HH/HLST 2300: Quantitative Research Methods in Health Studies

Winter Term Assignment 3

Assigned: Sunday February 12, 2017; Due 5PM Friday March 3, 2017
Submit 1 file for Assignment 3: PDF
PDF document name: LASTNAME_FIRSTNAME_WTAssignment3
Submit via Moodle

Note1: WT Assignment 3 is worth a total of 53 marks. Therefore, assignments submitted late were
deducted 6.3 marks per day (53 *0.05 = 2.65)
Note2: If you did not submit a PDF file, 0.5 marks were deducted.
Note3: If you did not use the proper assignment naming convention, 0.5 marks were deducted.

The Canadian Institute for Health Information (CIHI) published a 2016 report entitled Measuring Patient
Harm in Canadian Hospitals (Chan B, Cochrane D. Ottawa, ON: CIHI; 2016). The report investigated
harmful events (an unintended outcome of care that may be prevented with evidence-informed
practices and that is identified and treated in the same hospital stay) among medical and surgical
patients of varying levels of complexity. Complex patients are people with diseases in addition to the
one they are being hospitalized for (called comorbidities) and/or those who are treated by several
types of physicians. Each patient was given a complexity score and then categorized as high, medium or
low complexity; highly complex patients scored 4 and above; medium-complexity patients scored 2 to 3,
and patients who scored 1 are low complexity. The below table summarizes rates of at least 1 harmful
event among medical and surgical patients, by complexity level.

You are a data analyst employed at Hospital ABC. Hospital ABCs harm data for the previous fiscal
year is summarized below.

Hospital ABC Medical Patients Surgical Patients

Complexity level No Harm At least 1 No Harm At least 1
harmful event harmful event
Low 1119 33 978 30
Medium 2516 169 1038 107
High 3285 259 645 97

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1. The CEO has asked you to determine whether the distribution of complexity levels experienced
among medical patients in Hospital ABC differed from the Canada-wide CIHI data. Run the
appropriate test in SPSS. Copy and paste the relevant output table(s) and report the results.

We first need to determine the Canada-wide distribution of complexity levels experienced

among medical patients, or in other words, the number of medical patients Canada-wide who
are of low, medium and high complexity levels. [15.5 MARKS]

We are provided with the Canada-wide number of medical patients that experienced harm by
complexity level as well as the proportion of the total Canada-wide medical population that
experienced harm. From these values, we can determine the number of medical patients
Canada-wide who are of low, medium and high complexity levels:

14701 2.2
= =
100

Solving for x, we find that x = 668227.27273 (total number of low complexity medical patients)

Similarly, for medium complexity medical pts:

32143 6.4
= =
100

Solving for x, we find that x = 502234.375 (total number of medium complexity medical patients)

Finally, for high complexity medical pts:

39218 17.5
= =
100

Solving for x, we find that x = 224102.85714 (total number of high complexity medical patients)

Next, we need to determine the distribution of complexity levels, or equivalently, the proportion
of patients that are of low, medium and high complexity:

Total number of medical pts = 668227.27273 + 502234.375 + 224102.85714 = 1394564.50487

668227.27273
Proportion that are low complexity = 1394564.50487 = 0.48

502234.375
Proportion that are medium complexity = 1394564.50487 = 0.36

224102.85714
Proportion that are high complexity = 1394564.50487 = 0.16

The final calculation we need to perform before running the test in SPSS is to calculate the
expected number of low, medium and high complexity medical patients in Hospital ABC if the
null hypothesis is true (that they follow the same distribution as the Canada-wide data).

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 We first need to determine how many medical patients there are in Hospital ABC:

Complexity level No Harm At least 1 harmful event Total

Low 1119 33 1152
Medium 2516 169 2685
High 3285 259 3544
Total 6920 461 7381

In total, we have 7381 medical patients in Hospital ABC.

Expectedlow = 7381*proportionlow = 7381(0.48) = 3542.88
Expectedmedium = 7381*proportionmedium = 7381(0.36) = 2657.16
Expectedhigh = 7381*proportionhigh = 7381(0.16) = 1180.96

Entering the data in SPSS (weight cases by frequency):

Analyze, Nonparametric Tests, Legacy Dialogs, Chi-square:

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A 2 goodness-of-fit test was performed to test the null hypothesis that the distribution of low,
medium and high complexity among medical patients at Hospital ABC was 48%, 36% and 16%,
respectively. The results were statistically significant and we reject the null hypothesis that the
distribution of complexity levels at Hospital ABC are the same as the Canada-wide data (2 (2, N =
7381) = 6342.08, p <.001).

