DNP 851B Module 5 Answering the PICOT Question Example

Yes, With Qualifications: Answering the PICOT Question of a Nurse-Led Pediatric Asthma Program

Student Name

Doctor of Nursing Practice Program, Aspen University

DNP 851B: Project Data Analysis

Instructor Name

Month Day, Year

Yes, With Qualifications: Answering the PICOT Question of a Nurse-Led Pediatric Asthma Program

Every analysis in a DNP project exists to answer one question, and the answer should be stated plainly before it is qualified. This paper answers the question my project set out in its proposal, using the results of the data analysis. It restates the question, gives a direct answer, presents the evidence for each outcome, judges the size of the changes, considers other explanations and ends with the answer stated at the level of confidence the design supports.

The Question

The project asked: Among school-age children and adolescents with persistent asthma seen at a pediatric primary care clinic (P), does a nurse-led visit providing a written action plan, inhaler technique coaching with teach-back, sharing of the plan with school and a follow-up call (I), compared with their own care in the 12 weeks before enrollment (C), increase the proportion with well-controlled asthma and reduce emergency or urgent care visits for asthma (O) over 12 weeks (T)?

The Answer in One Sentence

Yes: after the nurse-led visit, more than half the children, up from about a fifth, had well-controlled asthma, and fewer than one in ten, down from nearly one in five, needed acute care, although a single-group design cannot prove that the visit alone caused these changes.

Evidence for Each Outcome

For asthma control, 91 children had paired scores on the age-appropriate test. Nineteen were well controlled at baseline and 52 at 12 weeks; 36 children moved into control and 3 moved out, a difference McNemar's test found very unlikely to be chance, p < .001. Mean scores rose by 3.7 points on the childhood test and by 3.3 points on the adolescent test. The conclusion held when late scores were added and when every missing child was counted as not controlled.

For acute care, all 104 enrolled children were included. Nineteen children had needed acute asthma care in the 12 weeks before their nurse visit and 8 in the 12 weeks after it, with 23 visits falling to 9, p = .008 for the share of children and p = .006 for the number of visits. Across the whole clinic, acute visits ran 20% below the level of a year before, a smaller fall than among enrolled children, as expected when most registry children did not enroll.

How Large Are the Changes?

Researchers working with adults have put the smallest change patients notice on the adolescent and adult control test at roughly 3 points (Schatz et al., 2009). The mean change in both age groups exceeded that figure, although the threshold was derived in adults and should be applied to the childhood test with caution. A rise of 36 percentage points in well-controlled asthma is large in absolute terms. The fall in acute care is also meaningful: roughly one child in ten who would have needed emergency care in 12 weeks did not. These effects are in the direction the evidence predicts; in a review of randomized pediatric trials, children given written plans needed fewer acute care visits and had fewer symptoms (Zemek et al., 2008).

Did the Answer Differ by Language?

The clinic asked whether Spanish-speaking families benefited as much as English-speaking ones, since the plan and coaching were offered in both languages. The groups were too small for a formal test, so the results are descriptive. At 12 weeks, 22 of the 38 children from Spanish-speaking families had well-controlled asthma, 58%, against 30 of the 53 from English-speaking families, 57%. Baseline control had been similar in both groups. On this limited evidence, the program worked about equally well in both languages, which matters for a clinic where two families in five prefer Spanish and where earlier trials rarely reported results by language.

What Else Could Explain the Changes?

Four alternatives were considered. Season is the first, since enrollment began in late summer and follow-up ran into autumn, when asthma usually worsens; that would bias the results against the program, not in its favor. Regression to the mean is the second: some children may have enrolled after a bad spell and improved anyway. Year-on-year clinic data and the run chart both suggest that regression cannot account for all of it. The third is new medicine: 9 of the 27 children without a controller at baseline had one prescribed during follow-up, often after the nurse flagged poor control, which is part of the program's pathway but not its nursing core. The fourth is attention: families who enroll in a program may manage asthma more carefully simply because someone is watching. Harris et al. (2006) note that single-group pre-post designs cannot exclude such explanations, and this project cannot either.

Inhaler Technique as a Supporting Result

Inhaler technique supports the main answer by showing that the program's mechanism worked. Before teaching, 19% of the 91 children met the checklist standard; at 12 weeks, 70% still did, after reinforcement was added at the midpoint. A change in the behavior the program targeted, alongside a change in outcomes, makes it more plausible that the program contributed to the outcomes.

Technique is also the element families can keep practicing at home, which makes it a durable part of the program.

The Answer, Stated With Appropriate Confidence

The project's answer to its question is yes, with qualifications. Among children who received the nurse-led visit, asthma control improved substantially and acute care fell, the changes were larger than a published threshold for importance, the program's mechanism measurably changed, and the clinic's overall plan coverage shifted when the program began. The design cannot exclude regression to the mean or the effect of attention, and it cannot separate the nurse visit from new prescriptions that followed it. The answer supports continuing the program and evaluating it further with a stronger design.

Conclusion

The PICOT question has been answered directly and with its limits stated. The next modules consider the strengths and weaknesses of implementation and what the results mean for practice.

The answer will be carried unchanged into the results chapter.

References

Harris, A. D., McGregor, J. C., Perencevich, E. N., Furuno, J. P., Zhu, J., Peterson, D. E., & Finkelstein, J. (2006). The use and interpretation of quasi-experimental studies in medical informatics. Journal of the American Medical Informatics Association, 13(1), 16-23. https://doi.org/10.1197/jamia.M1749

Schatz, M., Kosinski, M., Yarlas, A. S., Hanlon, J., Watson, M. E., & Jhingran, P. (2009). The minimally important difference of the Asthma Control Test. Journal of Allergy and Clinical Immunology, 124(4), 719-723. https://doi.org/10.1016/j.jaci.2009.06.053

Zemek, R. L., Bhogal, S. K., & Ducharme, F. M. (2008). Systematic review of randomized controlled trials examining written action plans in children: What is the plan? Archives of Pediatrics & Adolescent Medicine, 162(2), 157-163. https://doi.org/10.1001/archpediatrics.2007.34