Chapter 13: Outcomes Research

Chapter 13: Outcomes Research

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. Sampling in outcomes studies differs from that in traditional quantitative research in several ways. Which of the following is true?

a.	A heterogeneous sample is preferred.
b.	A random sample is required.
c.	A small, focused sample is artificially assembled.
d.	The sample is selected before an intervention occurs.

 

 

ANS:  A

The preferred methods of obtaining samples are different in outcomes studies; random sampling is not considered desirable and is seldom used. Heterogeneous, rather than homogeneous, samples are obtained. Rather than using sampling criteria that restrict subjects included in the study to decrease possible biases and that reduce the variance and increase the possibility of identifying a statistically significant difference, outcomes researchers seek large heterogeneous samples that reflect, as much as possible, all patients who would be receiving care in the real world.

 

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2. A preference for type I error, as compared with type II error, in outcomes research means that

a.	The outcomes researcher is not particularly concerned with drawing incorrect conclusions.
b.	The outcomes researcher would rather identify a possible connection that doesn’t end up being true than miss something.
c.	The outcomes researcher would rather establish definite causation than an indefinite connection.
d.	Patients usually don’t recognize what quality of care really is.

 

 

ANS:  B

Donabedian (1987) identified the following problem-solving styles: (1) routine approaches to care versus flexibility, (2) parsimony versus redundancy, (3) variations in degree of tolerance of uncertainty, (4) propensity to take risks, and (5) preference for type I errors versus type II errors. In a type I error, the null hypothesis is rejected when it is true; this means that a promising glimmer that may affect outcomes is not noted.

 

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3. A researcher is studying the likely occurrence rate of secondary cancers after a new schedule of chemotherapy for childhood leukemia, using a biochemical marker obtained by blood draw six months after the initiation of chemotherapy. What is the rationale for using this marker as a proximate outcome, rather than counting the actual rate of secondary cancers?

a.	Research on recurrent cancers in children labels them as vulnerable, causing psychological harm.
b.	The final endpoint is not obtainable over a reasonable span of time, since secondary cancers can occur at any age.
c.	Most proximate endpoints are unreliable variables and should not be used unless there are no final endpoints.
d.	The researcher is not interested in whether children suffer a secondary malignancy; the researcher is merely interested in the marker value.

 

 

ANS:  B

At the outset of a research project, there may be as yet little scientific basis for judging the precise relationship between factors and outcome. Many of the influencing factors may be outside the jurisdiction or influence of the healthcare system or of the providers within it, occurring much later in time, when subjects have been lost to follow-up. One solution to this problem of identifying relevant outcomes is to define a set of proximate outcomes specific to the condition for which care is being provided. Critical pathways and care maps may help the researcher to define at least proximate outcomes.

 

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4. Which of the following is a prospective cohort study?

a.	All of the children in Toledo, Ohio, are weighed and measured to obtain an accurate statistic for malnutrition occurrence.
b.	A physician’s records are analyzed to identify how many of his patients have remained in his care for more than 20 years.
c.	The citizens of a city experiencing a nuclear accident are tracked for cancer occurrence.
d.	A database is accessed to identify mortality rate in patients with sepsis.

 

 

ANS:  C

A prospective study is an epidemiological study in which the researcher identifies a group of people who are at risk for experiencing a particular event. Sample sizes for these studies often must be very large, particularly if only a small portion of the at-risk group will experience the event. The entire group is followed over time to determine the point at which the event occurs, variables associated with the event, and outcomes for those who experienced the event compared with those who did not.

 

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5. A hospital has recently converted to an “80% BSN staff” policy.” In service of this goal, all newly hired nurses are expected to hold at least a bachelor’s degree in nursing. Within the area of outcomes research, the variable “educational preparation of nurses” is what kind of a variable?

a.	Practice profile
b.	Structure of care
c.	Process of care
d.	Outcome of care

 

 

ANS:  B

Structures of care are the elements of organization and administration, as well as provider and patient characteristics, which guide the processes of care. The first step in evaluating structure is to identify and describe the elements of the structure. Various administration and management theories could be used to identify the elements of structure. These elements might be leadership, tolerance of innovativeness, organizational hierarchy, decision-making processes, distribution of power, financial management, and administrative decision-making processes.

 

DIF:    Cognitive Level: Application           REF:   Page 298