DNP 851B Module 8 Results Chapter With Tables and Figures Example

Chapter Four: Results of a Nurse-Led Asthma Action Plan and Inhaler Technique Program for Children

Student Name

Doctor of Nursing Practice Program, Aspen University

DNP 851B: Project Data Analysis

Instructor Name

Month Day, Year

Chapter Four: Results of a Nurse-Led Asthma Action Plan and Inhaler Technique Program for Children

Chapter Four: Results

This chapter reports the results of the project in the order of its question: who took part, how the program was delivered, and what happened to asthma control, inhaler technique and acute care. Interpretation is left to chapter five. Statistical methods were those set out in chapter three, with McNemar's test in its asymptotic form for paired proportions, a choice supported by comparisons of its versions (Fagerland et al., 2013), and paired t-tests for scores. Reporting follows the SQUIRE 2.0 headings for results, which ask for the course of the intervention, its details as delivered and the outcomes (Ogrinc et al., 2016).

Participants

Over eight weeks, 104 children aged 5 to 17 were enrolled. All 104 contribute to the acute care and process results. Ninety-one contribute to the paired control results; 13 were excluded: four for want of a usable baseline, six for follow-up outside weeks 10 to 14, two after moving and one on withdrawal. The 91 had a mean age of 9.8 years; 62 were aged 5 to 11 and 29 were 12 to 17. Forty-two were girls. Families of 38 preferred Spanish. Seventy-one were covered by Medicaid, 11 by private plans and 9 had no insurance. Sixty-four had a controller medicine prescribed at enrollment, and 27 had a written plan on file from the preceding year. The excluded 13 were similar in age, language and baseline score, and more often uninsured.

Delivery of the Program

All 104 children received the nurse visit and a written plan in their family's preferred language. Every core element was documented in 98 visits, or 94%. Of 81 families consenting to share the plan with school, 78 had it sent within a week. The follow-up call reached 85 families. Six adaptations were made during delivery, all to supporting tasks rather than the core; the most consequential were a named owner for school plans in week six and a technique check at calls and routine visits from week fifteen. Mean visit length settled at 42 minutes.

Process Measures Over Time

Weekly process data were read on run charts. Same-day sending of consented school plans stayed below its 85% target through week six and rose above it from week seven, the first full week after the change of owner, and remained above target to the end of enrollment. The share of families reached by the two-week call rose from 78% in weeks one to six to 87% in the later weeks, once front-desk staff started checking phone numbers when families arrived. Mean visit length fell from 52 minutes in the first week to about 42 minutes by week six and then held steady. Checklist audits of one visit in five found documentation in agreement with the chart for 20 of 21 audited visits.

Outcomes

Table 1 presents the outcomes. Scores are reported separately for each test because the two tests have different ranges; the share of children above the shared cut point of 19 combines them.

Among the 91, 36 children moved from poorly to well-controlled asthma and 3 moved the other way. A controller medicine was newly prescribed during follow-up for 9 children who had arrived without one. No adverse event linked to the program occurred.

Sensitivity Analyses

With the six late scores added, the paired sample grew to 97, and the change from 21 to 55 children in control remained significant, p < .001. Counting all 13 excluded children as not controlled at follow-up gave 21 of 104 at baseline and 52 at follow-up, and the difference remained significant. The direction and approximate size of the result were unchanged in both.

A third check, restricting the acute care comparison to the 91 children with complete control data, gave 17 children with a visit before and 7 after, a similar reduction.

Clinic-Level Results

Figure 1 would plot, month by month, what proportion of the 640 registry children had a plan on file from the past year, over 12 baseline and 8 project months. Its note would read: Baseline median 31%; every project month, 33% rising to 47%, sits above that median in one continuous run, meeting the shift rule for a non-random change; points on the median were excluded as the method requires (Anhøj & Olesen, 2014). Across the registry, acute asthma visits numbered 74 during the project months; the matching months one year earlier had 93.

Results by Language and Cohort

At 12 weeks, well-controlled asthma was found in 22 of 38 children from Spanish-speaking families, 58%, and 30 of 53 from English-speaking families, 57%. Children enrolled in weeks five to eight had higher rates than those enrolled in weeks one to four for well-controlled asthma, 60% against 55%, and for correct technique, 77% against 64%. These comparisons are descriptive and were not tested.

Summary

The program was delivered to 104 children with high fidelity to its core. Among 91 children with complete data, asthma control scores rose on both instruments, the proportion with well-controlled asthma reached 57%, from 21%, and correct inhaler use 70%, from 19%. Among all 104, the share needing acute care fell from 18% to 8%. The results held under two sensitivity analyses, clinic-wide plan coverage showed a signal of change beginning with the project, and results were similar across language groups.

Chapter five interprets these results against the published literature on action plans.

References

Anhøj, J., & Olesen, A. V. (2014). Run charts revisited: A simulation study of run chart rules for detection of non-random variation in health care processes. PLOS ONE, 9(11), Article e113825. https://doi.org/10.1371/journal.pone.0113825

Fagerland, M. W., Lydersen, S., & Laake, P. (2013). The McNemar test for binary matched-pairs data: Mid-p and asymptotic are better than exact conditional. BMC Medical Research Methodology, 13, Article 91. https://doi.org/10.1186/1471-2288-13-91

Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality & Safety, 25(12), 986-992. https://doi.org/10.1136/bmjqs-2015-004411