• Home

WORK

DISSERTATION DEVELOPMENT 1

DISSERTATION DEVELOPMENT 3


How Autism Effect the Family and the Parents in Denial

Rosaline Nixon

College of Doctoral Studies, Grand Canyon University

RES820A: The Literature Landscape: Organizational Leadership

Dr. Davis

March 23, 2022,

How Autism Effect the Family and the Parents in Denial



Dietz, P. M., Rose, C. E., McArthur, D., & Maenner, M. (2020). National and state estimates of adults with autism spectrum disorder. Journal of Autism and Developmental Disorders50(12), 4258-4266.DOI: 10.1007/s10803-020-04494-4

The article aimed at assessing the number if adults 18-84 years who are living with autism spectrum disorder since there is lack of a surveillance system for monitoring the number of adults living with the condition. The study studied prevalence rates at both the state and federal levels. This is helpful in the development if surveillance systems that would help to determine the need for diagnosing and offering services to unidentified members of the population. The findings of this article are important for this study because it would help establish prevalence rates of ASD, which are not well-known. This would help inform what measures should be adopted in evaluating how people can be affected by autism. Such information would be important for the research topic because it aims at evaluating how autism affects families and parents in denial. Knowing prevalence of autism would be important when evaluating how families and parents in denial by the condition.



Farooq, A., & Ahmed, S. (2020). Sociocultural Barriers to Early Diagnosis of Autism Spectrum Disorder. Life and Science1(4), 6-6. DOI: 

https://doi.org/10.37185/LnS.1.1.106

The review aimed to subjectively layout how the local area, family, and medical services frameworks go about as hindrances to the early finding of mental imbalance range jumble in kids. A phenomenological subjective methodology was taken while assessing moms’ encounters for getting ASD treatment for their Children.The main barriers to receiving ASD treatment resulted in the lack of knowledge and perception among parents, unidentified pathways to healthcare in healthcare systems, and structural and process barriers. Family denial and stigma surrounding mental health and financial constraints were also identified. The article concludes that institutional policies can be addressed through promotion of education among families about ASD, addressing procedural barriers, and offering support for parents with children at risk of ASD. This article is important to the dissertation topic because unmasks some factors are liked with increased denial of ASD condition. The article provides important insights that would be crucial in the development of the study.


Magalhães, J. M., Rodrigues, T. A., Neta, M. M. R., Damasceno, C. K. C. S., Sousa, K. H. J. F., & Arisawa, E. Â. L. S. (2021). Experiences of family members of children diagnosed with autism spectrum disorder. Revista Gaúcha de Enfermagem42. DOI: 

10.1590/1983-1447.2021.20200437

 

The purpose of the study was to evaluate mother’s perceptions, and experience that have lived by families when caring for children with autism spectrum disorder. The study interviewed 20 mothers with children who was diagnosed with autism spectrum disorder in Teresina-Piaui, in Brazil. The findings indicated that families have mixed reactions ranging from denial to acceptance. Families are also exposed to sadness realizing that the condition cannot be cured, and more families are faced with denial when learning on adaptation requirements needed to support their children. Therefore, families should not only learn about structural factors, but also emotional support aspects of the program. These findings are very important when addressing the topic under consideration since it gives an overview of the state of affairs among families with children who have autism spectrum disorder. The findings would be instrumental in trying to create an interface between needed support and perceived denial.


Lamba, N., Van Tonder, A., Shrivastava, A., & Raghavan, A. (2022). Exploring challenges and support structures of mothers with children with Autism Spectrum Disorder in the United Arab Emirates. Research in developmental disabilities120, 104138. DOI: 

10.1016/j.ridd.2021.104138

The review pointed toward assessing the difficulties and backing structures for moms of kids with ASD. Mothers are the primary caregivers, but at the same time experience high stress levels, although their experience is not well-known. Mothers aged 33-58 years were consulted with respect to finding, restorative intercessions, encouraging group of people, and pandemic. Findings indicates lack of necessary information to help them seek the correct diagnosis. Moreover, most mothers are forced to take care of their children without a support system from their families, and experience many challenges during pandemic. This contributes to their feeling rejected from their families. However, exposure to support groups that informed them on how they can help their children improved their satisfaction. These findings are important for the study topic because they help propose strategies that can be adopted to reduce denial and promote embracing these children to improve their well-being. Acceptance of children with ASD is dependent on existence of the necessary support networks, which would address stresses faced by parents and potential denial.


Kang-Yi, C. D., Grinker, R. R., Beidas, R., Agha, A., Russell, R., Shah, S. B., … & Mandell, D. S. (2018). Influence of community-level cultural beliefs about autism on families’ and professionals’ care for children. Transcultural psychiatry55(5), 623-647. Doi: 

10.1177/1363461518779831

The objective of the study was to find out how community-level cultural beliefs affect families and ASD care for children with developmental delays among immigrant communities as a step towards identification and timely access to services. The study was conducted in New York City and targeted Korean American communities using an inductive approach to identify concepts and categories associated with autism. The study established that the factors that influence ability to access the correct care for children with autism included stigma, discomfort and discrimination. These factors influence the ability of this community to access the right autism care. The findings of this community are important for the research topic because cultural and community perceptions are some factors that influence the ability of families and children accessing the appropriate care for children with autism. The study informs the research topic in availing evidence why most of the parents and families live in denial about children with autism.


Gentles, S. J., Nicholas, D. B., Jack, S. M., McKibbon, K. A., & Szatmari, P. (2020). Coming to understand the child has autism: A process illustrating parents’ evolving readiness for engaging in care. Autism24(2), 470-483.

https://doi.org/10.1177/1362361319874647

The purpose of this study was to assess how parents came to understand their children had autism and conforming the appropriate care. The study also presents findings on how parents are engaged and get prepared to offer help to their children at this early stage. Information was gathered from 45 meetings with 32 moms and 9 specialists’ experts from metropolitan and rustic areas of Ontario in Canada. The findings indicate that parent’s motivation and readiness for engagement is dependent on an individual rate. Most parents explained that they were hesitant to access the right care, and had to time to confirm the difference and whether the disease was autism before they could access care. These findings are instrumental for the research topic since it offers varied perspective on how parent take the autism and how it influences their acceptance of the disease on the first account. It helps establish how parents engage and get used to the fact that their child has autism.


