the high costs. Monitoring persons with ORAI after attaining the age of 65 will not be operative in averting OP. it will even not restore health along with preventing any fracture surely. It can cause to negligence in the care and can lead to the malpractices. It can even lead to weakened functions and prominent to a superior chance of disability in life and expensive to the employees.
Policy implications
The policies such as Medicare payment supports to the people above the age of 65 who are out of the pocket costs. Although, Medicare and concerning federal and isolated insurance plans have changing severe rules and exposure policies and repayments to PCPs (Morden et al., 2014, pp. 2307-2311 ). Consequently, the project was applied at other clinics and a great number of the patients were referred on time before the occurrence of the fracture. It raised the consciousness of the issue along with the requirement of losing the severe recompense policies.
Covering a wide range of patients’ former than the suggested practice will upsurge clinical income and fetch more patients with OP to their primary care offices back.
