HS840 Unit 6 Outcome Measures Instrument Review Example

A Billing Code and a Four-Item Scale: A Unit 6 Instrument Review of the Two Measures in a Same-Day Contraception Study

[Student Name]

Purdue University Global

HS840: Advanced Health Research and Analysis Methods

Unit 6 Instrument Review

[Instructor Name]

[Date]

The network's records system and validation figures are composite and shown as placeholders; the published instruments and their evidence are real.

Why Both Measures Are Needed

The primary outcome asks whether same-day service gets devices into patients who want them. A secondary outcome asks whether it does so without pressure. Long-acting methods have a history of being promoted to some groups of women in ways that limited their choices, and a service that raised insertion rates by steering patients would fail on the terms that matter most (Gubrium et al., 2016). The study therefore needs a measure of what happened and a measure of how patients experienced the counseling that led to it.

Part One: Completed Insertion From the Record

Definition. The numerator is a request followed by an insertion of an implant or IUD within 30 days at any network clinic. A request is identified by a structured contraception order or a coded visit reason; an insertion is identified by a procedure code for IUD insertion or implant insertion on a claim, matched to a device lot number recorded in the procedure note. The denominator is all requests meeting the inclusion criteria in the sampling plan.

What could go wrong. Records measure what is documented, not what happened. Three errors are possible. Requests may be missed when a patient asks in conversation and the clinician records only a note, which would undercount the denominator unevenly if same-day clinics document requests differently once insertion follows at once. Insertions may be missed if a device is placed but billed under a bundled visit code. And insertions outside the network, at a specialty clinic, would be invisible.

Validity evidence. No published study validates this exact algorithm, so the study will produce its own. During the baseline period, a trained abstractor blind to clinic schedule will review [200] randomly selected charts with a contraception-related visit, and compare the algorithm's classification of request and insertion with the chart. Sensitivity and positive predictive value will be reported for each component. The network's prior quality audit found that [94] percent of billed insertions had a matching procedure note, which suggests the insertion component is accurate; the request component is less certain.

A measure collected automatically is not thereby accurate; it is accurate to the extent that documentation practice is the same everywhere it is collected, and an intervention that changes workflow can change documentation too.

Differential error. The key risk is not error itself but error that differs between conditions. If clinics that start same-day service begin to record requests only when a device is inserted, the denominator would shrink and the proportion would rise artificially. The chart review will therefore be repeated in the last period, when all clinics have crossed over, and the request sensitivity compared with baseline.

Verdict. Adopt with conditions: the algorithm is used, the chart review is completed before the first step, and a request sensitivity below [85] percent in either review triggers a sensitivity analysis using visit reason codes alone.

Part Two: Counseling Experience on the PCCC

The instrument. The Person-Centered Contraceptive Counseling scale has four items asking patients to rate how well the clinician respected them as a person, let them say what mattered to them about birth control, took their preferences seriously and gave them enough information to make the best decision. Each item is rated from poor to excellent.

Origin and validity evidence. The scale is a short form of the eleven-item Interpersonal Quality of Family Planning scale, developed from qualitative work on patients' preferences and tested with 346 women receiving contraceptive counseling in the San Francisco area; it showed a single factor, a Cronbach's alpha of 0.95, and associations with satisfaction and with coded measures of patient-centered communication in audio-recorded visits (Dehlendorf et al., 2018). The four-item version was selected through cognitive interviews in English and Spanish with 33 patients and psychometric analysis of 1,097 earlier responses, and it retained a single-factor structure, internal consistency of 0.92 against 0.97 for the long form, and the long form's construct and predictive validity (Dehlendorf et al., 2021).

Fit with this study. The short form is suited to a busy primary care setting, and its English and Spanish versions match the network's patient population. Its development took place in family planning settings, not general primary care, so the study will report item distributions to check that the scale behaves similarly here.

Scoring caveat. Ratings of care cluster at the top of the scale, which is why the scale is commonly scored as a top-box measure, the share of patients rating all four items excellent, rather than as a mean. A mean would hide differences among the many patients who rate care highly. The study will use top-box scoring as its primary summary and report means as a secondary description, stating this choice in advance.

Comparison with alternatives. The full eleven-item scale has stronger internal consistency but would add length to a survey sent by text after the visit. A single global satisfaction question would be shorter but has no validation for counseling quality and would not separate respect from information. The four-item scale balances these.

Verdict. Adopt, with top-box scoring stated as primary and a check on item behavior in primary care.

Measures Considered and Set Aside

Two other candidate measures were weighed and set aside. Time from request to insertion could have served as the primary outcome, since it captures delay directly, but it is undefined for patients who never receive a device, and those patients are exactly the ones the study most needs to count; it is kept as a secondary outcome among completed insertions. Patient-reported receipt of the method, gathered in the follow-up survey, could have corrected for insertions outside the network, but survey response is voluntary and likely to differ by condition, which would bias a primary outcome far more than the small number of outside insertions. The records measure, with its validation, remains the better choice for the primary outcome, and the survey stays where its strengths lie, in describing how counseling felt.

Summary Table, Written Out

Completed insertion: source, health record; validation, local chart review at baseline and end; main risk, differential documentation; decision, adopt with conditions. Counseling experience: source, patient survey after the request visit; validation, published in family planning settings with alpha of 0.92; main risk, ceiling effects; decision, adopt with top-box scoring.

Limits

The survey reaches only patients who respond, and response may differ by clinic or period. The analysis plan will report response rates by condition and treat the counseling outcome as secondary for this reason.

References

Dehlendorf, C., Fox, E., Silverstein, I. A., Hoffman, A., Campora Pérez, M. P., Holt, K., Reed, R., & Hessler, D. (2021). Development of the Person-Centered Contraceptive Counseling scale (PCCC), a short form of the Interpersonal Quality of Family Planning care scale. Contraception, 103(5), 310-315. https://doi.org/10.1016/j.contraception.2021.01.008

Dehlendorf, C., Henderson, J. T., Vittinghoff, E., Steinauer, J., & Hessler, D. (2018). Development of a patient-reported measure of the interpersonal quality of family planning care. Contraception, 97(1), 34-40. https://doi.org/10.1016/j.contraception.2017.09.005

Gubrium, A. C., Mann, E. S., Borrero, S., Dehlendorf, C., Fields, J., Geronimus, A. T., Gómez, A. M., Harris, L. H., Higgins, J. A., Kimport, K., Luker, K., Luna, Z., Mamo, L., Roberts, D., Romero, D., & Sisson, G. (2016). Realizing reproductive health equity needs more than long-acting reversible contraception (LARC). American Journal of Public Health, 106(1), 18-19. https://doi.org/10.2105/AJPH.2015.302900