Some of the typical errors found in Question 1:

Entered incorrect low complexity observed value. [-1 MARK]
Entered incorrect medium complexity observed value. [-1 MARK]
Entered incorrect high complexity observed value. [-1 MARK]
Entered incorrect low complexity expected value. [-2 MARKS]
Entered incorrect medium complexity expected value. [-2 MARKS]
Entered incorrect high complexity expected value. [-2 MARKS]
Did not copy and paste the Test Statistics Table or values in the table are different than
those shown. [-2 MARKS]
Did not report chi-square value or value reported is incorrect. [-0.5 MARKS]

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 Did not report degrees of freedom or value reported is incorrect. [-0.5 MARKS]
Did not report n value or value reported is incorrect. [-0.5 MARKS]
Did not report p-value or value reported is incorrect. [-1 MARK]
Did not report that result was statistically significant. [-1 MARK]
Did not indicate that we are interested in the distribution of complexity levels. [-1
MARK]
Rounding errors. [-0.5 MARKS]

2. The CEO would also like to know if there is an association in Hospital ABC between harm and
service type (medical vs surgical). Run the appropriate test in SPSS. Copy and paste the relevant
output table(s) and report the results. [10.5 MARKS]

The CEO is not concerned about complexity level, so we can collapse the complexity levels and
create a contingency table where the categories for harm (no harm, at least 1 harmful event)
are listed across the top row of the table and the categories for service (medical vs surgical) are
listed down the first column:

Service No Harm At least 1 Total

harmful event
Medical 6920 461 7381
Surgical 2661 234 2895
Total 9581 695 10276

Entering the data in SPSS (weight cases by frequency):

Analyze, Descriptive Statistics, Crosstabs.

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There was a statistically significant association between harm and service type (2 (1, N = 10276) =
11.13, p = .001). Medical patients experienced less harm (6.2% had at least 1 harmful event)
compared to surgical patients (8.1% had at least 1 harmful event).

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 Some of the typical errors found in Question 2:
Did not generate a Crosstab Table of harm (no harm and at least one harmful event) by
service (medical and surgical). [-2 MARKS]
Values in the crosstab table are different than those shown. [-2 MARKS]
Did not generate Chi Square Test Table or values in the table are different than those
shown. [-1 MARK]
Did not report chi-square value or value reported is incorrect. [-0.5 MARKS]
Did not report degrees of freedom or value reported is incorrect. [-0.5 MARKS]
Did not report n value or value reported is incorrect. [-0.5 MARKS]
Did not report p-value or value reported is incorrect. [-1 MARK]
Did not report that result was statistically significant. [-1 MARK]
Did not indicate that we are interested in harm and service type. [-1 MARK]
Did not report % at least 1 harmful event in medical patients or value reported is
incorrect. [-0.5 MARKS]
Did not report % at least 1 harmful event in surgical patients or value reported is
incorrect. [-0.5 MARKS]
Rounding errors. [-0.5 MARKS]

3. How many medical patients would be expected to have experienced at least 1 harmful event if
the null hypothesis for question 2 was true? Show your calculations. [2 MARKS]

If the null hypothesis was true, we would expect () = . medical patients to have

experienced at least 1 harmful event.

Some of the typical errors found in Question 3:

Incorrect value for fraction of patients who experienced at least 1 harmful event (any
value other than 695/10276 or 0.06763). [-1 MARK]
Incorrect value for total number of medical patients (any value other than 7381). [-0.5
MARKS]
Incorrect final answer (any value other than 499.20 or 499.2 (value generated in SPSS
crosstab table)). [-0.5 MARKS]

The CEO decides to implement a staff initiative to improve competency of patient safety. This includes
education on evidence-informed practices for reducing the occurrence of harm. Staff were graded on
their competency of best-practices (1= incompetent; 2 = competent) before and after the safety
intervention. Questions 4-7 pertain to the Excel file: 2300 WT Assignment3 which lists the staff gender
(1 = female; 2 = male), age, years of working experience and pre- and post-education initiative safety
competency rating for data collected on 109 staff.

