Methods/Design and Statistical Analysis

PICOT formatted Clinical Project Question
P: In the home health setting of patients aged range 60-to 75 with depression symptoms.
I: Does the PHQ-2 depression screen assist in the early identification of symptom severity and monitor for symptom changes for clinical depression.
C: Using the GDS-15 screening tool.
O: To improve the identification of clinical depression in the elderly by 100%.
T: In the initial office visit and over 6 months?

Submit 2-3 pages describing the Methods/Design and Statistical Analysis that you will use in your project. Use the evidence from the peer reviewed articles that you have critically appraised and synthesized. Follow APA format and cite references. Include the following:

Describe the evaluative criteria (indicators or variables) to be addressed in answering each evaluation question.
Describe the research approaches to be used to answer each question and why they are appropriate to the evaluation questions posed.
Describe in specific detail how data will be collected related to each of your evaluative criteria/indicators. Discuss exactly how the data be collected, when, and by whom. Describe any data collection tools in terms of their development and appropriateness in answering the evaluation questions. Provide information on validity and reliability of tools, if available. Explain why the data collection methods are appropriate to the research approach, type of data, and purpose of the evaluation.
Describe how you will analyze the data, including specific statistical tests to be used. Include dummy data tables if applicable to show how you will display your findings.

FINAL PAPER ATTACHED TO BE USED FOR METHODS/DESIGN AND STATISTICAL ANALYSIS

ANSWER

Methods/Design and Statistical Analysis

Quasi-experimental, pre-post intervention design

The purpose of the study was to compare PHQ-2 and GDS-15 performance in early identification of depression among the elderly patients by 100%. There were a number of indicators that were used to answer the evaluation questions. These included screening effectiveness, the number of patients with depression diagnosis depending on the screening tool (change in depression scores) and the encounters that show positive screening results for each screening tool. The changes in the number of patients with depression in the home health setting will be an effective indicator of changes in the depression scores with regard to changes in the intervention. The positive screening results will indicate the appropriateness of the screening tool. The screening effectiveness will focus on the ease of administration, administration time and ease of scoring.

The research approach used to answer the evaluative indicators was quasi-experimental, pre and post intervention design. The quasi experimental study design is non-randomized intervention study that evaluates the benefits of a certain intervention (White and Sabarwal, 2014). For instance, the home health setting introduced a new depression screening tool and wants to study the impact of the intervention as compared to the previous screening tool which means they measure the before and after intervention. In the quasi experiment design the study identifies a comparison group that is similar as possible to the treatment group (Handley et al., 2018). The comparison group in this case will be patients using the GDS-15 screening tool to determine the outcome if the PHQ-2 was not implemented.

The pre-posttest design approaches were used to measure before and after implementation of the screening tools. The pre-posttest research approaches were used to measure screening effectiveness and positive screening results. Considerably, the pre-posttest design are widely utilized in behavior study, primarily for the aim of comparing groups and measuring change that results from the interventions (Miller, Smith and Pugatch, 2020). The research approach is effective in assessing the knowledge on the depression screening tools through a comparative analysis.

The retrospective chart review will also be utilized as a research approach in which there is pre and post-recorded data. The retrospective chart review will be conducted to evaluate the current frequency of depression in the home care health settings. A final chart review will be included to evaluate the potential changes in the number of patients with depression diagnosis.

Data Collection Process

Central to the depression screening process improvement was utilization of validated screening tools that will aid early identification and offer measurable treatment outcomes. The data collection process will include how the data will be collected, by whom, the instruments used and how the data will be related to the evaluative indicators. The data collected will include depression scores which indicated the effectiveness and outcomes of the changes. The participants will include elderly home health setting patients at the range of 60-75. All the subjects that provide consent to participate in the study will be screened using the two instruments.

The instruments used to collect are the PHQ-2 and GDS-15. Both instruments used questionnaires that were used to measure severity of the depressive disorder. The PHQ-2 is a brief screening tool that allows efficient way of detecting depression cases and improving diagnostics (Lakkis and Mahmassani, 2015). The PHQ-2 will collect data through 2 questions that focus on the frequency of the depressed mood and persistence of the symptoms. This will measure the occurrence over the last two weeks (feeling depressed, down and hopeless) little pleasure or interest in doing things. The score of the two items range from 0-3.  Score of two or three indicates high sensitivity and specificity for diagnosing depression.

The GDS-15 is an effective screening tool that facilitates depression assessment especially among the older adults. The GDS-15 will collected data through its 15 item geriatric depression scale. The data will be collected by home care nurses using the depression screening tools to assess the signs and symptoms of depression in the patient. Home health nurses play a major role in collaboration with other healthcare providers in assessing and sustaining depression. The validity and reliability of the instruments were reviewed and conformed by a psychiatric mental health nurse practitioner

Data on screening effectiveness will be collected through examining how well the screening tool improves depression identification. The pre-posttest will compare the ease of administration, administration time and ease of scoring between the two screening tools. Data on the number of patients with depression diagnosis and positive screening results will be obtained through evaluation of severity score and depression screening score in the pre-post retrospective chart review.

Data Analysis

After data collection, the data will be analyzed using descriptive statistics. Descriptive statistics focuses on offering basic information regarding variables in data sets and highlighting potential connection between the variables (Zauszniewski and Bekhet, 2012). The descriptive statics will measure the effectiveness of the two depression screening tools in early identification by the number of screen patients and positive depression screening.

Data will exported to the statistical packages for social sciences for analysis. The descriptive techniques will be used to summarize the evaluative indicators. Relatively the multivariate logistics regression was used in predicting the single binary variable and determine the numerical connected between the evaluative indicators. Paired t-tests will be prepared to compare the mean depression scores of the two depression screening tools to evaluate the most effective in early identification of depression.

References

Handley, M. A., Lyles, C. R., McCulloch, C., & Cattamanchi, A. (2018). Selecting and improving quasi-experimental designs in effectiveness and implementation research. Annual review of public health, 39, 5-25.

Lakkis, N. A., & Mahmassani, D. M. (2015). Screening instruments for depression in primary care: a concise review for clinicians. Postgraduate medicine, 127(1), 99-106.

Miller, C. J., Smith, S. N., & Pugatch, M. (2020). Experimental and quasi-experimental designs in implementation research. Psychiatry research, 283, 112452.

White, H., & Sabarwal, S. (2014). Quasi-experimental design and methods. Methodological briefs: impact evaluation, 8(2014), 1-16.

Zauszniewski, J. A., & Bekhet, A. K. (2012). Screening measure for early detection of depressive symptoms: the depressive cognition scale. Western Journal of Nursing Research, 34(2), 230-244.