Pearson, J. N., Meadan, H., Malone, K. M., & Martin, B. M. (2020). Parent and professional experiences supporting African-American children with autism. Journal of Racial and Ethnic Health Disparities7(2), 305-315. DOI: 10.1007/s40615-019-00659-9

The examination was led with the target of assessing the experience of guardians and experts supporting African American children with autism. The care for children with autism has stabilized in the US and children are able to access autism care as early as two years, but African American children have not been able to access the desired level of care. Findings indicates that both parents and professionals face similar factors a most being a few facilitators to accessing services and also faced similar barriers about timely access to quality autism care services. Due to such barriers, parents find it difficult to seek autism care services and are likely to live in denial of the reality their child has autism. This research is important to the study topic since it highlights some the factors that may influence parents to live in denial and fail to access the right care for their children.



Gordillo, M. L., Chu, A., & Long, K. (2020). Mothers’ adjustment to autism: exploring the roles of autism knowledge and culture. Journal of Pediatric Psychology45(8), 877-886.

https://doi.org/10.1093/jpepsy/jsaa044

The study explored the relationship between culture and service-use barriers among culturally diverse mothers of children with ASD. The study involved in the semi-structure qualitative interview about their experience with ASD, and thematic analysis used to analyze the data collected. The results indicated that mothers had similar gains if knowledge was available and their children had access to care, and they felt empowered by availability of knowledge, but still there were difficulties about utilizing the knowledge to identify children specific needs. The study further established that cultural-based stigma against ASD such as rejection from the community were among the factors that stimulated denial and lack of belief that mothers had about the conditions of their child being treatable. The findings are instrumental to building the effect of autism on parents with denial, but educational programs addressing informational and cultural needs may help in addressing the existing cultural disparities about diagnosis of ASD.


Rabba, A. S., Dissanayake, C., & Barbaro, J. (2019). Parents’ experiences of an early autism diagnosis: Insights into their needs. Research in Autism Spectrum Disorders66, 101415.

https://doi.org/10.1016/j.rasd.2019.101415

The objective of the research was to investigate parental needs when their children have early ASD diagnosis. The study focused on 13 mothers and fathers who had a child less than 36 months diagnosed with autism based on semi-structured interviews and focus groups. Based on thematic analysis, four themes were identified; emotional response to diagnosis, ability for managing uncertainties after diagnosis, availability of resources, and ability to share diagnosis. If a child has an early diagnosis, various emotions are stimulated and eventually influence their coping. The findings have important implications on the study topic, since they open to new facts that can be used to determine how autism affects parents living with denial. Moreover, it forms basis for formulation of strategies that can be used to address factors that may lead to delayed access to care, which may cause long-term health consequences on the child. Getting information about early diagnosis is important to timely diagnosis.


Papoudi, D., Jørgensen, C. R., Guldberg, K., & Meadan, H. (2021). Perceptions, experiences, and needs of parents of culturally and linguistically diverse children with autism: a scoping review. Review Journal of Autism and Developmental Disorders8(2), 195-212.

https://link.springer.com/article/10.1007/s40489-020-00210-1

The study provided a review of research articles from the United Kingdom and the United States. The objective was to establish the perceptions, experiences, and culturally diverse families of children with autism. 32 articles were selected out of which 25 were from the United States and 7 from the United Kingdom. The review recognized four subjects about information and conviction about chemical imbalance, chemical imbalance and everyday life, family encounters with getting to administrations and backing, and multi-language. The findings indicated that family perception about the lack of knowledge and experiences like social stigma and service unavailability. Recommendations such as provision of culturally sensitive strategies, availing information in diverse languages and promotion of parent-professional collaboration would go a long way in promotion of service access among parents. Findings indicate that autism does not necessarily influence one’s perception, but to a large extent it’s a lack of information and support services which would help understand the context of the study topic.


Bloch, J. S., & Weinstein, J. D. (2009). Families of young children with autism. Social Work in Mental Health8(1), 23-40.

https://doi.org/10.1080/15332980902932342

The article highlights the experiences of families of children with autism spectrum disorder. There has been increased awareness of the need to offer services for children with autism. While access to service for children with this condition is important, it is equally important to recognize the family functioning of the children receiving this care and the outcome. The article indicates the importance of understanding the range of stressing factors that families are exposed to including family systems, family values, cultural beliefs and priorities. The primary objective of this article was to evaluate these factors in order to understand how they affect family systems so that it can be easier to use family perspectives to address the complex needs facing the families and children with autism. The article provides important insights that would be significant in understanding some motivations towards family denial of children living with autism spectrum disorder.



Zuckerman, K. E., Sinche, B., Cobian, M., Cervantes, M., Mejia, A., Becker, T., & Nicolaidis, C. (2014). Conceptualization of autism in the Latino community and its relationship with early diagnosis. Journal of developmental and behavioral pediatrics: JDBP35(8), 522. Doi: 

10.1097/DBP.0000000000000091

The article focused on subjectively understanding the conceptualization of ASD inside the Latino people group to get existing obstructions to early findings. Five center gatherings and four subjective meetings were with 30 guardians occupied with Oregon. Most of the families had no knowledge about autism. Many believed that some symptoms of ASD were associated with family dysfunctions. Some concerns that were raised by parents included communication of the providers and access to language services. Parents with children with developmental delays were likely to face rejection, embarrassment, and children were perceived as a burden to the family. As a result, parents were less likely to seek medical services with providers. The findings of this research study are important to understanding what factors influence parents’ failure to seek medical services for their children if they have autism spectrum disorder. The findings that parental denial is usually associated with cultural beliefs is critical to the development of this research study.


