Statistical_Use

Statistics in the Adult Medical Daycare Setting At first glance a small medical daycare setting would seem the last place one would find statistics in use. Patients arrive at the center transported by buses from their homes; spend the day in the facility and are provided with services including nursing and personal care; medication management; social services; rehabilitation services; recreational and social activities; meals and transportation. However, underlying the superficial appearance of a babysitting operation lies a health care facility, at which statistics plays an integral part in the everyday operations. Participants are admitted to medical daycare because of some medical condition that limits their functioning. Upon admission a health care professional from each discipline performs an assessment on the participant to establish a baseline from which to create an individual plan of care. The care plan specifies six-month goals and daily interventions that are carried out in accordance with the plan of care. Each health care professional performs an evaluation of goals that occurs at three-month intervals. Past and present statistics are compared to identify changes in condition, and to ascertain their progress toward the set goals, and changes made to the care plan as necessary. Outside the patient care arena statistics become important when billing for services rendered. The majority of patients who attend the facility are funded by the Medicaid program. Medicaid filters patients into the adult daycare system, which is a cost-effective alternative to nursing homes (Day, 2011). Whereas Medicaid recognizes the need for the services provided by the day centers it maintains very strict guidelines for reimbursement on services. Justification for participant’s attendance at the center must be accompanied by statistical data. The nurse submits the treatment authorization requests to the state Medicaid office. These requests contain all forms of data collected surrounding care of the patient. However, because participant care generates a large quantity of data in the six months between authorization periods, descriptive and inferential statistics are used to complete these reports. Descriptive and Inferential Statistics Descriptive statistics such as mean and mode are the descriptive statistics used most often by nursing to report readings such as mean arterial pressure for hypertensive patients or a mode may be used for a diabetic participant to report a blood sugar reading that occurs more often than others in that quarter. Often when evaluating goals, percentages are used to clarify how close or how often the participant came to meeting the goal. Sections of the nursing care plan and Medicaid treatment authorization plan require an evaluation of prior goals and setting of new goals. These sections require the use of inferential statistics to assist in the health care professional determine needed changes to the plan of care based on changes in the participants condition. Ratio is frequently used in the setting of goals. For example, if a participant has difficulty independently checking their blood sugar and completes the task without assistant only one out of five days a week, the goal may read: participant will correctly check blood sugar independently three out of five days a week over next three months. When the participant is reevaluated at the quarterly point, nursing can check the statistics and by studying the ratio can determine whether progress has been made and readjust the plan of care if needed. Following evaluation of collected data, new care plans are created primarily using subjective probability. Nurses and other health care professionals drawn on their professional knowledge and experience with each participant to form an individualized care plan. Once the statistics are gathered and plotted, formed into care plans and treatment authorization plans, nurses submit the paperwork to the Medicaid office for approval. Medicaid compares these statistics to previous data to determine a need for further services. If we have done our job correctly, we have justified continued attendance for our participants at the center. Four Levels of Measurement Four levels of measurement exist to collect data, each with unique characteristics. All data collected fits into one of the following four categories. The simplest of the four levels is the nominal level. Here the data has no order or can be placed in categories. Our facility classifies participants according to age, diagnosis, feeders, developmentally disabled, diabetics, and renal patients. These categories assist staff in providing appropriate care for individual participant. Some categories that we track are mandated by the state such as diabetics, developmentally disabled, and diabetics. The second level of measurement is the ordinal level. Data in this level is that of ordered categories. Participants or caregivers fill out admission questionnaires in prior to attending in which they are asked to rate such things as their health, motivation, satisfaction with living situation on a scale of one to 10. Other areas on the survey include questions regarding smoking and the number of cigarettes, how much exercise they receive, etc. This data is used by various disciplines to assist in the initial assessment process, and further used to in creating the care plan. Data spaced at equal distances such as years of birth, and Fahrenheit temperatures are considered at the interval level of measurement. Date of birth is used as an identifying criterion by the facility, the corporate office, and for billing purposes. Temperatures are seldom taken at our facility except upon admission or if a participant exhibits signs of illness. This data is recorded and reported to the physician and family for follow up. The highest level of measurement of data is the ratio level. Levels of natural zero exist, unlike in the interval level. Vital signs such as blood pressure, pulse, and respiration fit into this category, as do blood sugar testing and laboratory values. Nurses use this information to track the disease processes of patients over time and to ascertain the performance of their medications. Importance of accurate interpretation Decisions regarding the care of participants at the daycare facility are dependent on accurate interpretation of the data collected. Through the vital signs, lab values, satisfaction surveys, and other previously stated data collected at the facility we can create a comprehensive picture of the participant status in regard to several aspects of life. With accurate interpretation of changes to care plans, staffing, policies, and the like can be made to reflect and serve the needs of the participants. References Day, T. (2011). About Adult Day Health Care. Retrieved 9 15, 2011, from National Care Planning Council. Retrieved from http://www.longtermcarelink.net/ eldercare/adult_day_care.htm McNeil, J. (2009). Summary of the four levels of measurement:appropriate descriptive statistics and graphs. Retrieved from http://wilderdom.com/research/ Summary_Levels_ Measurement.html