4. Was there a significant change in pre- and post-education initiative for safety awareness? Run
the appropriate test in SPSS. Copy and paste the relevant output table(s) and report the results.
[6 MARKS]

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Since we are provided with each individual employees pre- and post-safety competency ratings,
we can run McNemars Test by selecting Analyze, Nonparametric Tests, Legacy Dialogs, 2-
related samples:

Alternatively, we can choose Analyze, Descriptive Statistics, Crosstabs (note, since we are
provided with employee-level data, we do not need to weight cases):

8
 McNemars test was used to test the null hypothesis that the proportion of competent
employees before and after education initiative for safety awareness was the same. Using
McNemars test, we found a statistically significant effect on competency levels after the
intervention (p <.001).

Some of the typical errors found in Question 4:

Did not conduct the McNemar test. [-2 MARKS]
Values in the test statistics table are different than those shown. [-2 MARKS]
Did not report p-value or value reported is incorrect. [-1 MARK]
Did not report that result was statistically significant. [-1 MARK]

5. Is there a positive correlation between age and years of working experience? Test this
hypothesis by running the appropriate test in SPSS. Copy and paste the relevant SPSS output
table(s) and report the results. Remember to produce a scatterplot. [10.5 MARKS]

9
The scatterplot shows a positive linear trend.

Both age and years of working experience are scalar variables and we have a large sample size
(n 30), so Pearsons r is appropriate.

10
The linear relationship between age and years of working experience was measured using
Pearsons correlation coefficient. There was a strong, positive relationship which was
statistically significant, r(109) = 0.89, p <.001. For this data, the mean (SD) for age was 44.06
(9.81) and for year of working experience was 16.28 (9.77).

Some of the typical errors found in Question 5:

Did not produce a scatterplot of age and years of working experience [-2 MARKS]
Did not comment that the scatterplot shows a linear trend [-1 MARK]
Did not generate a frequency table of age and years of working experience (both scalar
variables) to justify use of Pearson r. [-1 MARK]
Did not copy and paste the Pearson r Correlations Table or values in the table are
different than those shown (eg incorrect to generate 2-tailed p-value since our
hypothesis had a direction - positive correlation). [-1 MARK]
Did not report that relationship was strong in strength. [-0.5 MARKS]
Did not report r value or value reported is incorrect. [-0.5 MARKS]
Did not report n value or value reported is incorrect. [-0.5 MARKS]
Did not report p-value or value reported is incorrect. [-1 MARK]
Did not report that result was statistically significant. [-1 MARK]
Did not report mean and standard deviation for age or value reported is incorrect. [-1
MARK]
Did not report mean and standard deviation for years of working experience or value
reported is incorrect. [-1 MARK]
Rounding errors. [-0.5 MARKS]

11
6. Among males, is there a positive correlation between age and years of working experience? Test
this hypothesis by running the appropriate test in SPSS. Copy and paste the relevant SPSS output
table(s) and report the results. Remember to produce a scatterplot. [8.5 MARKS]

The scatterplot shows a monotonic increasing trend.

Both age and years of working experience are scalar variables and we have a small sample size
(n< 30), so Spearmans rho is appropriate.

12
Spearmans correlation was used to examine the association between age and years of working
experience among males. Spearmans rho for age and years of working experience was rho(27) = .76,
p<.001. This indicates that greater ages tended to have greater years of working experience and vice
versa. The correlation was strong and statistically significant.

Some of the typical errors found in Question 6:

Did not produce a scatterplot of age and years of working experience for males [-2
MARKS]
Did not comment that the scatterplot shows a monotonic increasing trend [-1 MARK]
Did not generate a frequency table of age and years of working experience (both scalar
variables) for males to determine sample size (small) and justify use of Spearman rho [-1
MARK]
Did not copy and paste the Spearman rho Correlations Table for males or values in the
table are different than those shown (eg incorrect to generate 2-tailed p-value since our
hypothesis had a direction - positive correlation). [-1 MARKS]
Did not report that relationship was strong in strength. [-0.5 MARKS]
Did not report rho value or value reported is incorrect. [-0.5 MARKS]
Did not report n value or value reported is incorrect. [-0.5 MARKS]
Did not report p-value or value reported is incorrect. [-1 MARK]
Did not report that result was statistically significant. [-1 MARK]
Rounding errors. [-0.5 MARKS]

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