Altiere, M. J., & von Kluge, S. (2009). Searching for acceptance: Challenges encountered while raising a child with autism. Journal of intellectual and developmental disability34(2), 142-152.

https://doi.org/10.1080/13668250902845202

The study was conducted with the aim of establishing the challenges that families goes through when raising children with autism. The review drew in 52 guardians of youngsters with autism spectrum disorder, who were consulted to figure out their battles and triumphs. The discoveries showed five obvious difficulties among these families including improvement, addressing, obliteration, arrangements, and development. The findings further indicated that parents experienced confusion as a result of behavioral presentation of children when they realized their children had autism. However, the findings also indicate the willingness of parents to support their children in whatever possible way. Although there are challenges experienced when raising a child with autism, there were positive experiences that were notable. The article gives important insights that are applicable by families and professionals in order to ensure services are availed to the children that need them. This would help avoid perceived denial by families of children with autism.


Rebeiro, M. J., Azad, S. A. K., & Mahmud, A. Y. (2019). Psychological service needs of parents in the management of ASD. Bioresearch Communications-(BRC)5(2), 744-749.

www.bioresearchcommunications.com

The research study was aimed at establishing psychological services that are needed by parents of children with ASD between the age of 4-12 years. Twenty-seven parents of children with Austin were the caregivers who participated in the study, and were selected in a special children school. Information assortment was through interviews, while the seriousness of the downturn and uneasiness were gathered utilizing psychometric instruments. The outcomes demonstrated that guardians with ASD experienced shifting levels of nervousness that went from gentle to serious. The results additionally show that the vast majority of the guardians likewise experienced gentle to extreme degrees of depression. Parents also demonstrated communication, behavioral and cognitive disturbances as notable among children with ASD. These problems indicated the need for psychological services among these parents for them to seek appropriate services and support for their children. These findings are instrumental to understanding reasons why parents are unable to seek the needed services and support when they realize their children have autism. Moreover, children also need psychological services for them to learn appropriate skills such as behavior, communication and cognitive developments.


Brewer, A. (2018). “We were on our own”: Mothers’ experiences navigating the fragmented system of professional care for autism. Social Science & Medicine215, 61-68.

https://doi.org/10.1016/j.socscimed.2018.08.039

The article explains the sacrifices that mothers have to take in order to take care of their children with autism. Information from 620 guardians of medically introverted youngsters was locked in to investigate their encounters with the divided arrangement of expert consideration. The discoveries propose that drawing in with treatment for youngsters sent such families into the disarray of conclusion and treatment. Since the assistance framework is divided into clinical and school systems guardians were battling to track down complete proficient consideration as suggested by research associations. Due to the demanding state of children care systems, parents gave up their work commitments in order to offer the necessary support for their children. However, such moves had implications on their families, which is why families may tend to overlook their children with autism to maintain their incomes. These factors coupled with low socioeconomic status had a negative implication on the ability of parents to offer support for their autistic children, which could explain perceived denial.



Pozo, P., Sarriá, E., & Brioso, A. (2014). Family quality of life and psychological well‐being in parents of children with autism spectrum disorders: a double ABCX model. Journal of Intellectual Disability Research58(5), 442-458.  

https://doi.org/10.1111/jir.12042

The article examined the family quality of life and psychological well-being based on multidimensional perspectives based on ABCX model, with severity of disorder, behavioral problems, social support, sense of coherence, and strategies for coping. A sample of 118 parents who had children with autism were involved and quality of life analyzed between mothers and fathers. The result of the study indicates that having behavioral problems will have negative effects on adaptation of parents. The existence of support for both mothers and fathers had significant impact on family quality of life. There was a connection between survival techniques and variation, dynamic aversion adapting for fathers, and positive and issue-centered adaptation to moms’ mental well-being. The article is relevant in the research topic because it highlights family quality of life and coping strategies and coping strategies as critical in understanding how families with autistic children are affected, which is linked to other psychological and behavioral consequences.


Moorcroft, A., Scarinci, N., & Meyer, C. (2020). ‘We were just kind of handed it and then it was smoke bombed by everyone’: How do external stakeholders contribute to parent rejection and the abandonment of AAC systems?. International Journal of Language & Communication Disorders55(1), 59-69.

https://doi.org/10.1111/1460-6984.12502

The study was based on evaluation of parents’ perception about the contribution of stakeholders towards rejection in the augmentative and alternative communication (AAC) system. Semi-structured interviews were conducted with 12 parents who had rejected or abandoned the AAC system that has been recommended for their children, then data relating to the role of external stakeholders extracted from the transcriptions, and a thematic analysis conducted. The findings indicated four themes relating to the role of stakeholders in parents’ rejection and abandonment of the AAC system. The findings indicated that parents were influenced by attitudes and experiences of professionals, they felt unsupported by SLP, communication with stakeholders was ineffective, and difficulties using AAC without support of the external stakeholders. The study is important for the research topic because it highlights the importance of offering family-centered support programs to avoid family failing to seek needed support for their children which would promote their well-being and awareness.


Liao, X., Lei, X., & Li, Y. (2019). Stigma among parents of children with autism: A literature review. Asian Journal of Psychiatry45, 88-94.

https://doi.org/10.1016/j.ajp.2019.09.007

The study was based on literally review of studies evaluating experiences of stigma among parents of children with autism. Systematic literature search was conducted to find the right research articles, and two independent reviewers mandated with the screening of the articles, and then identified articles classified based on sociocultural setting. Evaluation of the articles selected indicated that parents were exposed to courtesy stigma, which eventually developed into affiliate stigma. The findings also indicated lack of adequate attention on subject of stigma associated with parents of children with stigma. Parents of children with autism were affected by stigma, which was associated with severity of behavior. Some factors associated with failure of seeking the necessary help for children with autism is linked to lack of systems that could evaluate parent’s exposure to stigma. This could explain some factors that affect parents of children with autism disorder, and consequential denial related to the condition.


