Questions for the Mundinger Article, Coursework Example

• What was the primary research question?

Is the quality of primary care administered by nurse practitioners the same as the care administered by physicians?

• What were the primary research hypotheses?

The quality of care administered by nurse practitioners is equal to the quality of care administered by physicians.

• Statistical measurement of the care administered by each of the groups (1. Nurse Practitioners, and 2. Physicians) will suggest the null hypothesis:

There is NO difference.

• What was the study design?

This was a controlled group consisting primarily of Hispanic females. According to the information provided the mean age was 45.9 years consisting of 90.3% Hispanic of which 76.8% were female.

• Did the design adequately address the primary research question?

The answer is Yes. In pure measurement (raw data) comparing nurse practitioners to physicians, it is safe to establish that the patients seen by each of the health care groups was equal.

• What was the primary independent or predictor variable (X)?

The independent variable is patient care.

• What was the primary dependent , response, or outcome variable (Y)?

The dependent variable is the health care group: nurse practitioners or physicians.

• Why was a control condition included?

Being enrolled in a nursing program of an applied mathematics program, it is easier to work with and to understand controlled samples than to work with randomized samples. A controlled group has fewer variables to be concerned with. The greater the number of sampling variables, the more involved the study becomes. Assuming that all of the participants are approximately the same age and from the same socioeconomic class, the easier it will be to gather meaningful results. In this study almost of the participants were of lower socioeconomic status and from the Dominican Republic.

• What was the clinical population?

1,316 patients with a mean age of 45.9 years consisting of 76.8% female and 90.3% Hispanic.

• Was the sampling method appropriate for the research question and design?

The sampling method is questionable. The sample consisted of individuals from a lower socioeconomic bracket who were mostly immigrants from the Dominican Republic. Validity and reliability can only be achieved when the same results can be replicated from other samples. The question, therefore, is whether replication would take place if the group tested was from an American City (for instance: New York, Los Angeles, or Chicago) and if they were professionals in a high tax bracket? I think the results might be substantially different, and therefore you lose validity and reliability.

• What statistical methods were used to address the primary hypothesis?

The researcher sought probability values (P). The smaller the P value, the greater the evidence against the null hypothesis, typically written as HO. In this case the P value was statistically high (at six months P=.92). Therefore, the null hypothesis is indicated: There is no difference in the quality of care provided by nurse practitioners v. physicians.

• Was the statistical approach appropriate given the design study?

In this particular case making the assumption that the null (HO) is true, is probably not the best way to go. The reason is because the patient sample was static. The patient group consisted of individuals all within the same age range, all from within the same economic bracket, almost all were women, and more than 90% were of Hispanic origin from the Dominican Republic. For the people of these characteristics, there was no difference and the researcher could claim the results suggested evidence of the null hypothesis. But what about different groups—people of different characteristics? Would the null still be true? This answer is unknown without further testing.

• What were the key statistical results?

Without being redundant, the answer to this question is about the same as the answer for question 11. The results for this group of participants suggested the null (HO) is true. There was no difference between the care administered by nurse practitioners and physicians.

• What was the effect size for the primary outcome?

An effect size is actually more of a descriptive statistic than it is an inferential statistic.  It suggests a relationship without making an actual statement about whether an apparent relationship reflects a true relationship. In this study there is an apparent relationship in that the medical care provided by two different groups was approximately the same quality. The answer can be construed as, indeed, the same health care was provided. However, the difficulty is accepting this is not the quality of the health care per se, but the sample group receiving that care. Had the group been larger or had the group been more randomly selected would the outcomes have been the same? No one can say because although the participants were selected randomly they were all selected from a single group with similar characteristics.

• Was the study adequately powered to answer the primary research question?

The term adequately powered is probably a poor choice of words. One might say, was the study done correctly? The study was done honestly and with the researcher’s desire to determine whether nurse practitioners and physicians can provide the same quality of medical care. The study was important because in these days of rising health care costs, seeking medical attention from physicians may be beyond some peoples’ financial means. If quality health care can be provided by nurse practitioners, the study may mean more affordable health care for certain groups of people.

• What were the strengths and weaknesses of this published report?

A single strength is noted: The study reflected that health care is approximately of the same quality whether administered by physicians or nurse practitioners.

Two weaknesses are noted: First, the study was done in a major urban teaching hospital. Since tests were not done in neighborhood clinics, there may be a skewing of the results in favor of both groups (physicians and nurse practitioners). Away from a major hospital and in local clinics these results may have been statistically different. Second, although the participant sample was randomized, it was randomized from a similar group: low income immigrants from the Dominican Republic. Validity and reliability will only be achieved by subsequent studies using different patient groups of varying incomes and from different areas of the country.

• Was there evidence of clinical or practical significance?

The answer is yes. The study suggests that there is little difference between the services provided by each of the two professional groups. However, based on the strengths and weaknesses discussed in the preceding question, not enough studies and not enough variations of the study have been conducted to make the accurate statement that the null hypothesis has been suggested: There is no difference.

• Would you recommend changing clinical practice based on these findings?

I would not change clinical practice based upon a single study. Validity and reliability is achieved only through several studies producing similar results.