Bozkurt, G., Uysal, G., & Düzkaya, D. S. (2019). Examination of care burden and stress coping styles of parents of children with Autism Spectrum Disorder. Journal of pediatric nursing47, 142-147.

https://doi.org/10.1016/j.pedn.2019.05.005

The point of the review was to inspect the guardian burden and stress survival techniques for guardians of youngsters with chemical imbalance range jumble (ASD). 131 children with ASD from a private education center in Istanbul were involved and data was collected using questionnaires prepared by the researcher. The examination discoveries shows that guardians of kids with ASD had higher weight of care; nonetheless, the weight of care was higher for guardians with a solitary kid contrasted with guardians with more youngsters, and contrasts was likewise prominent for guardians with little girls contrasted with children Mothers were more likely to seek social support compared to fathers. These findings have an implication in the study topic because it highlights the important role-played by the caregiver or the parent. Whether to seek social support or any other form of intervention is dependent on the parent’s willingness to mitigate the burden of care for children with autism.


Salimi, M., Mahdavi, A., Yeghaneh, S. S., Abedin, M., & Hajhosseini, M. (2019). The effectiveness of group-based acceptance and commitment therapy (ACT) on emotion cognitive regulation strategies in mothers of children with autism spectrum. Maedica14(3), 240. Doi: 

10.26574/maedica.2019.14.3.240

The article investigates the importance of group-based acceptance and commitment therapy on cognitive emotion regulation strategies in mothers of children with autism. The study was quasi-experiment with a pretest and post-test control group. Mothers of children with autism spectrum disorder participated in the study, and a random sample of 30 mothers was selected and assigned experimental and control groups. The participants responded to the cognitive emotion questionnaire, and data analyzed using co variance analysis. Results indicated that group-based acceptance and commitment had significant effect on planning strategy. The study indicates that planning therapy centers can adopt group-based and acceptance therapy as a way of improving cognitive emotions regulatory strategy for mothers of children with autism. The study findings are significant to the study because autism affects people different, and engaging them as a group can achieve results they could not achieve when such measures are adopted as a group.

Degree

My degree program is Doctor of Education in Organizational Leadership specializing in special education.

Research Focus

The topic aligns with the study area in that organizational leadership is important for leading a learning institution, while understanding special education is important to offering quality education to learners with autism.

Feasibility of Research Problem

Most studies have focused on psychological implications that parents suffered when they realized their children had autism, but no study has described how autism affects families and parents living in denial.

Problem Statement

Based on what is known in literature, autism has serious psychological effects on parents when they realize their children has autism, what needs to be understood how autism affects families and parents living in denial.

Need for Study

The effects of autism in families have been identified to be diverse. Many studies have focused on evaluating the consequences of parents realizing their children had autism. Moreover, psychological consequences of autism have been identified among parents of children with autism. Despite many researches providing evidence that autism causes stress and anxiety among families, there are still many knowledge gaps that are yet to be filled. The objective of this study is to establish the effects of autism on families and parents living in denial. Many care professionals have tried their best in addressing the psychol

WORK

How Autism Effect the Family and the Parents in Denial

Rosaline Nixon

RES 831 Foundations of Research Design 1

April 26, 2022

CONFIDENTIAL

GCU – For Internal Use Only

1

Literature Review: Background to the Problem

. • There is a small population in the US living with Autism

•Autism Spectrum disorder affects minority communities disproportionally compared to whites. There is lower accessibility of available services for ASD treatment across different ethnic communities

10/9/2019

CONFIDENTIAL

GCU – For Internal Use Only

According to the national state population-based estimates, there is a small population of individuals living with autism spectrum disorder (ASD). However, there is a lack of a monitoring system for the condition’s prevalence within the population. The estimates for Louisiana and Massachusetts include 1.97% and 2.42 respectively. Approximately 5,437,988 U.S. adults under 18 and above living with ASD in the U.S. However, most adults usually deny having autism hence affecting the treatment of the disease. An example is where mothers in Brazil have mixed reactions, including denial and acceptance, when taking care of children with autism. In addition, they are exposed to more sadness when learning how to take care of children with autism (Magalhaes et al., 2021). Disparities in service usage for autism spectrum disorder (ASD), including limited access and use, disproportionately affect racial and ethnic minority families (Angell, Empey, & Zuckerman, 2018). Latinos are the country’s largest racial and ethnic minority group and are predicted to continue expanding faster than other racial and ethnic groupings (U.S. Census Bureau, 2018). Latino families with autistic children continue to be underrepresented in autism research and underserved by an autism diagnosis and intervention programs (Angell et al., 2018). Latino children with ASD are identified later, get less specialized treatment services, and have worse unmet service requirements than White, United States-born children (Angell et al., 2018). These inequalities in ASD prevalence have continued over time and have occasionally been worse for Latino households than White, US-born families.

2

Literature Review: Theoretical Foundations

Theoretical foundation

ABC-X Theory

A- Stressor event

B- Available resources for a family

C- Perception

X- Probability of an event occurring

10/9/2019

CONFIDENTIAL

GCU – For Internal Use Only

The ABC-X model is mainly applied in analyzing hardships encountered by families when trying to cope with stress. A represents the stressor event, while B represents available resources for a family. C finally represents the perception of a family towards a specific stressor, and X ultimately means the probability of an event occurring. Thus, the study variables to be used in the research as stressor event (A) include the presence of a family member with autism.

In contrast, therapeutic and other activities are commonly used among children with special needs, such as ABA therapy, as significant resources available for families will be used as B. The perception (C) will entail parents’ perception regarding the effectiveness of therapeutic approaches to addressing autism in children. The results will be the quality of marital relationships, financial stability, and parents’ mental health. 

Research questions

What are the impacts of children living with autism on parents’ mental health?

What is the probability of parental denial of autism reduced through group-based therapeutic approaches?

What is the relationship between the health of the marital relationship and the presence of a family member with autism? 

3

Literature Review: Review of Literature

Major Topic Topic Description Empirical Sources APA Formatted Reference
Impacts of social structures on parental denial Identifies several social structures impacts, for example, religious views on beliefs regarding autism. Faroooq and Ahmed (2020), Brewer (2018), Liao et al. (2019)
Impacts of autism on family Identifies issues arising as a result of prevalence of autism at the family context Magalhães et al. (2021), Pearson et al. (2020), Pozo et al., 2014)
Impact of culture on perceptions regarding autism Identifies cultural view of autism and how it impacts perceptions of individuals. Kang-Yo et al. (2018), Altiere (2009), Zuckerman (2014).

CONFIDENTIAL

GCU – For Internal Use Only

4

Problem Statement

Current research focused on sociocultural influences of autism on parental denial and family experiences.

It is not known determined whether there are any significant impacts of autism in families and parental denial

Based on what is known in the empirical research literature, specific impacts of autism and parental denial are still unknown or what still needs to be understood is the varying impacts of availability of resources,

10/9/2019

CONFIDENTIAL

GCU – For Internal Use Only

Based on the existing research, autism is directly related to the family’s issues and among parents. However, there is little collaborative research indicating the impact of autism on parents’ denial and the family members. Most studies have focused on the effects on parents’ mental health and financial stability instead of parents’ denial as the significant source of the issue. By investigating sociocultural factors that affect perceptions regarding autism, the research aims to increase awareness regarding adverse impacts on care for children.

Use this Slide for Quantitative Studies:
Variables

Variable Conceptual Definition Operational Definition Measurement Level Instrument/Data Source
Cultural beliefs Belief in something based on ethnic traditions, values, and norms.  Mediating factors within the society that determine an individual’s decision regarding treatment and status   Enrollments of parents into Group based Acceptance Training Programs (ATP) Engagement of parents in ATPs 
Parental denial (dependent) Refusal of parents to accept their children’s’ condition as autism  Impact of cultural factors on perception of parents about autism  Parental health seeking behaviors  National State population-based estimates of diagnosed autism patients
       

10/9/2019

CONFIDENTIAL

GCU – For Internal Use Only

6

Use this Slide for Quantitative Studies:
Research Questions and Hypotheses

RQ1: What is the impact of autism on family members

H10 Autism does not lead to adverse impacts on the relationships between family members

H1A Autism leads to adverse impacts on the relationships between family members

RQ2: What are the impacts of autism on parental denial of prevailing health conditions within their children?

H20 There is no significant correlation between sociocultural factors and parental denial of the status of their children

H2A There is a significant correlation between sociocultural factors and parental denial of the status of their children

10/9/2019

CONFIDENTIAL

GCU – For Internal Use Only

7

Methodology Justification

Quantitative
Seminal sources describing quantitative methodology:

Sheard, J. (2018). Research methods. Routledge.

Queirós et al., 2017

Justification for quantitative:

The fundamental techniques for analyzing numerical data are referred to as statistics. Statistical approaches are used to organize, analyze, interpret, and visualize numerical data.
The fundamental techniques for analyzing numerical data are referred to as statistics. Statistical approaches are used to organize, analyze, interpret, and visualize numerical data.

CONFIDENTIAL

GCU – For Internal Use Only

In contrast to qualitative research, quantitative research deals with numerical data or data that may be translated into numbers. The fundamental techniques for analyzing numerical data are called statistics, and statistical approaches are used to organize, analyze, interpret, and visualize numerical data. Statistics is a vast subject having applications in a wide variety of disciplines, including information systems and other fields of information research. With the development of computers, particularly personal computers, access to statistical techniques for handling and analyzing data has increased.

8

Feasibility – Slide 1

Resources for study:

Computer

Internet Connectivity

Institutional Review Board Approval

Ethical Concerns:

Privacy and confidentiality

Exclude identifying information during the data collection stage

Institutional Review Board (IRB) approval

Informed Consent

Provision of consent forms before research

CONFIDENTIAL

GCU – For Internal Use Only

Slide Requirements: 

Since the research will involve using empirical data evidence, there will be a need to obtain consent from the Institutional Review Board. 

(IRB) to make sure that the research subjects are adequately protected throughout the research. However, additional research from secondary sources will be needed to support research findings obtained from credible sources such as google scholar and other PsycNET. These sources will facilitate the development of adequate background for conducting the research.

Ethical Concerns/Considerations 

Ethical considerations for the research include the privacy and confidentiality of patients. The information provided by participants will eliminate identifying information such as names to reduce the risks of connecting participants to the research. In addition, there is also the issue of informed consent, where individuals will be presented with consent forms that explain the study, their roles, and rights during the research. Despite the various risks, the participants will gain by identifying evidence-based strategies for mitigating the prevalence of factors that lead parents into denial and mental health issues that might arise due to the presence of autistic children in parents and family in general.

Feasibility Concerns

Some of the most prevalent challenges likely to be encountered involve a lack of sufficient information from online sources and insufficient availability of resources for conducting the study. However, prior preparation will ensure all instruments and tools for the analysis. An example is obtaining IRB approval earlier to avoid delays. Based on the information collected, the study is feasible since it describes the underlying factors for parental denial of autism which is a significant determinant of health-seeking behaviors by the parents. 

List of References

Altiere, M. J., & Von Kluge, S. (2009). Searching for acceptance: Challenges encountered while raising a child with autism. Journal of Intellectual & Developmental Disability, 34(2), 142-152. https://doi.org/10.1080/13668250902845202

Angell, A. M., Empey, A., & Zuckerman, K. E. (2018). A review of diagnosis and service disparities among children with autism from racial and ethnic minority groups in the United States. International Review of Research in Developmental Disabilities, 145-180. https://doi.org/10.1016/bs.irrdd.2018.08.003

Brewer, A. (2018). “We were on our own”: Mothers’ experiences navigating the fragmented professional care system for autism. Social Science & Medicine, 215, 61-68. https://doi.org/10.1016/j.socscimed.2018.08.039

Farooq, A., & Ahmed, S. (2020). Sociocultural barriers to early diagnosis of autism spectrum disorder. Life and Science, 1(4), 6. https://doi.org/10.37185/lns.1.1.106

CONFIDENTIAL

GCU – For Internal Use Only

Slide Requirements:

Include a fully APA 7.0 correctly formatted reference for each citation used in the preceding slides. Add List of References slide as needed so that ALL quotations in your presentation are listed.

Gordillo, M. L., Chu, A., & Long, K. (2020). Mothers’ adjustment to autism: Exploring the roles of autism knowledge and culture. Journal of Pediatric Psychology, 45(8), 877-886. https://doi.org/10.1093/jpepsy/jsaa044

Kang-Yi, C. D., Grinker, R. R., Beidas, R., Agha, A., Russell, R., Shah, S. B., Shea, K., & Mandell, D. S. (2018). Influence of community-level cultural beliefs about autism on families’ and professionals’ care for children. Transcultural Psychiatry, 55(5), 623-647. https://doi.org/10.1177/1363461518779831

Magalhães, J. M., Rodrigues, T. A., Neta, M. M., Damasceno, C. K., Sousa, K. H., & Arisawa, E. Â. (2021). Experiences of family members of children diagnosed with autism spectrum disorder. Revista Gaúcha de Enfermagem, 42. https://doi.org/10.1590/1983-1447.2021.20200437

Pozo, P., Sarriá, E., & Brioso, A. (2013). Family quality of life and psychological well-being in parents of children with autism spectrum disorders: A double ABCX model. Journal of Intellectual Disability Research, 58(5), 442-458. https://doi.org/10.1111/jir.12042

CONFIDENTIAL

GCU – For Internal Use Only

Queirós, A., Faria, D., & Almeida, F. (2017). The fundamental techniques for analyzing numerical data are referred to as statistics.’ Statistical approaches are used to organize, analyze, interpret, and visualize numerical data. European Journal of Education Studies, 3(9). https://doi.org/ 10.5281/zenodo.887089

Sheard, J. (2018). Research methods. Routledge.

U.S. Census Bureau. (2018). Facts for features: Hispanic heritage month 2018. Census.gov. https://www.census.gov/newsroom/facts-for-features/2018/hispanic-heritage-month.html

Zuckerman, K. E., Sinche, B., Cobian, M., Cervantes, M., Mejia, A., Becker, T., & Nicolaidis, C. (2014). Conceptualization of autism in the Latino community and its relationship with early diagnosis. Journal of Developmental & Behavioral Pediatrics, 35(8), 522-532. https://doi.org/10.1097/dbp.0000000000000091

CONFIDENTIAL

GCU – For Internal Use Only

WORK

Review Details

Take a moment to review the details of this assignment below and gather any necessary files. Once you’re ready to submit your assignment, move on to Step 2.

Assessment Traits

Requires Lopeswrite

Assessment Description

In your upcoming Residency, you will be asked to defend your choices of potential research topic, background to the problem, problem space, theoretical foundation, initial literature review, problem statement, variables, research questions and hypotheses, study methodology, and study feasibility. In the Topic 4 assignment in this course, you prepared a defense based on a quantitative methodology. In this assignment, you will draft an initial defense of these items assuming your study will use a qualitative methodology.

General Requirements:
Use the following information to ensure successful completion of the assignment:

· Refer to your submission of “Quantitative Analysis and Argumentation” in Topic 4 of this course.

· Refer to your submission of “Dissertation Development” from RES-820.

· Locate the presentation template “RES-831 Qualitative Study Defense” attached to this assignment.

· This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

· Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.

· Refer to the Publication Manual of the American Psychological Association for specific guidelines related to doctoral level writing. The Manual contains essential information on manuscript structure and content, clear and concise writing, and academic grammar and usage.

· This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.

· You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Directions:

Refer to your potential dissertation topic from your submission of “Dissertation Development” in RES-820. For this assignment, you must use a qualitative methodology.

Review your submission of “Quantitative Analysis and Argumentation” in Topic 4 of this course and any feedback from your instructor on that assignment. Update the following as needed, and transfer the updated information to the presentation template “RES-831 Qualitative Study Defense” attached to this assignment:

· Potential Research Topic

· Background to the Problem

· Problem Space

· Theoretical Foundation

· Initial Literature Review

Continuing in the presentation template “RES-831 Qualitative Study Defense,” complete the template slides to prepare a presentation to describe and defend your choices of the following as a qualitative study:

· Problem Statement

· Research Questions and Phenomena

· Study Methodology

· Study Feasibility

Your choices must be defended with relevant current research.

Attachments


RES-831-RS-QualitativeStudyDefense.pptx

Rubric

Collapse All RubricCollapse All

collapse Integration of Instructor Feedback assessment

Integration of Instructor Feedback

19 points

Criteria Description

Integration of Instructor Feedback in Revision of Previously Submitted Components

5. 5: Excellent

19 points

Integration of instructor feedback is evident and meaningful. It is seamlessly incorporated into the flow of the presentation. All instructor comments and suggestions are addressed.

4. 4: Good

17.29 points

Integration of instructor feedback is evident and relatively well incorporated into the natural flow of the presentation. All instructor comments and suggestions are addressed.

3. 3: Satisfactory

16.15 points

Integration of instructor feedback is evident though it appears as a disjointed, cursory addition. Most of the instructor comments and suggestions are addressed.

2. 2: Less Than Satisfactory

13.87 points

Integration of instructor feedback is vaguely attempted but does not address the majority of instructor comments and suggestions.

1. 1: Unsatisfactory

0 points

Integration of instructor feedback is either missing or not evident to the reader.

collapse Defense of Proposed Research Problem assessment

Defense of Proposed Research Problem

38 points

Criteria Description

Defense of Proposed Research Problem

5. 5: Excellent

38 points

A defense of the proposed research problem is thorough. Scholarly research is used for support and is current or seminal. The proposed research problem directly emerges from a synthesis of the limitations or future study ideas from the cited literature. Argument is clear and convincing, presenting a persuasive claim in a distinctive and compelling manner.

4. 4: Good

34.58 points

A defense of the proposed research problem is thorough. The research used for support is current. There is a connection to the limitations or future study ideas from the cited literature. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion.

3. 3: Satisfactory

32.3 points

A defense of the proposed research problem is cursory. The research used for support is outdated. There is a vague connection to the limitations or future study ideas from the cited literature. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

2. 2: Less Than Satisfactory

27.74 points

A defense of the proposed research problem is illogical or inaccurate. The proposed research problem does not emerge from a synthesis of the limitations or future study ideas from the cited literature. Argument lacks consistent unity. There are obvious flaws in the logic.

1. 1: Unsatisfactory

0 points

A defense of the proposed research problem is either missing or not evident.

collapse Defense of Proposed Research Questions and Phenomena assessment

Defense of Proposed Research Questions and Phenomena

38 points

Criteria Description

Defense of Proposed Research Questions and Phenomena

5. 5: Excellent

38 points

A defense of the proposed research questions and phenomena is thorough. Scholarly research is used for support and is current or seminal. The proposed research questions and hypotheses are directly derived from the research problem. Argument is clear and convincing, presenting a persuasive claim in a distinctive and compelling manner.

4. 4: Good

34.58 points

A defense of the proposed research questions and phenomena is thorough. The research used for support is current. There is a connection to the cited literature. Argument shows logical progressions. Techniques of argumentation are evident.

3. 3: Satisfactory

32.3 points

A defense of the proposed research questions and phenomena is cursory. The research used for support is outdated. There is a vague connection to the cited literature. Argument logically, but not thoroughly, supports the purpose. Sources used are credible.

2. 2: Less Than Satisfactory

27.74 points

A defense of the proposed research questions and phenomena is illogical or inaccurate. The proposed research questions and hypotheses do not emerge from a synthesis of the cited literature. Argument lacks consistent unity. There are obvious flaws in the logic.

1. 1: Unsatisfactory

0 points

A defense of the proposed research questions and phenomena is either missing or not evident to the reader.

collapse Defense of Proposed Methodology assessment

Defense of Proposed Methodology

38 points

Criteria Description

Defense of Proposed Methodology

5. 5: Excellent

38 points

A defense of the proposed methodology is thorough. Scholarly research is used for support and is current or seminal. The proposed methodology is directly derived from the research problem. Argument is clear and convincing, presenting a persuasive claim in a distinctive and compelling manner.

4. 4: Good

34.58 points

A defense of the proposed methodology is thorough. The research used for support is current. There is a connection to the limitations or future study ideas from the cited literature. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion.

3. 3: Satisfactory

32.3 points

A defense of the proposed methodology is cursory. The research used for support is outdated. There is a vague connection to the limitations or future study ideas from the cited literature. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

2. 2: Less Than Satisfactory

27.74 points

A defense of the proposed methodology is illogical or inaccurate. The proposed methodology does not emerge from a synthesis of the limitations or future study ideas from the cited literature. Argument lacks consistent unity. There are obvious flaws in the logic.

1. 1: Unsatisfactory

0 points

A defense of the proposed methodology is either missing or not evident to the reader.

collapse Defense of Study Feasibility assessment

Defense of Study Feasibility

38 points

Criteria Description

Defense of Study Feasibility

5. 5: Excellent

38 points

A defense of the study feasibility is thorough. Scholarly research is used for support and is current or seminal. Argument is clear and convincing, presenting a persuasive claim in a distinctive and compelling manner.

4. 4: Good

34.58 points

A defense of the study feasibility is thorough. The research used for support is current. Argument shows logical progressions. Techniques of argumentation are evident.

3. 3: Satisfactory

32.3 points

A defense of the study feasibility is cursory. The research used for support is outdated. Argument logically, but not thoroughly, supports the purpose. Sources used are credible.

2. 2: Less Than Satisfactory

27.74 points

A defense of the study feasibility is illogical or inaccurate. Argument lacks consistent unity. There are obvious flaws in the logic.

1. 1: Unsatisfactory

0 points

A defense of the study feasibility is either missing or not evident to the reader.

collapse Mechanics of Writing assessment

Mechanics of Writing

9.5 points

Criteria Description

Mechanics of Writing

5. 5: Excellent

9.5 points

Writer is clearly in command of standard, written, academic English.

4. 4: Good

8.65 points

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

3. 3: Satisfactory

8.08 points

Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

2. 2: Less Than Satisfactory

6.94 points

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present.

1. 1: Unsatisfactory

0 points

Mechanical errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.

collapse APA Format assessment

APA Format

9.5 points

Criteria Description

APA Format

5. 5: Excellent

9.5 points

In-text citations and a reference page are complete and correct. The documentation of cited sources is free of error.

4. 4: Good

8.65 points

Required format is used, but minor errors are present. Reference page is present and includes all cited sources. Documentation is appropriate and citation style is usually correct.

3. 3: Satisfactory

8.08 points

Required format is generally correct. Reference page is included and lists sources used in the paper. Sources are appropriately documented though some errors are present.

2. 2: Less Than Satisfactory

6.94 points

Required format elements are missing or incorrect. A lack of control with formatting is apparent. Reference page is present. However, in-text citations are inconsistently used.

1. 1: Unsatisfactory

0 points

Required format is rarely followed correctly. No reference page is included. No in-text citations are used.

Work

MORE OF THE BASICS AND BEYOND
More of the Basics and Beyond
Overview
Using the same business you started in the first assignment, Your Business Venture, you will continue to build a financial plan for the business.

Instructions
Write 4–5 pages in which you:

Prepare a pro forma balance sheet for the first 12 months of your business. Include the assumptions on which it is based. Justify your balance sheet.
Prepare a pro forma income statement for the first 12 months of your business. Include the assumptions on which it is based. Justify your income statement.
Prepare a pro forma cash budget for the first 12 months of your business. Include the assumptions that you have made when creating the budget. Justify your budget.
Scrutinize tangible and intangible costs of obtaining financial capital for your business start-up to determine whether the costs justify the implementation of the funding source.
Assume your business is five years old and running profitably and consider how you would grow your business over the next five years. Determine the specific details that would make the equity approach to valuing your business worthwhile. Provide a rationale with your response.
This course requires the use of Strayer Writing Standards. For assistance and information, please refer to the Strayer Writing Standards link in the left-hand menu of your course. Check with your professor for any additional instructions.The specific course learning outcome associated with this assignment is:

Assess whether the costs of obtaining capital for a business justify use of the funding source, and whether equity-based valuation of the business is appropriate.
The business venture is internet cafe.

    • 30

    work

    MAE 400 – FALL 2017

    Third Individual Writing – Industrial Design Paper

    • The student should analyze the trademark issues facing industrial
    design –BMW Mini-Cooper 4-door vs the Lifan 320

    – BMW Sells its Mini-Cooper 4-door in the US.
    – Assume that the Chinese auto manufacturer Lifan was selling its SUV in the US.
    – If BMW were claiming that Lifan infringes their trademark design in the US, would they

    win?
    • Apply US Trademark Law in the context of sales / consumers in the U.S.

    • Format
    – Exec Summary / Main Body / References / Figures where appropriate

    Slide 204

    MAE 400 – FALL 2017

    Where will it all end? Knockoff cars!?!?

    Slide 201

    MAE 400 – FALL 2017

    Slide 202

    MAE 400 – FALL 2017

    BMW “Mini Cooper” vs Lifan 320

    BMW “Mini Cooper”
    Lifan 320

    Slide 203

    MAE 400 – FALL 2017

    Third Individual Writing – Industrial Design Paper

    • Remember the legal test!
    – The plaintiff (the party seeking court assistance) must prove

    • 1. that it owns a valid trademark,
    • 2. that it has priority (its rights in the mark(s) are “senior” to the defendant’s), and
    • 3. that the defendant’s mark is likely to cause confusion in the minds of consumers about the

    source or sponsorship of the goods or services offered under the parties’ marks.
    • When a plaintiff owns a federal trademark registration on the Principal Register, there is a legal

    presumption of the validity and ownership of the mark as well as of the exclusive right to use the
    mark nationwide on or in connection with the goods or services listed in the registration.

    • These presumptions may be overturned in the court proceedings if the defendant makes a
    persuasive argument.

    • Your paper must address:
    – Issue and the Conclusion: Does BMW own a valid mark? Yes/No/Maybe
    – Does BMW have a registered Federal Trademark? (Hint: look at TM 78781927)
    – Does BMW have “priority” – Yes/No – explain who is the senior user? Who is the

    junior user?
    – Will Lifan cause confusion in the minds of consumers?

    • Work through the 8 factors in the Trademark test
    – Will BMW prevail?

    USE IRAC writing wherever possible to EXPLAIN your reasoning!
    Slide 205

    MAE 400 – FALL 2017

    Industrial Design Paper

    • This paper should continue to conform to the margin and
    executive summary of the first two papers

    • The paper should continue to use APA format for references

    • There should be at least 10 direct quotes in the paper. Facts
    and outside opinions MUST be referenced.
    – Stick to Legitimate Sources

    • Newspapers (ex. LATimes, Arizona Republic)
    • Respectable Magazines (ex. BusinessWeek)

    • The paper should be long enough to adequately cover the
    assignment, but concise enough to hold the reader’s
    attention.
    – Please keep it around 2,500 words.

    Slide 206

    MAE 400 – FALL 2017

    work

    C H A P T E R 1

    Clinical reasoning, evidence­based
    practice, and symptom analysis
    Basic health assessment involves the application of the practitioner’s knowledge and skills to identify and
    distinguish normal from abnormal findings. Basic assessment often moves from a general survey of a body
    system to specific observations or tests of function. Such an approach to assessment and clinical decision
    making uses a deductive process of reasoning. For example, a specialist examining a patient with known
    hyperthyroidism would conduct a physical examination to test for deep tendon reflexes. Brisk or hyperreflexic
    reflexes would lead the practitioner to conclude that a hyperthyroid state is a likely cause of these findings. This
    would greatly narrow the choices of diagnostic tests and treatment decisions.

    Advanced assessment builds on basic health assessment yet is performed more often using an inductive or
    inferential process, that is, moving from a specific physical finding or patient concern to a more general
    diagnosis or possible diagnoses based on history, physical findings, and the results of laboratory and diagnostic
    tests. The practitioner gathers further evidence and analyzes this evidence to arrive at a hypothesis that will lead
    to a further narrowing of possibilities. This is known as the process of diagnostic reasoning.

    Diagnostic reasoning
    Diagnostic reasoning is a scientific process in which the practitioner suspects the cause of a patient’s symptoms
    and signs based on previous knowledge. The practitioner gathers relevant information, selects necessary tests,
    makes an accurate diagnosis, and recommends therapy. The difference between an average and an excellent
    practitioner is the speed and focus used to arrive at the correct conclusion and initiate the best course of
    evidence­based treatment with minimum harm, cost, inconvenience, and delay. This expertise of the
    practitioner is acquired through knowledge and a skill set developed through experience in clinical practice.
    Repeated practice with real cases helps to develop memory schemes for relating clinical problems and store
    them in long­term memory.

    By using diagnostic reasoning, the practitioner is able to accomplish the following:

    • Determines and focuses on what needs to be asked, what data need to be obtained, and what needs to
    be examined

    • Performs examinations and diagnostic tests accurately
    • Clusters all pertinent findings
    • Analyzes and interprets the findings
    • Develops a list of likely or differential diagnoses

    The diagnostic process

    The primary care context
    The process of assessment in the primary care setting begins with the patient or caregiver stating a reason for
    the visit or a chief concern. Most visits to primary care providers involve concerns or symptoms presented by
    the patient, such as an earache, vomiting, or fatigue. The initial evidence is collected through a patient history.
    Demographic information, such as gender, age, occupation, and place of residence, is obtained to place the
    patient in a risk category that may rule out certain diagnoses immediately. In most primary care settings,
    routine vital signs are obtained, which can include height and weight, temperature, pulse, respiratory rate,

    http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0001-print-1559848704.xhtml 6/6/2019

    blood pressure, last menstrual period, and smoking status. While obtaining the history, the practitioner also
    makes observations of the patient’s appearance, interaction with family members, orientation, and mental and
    physical condition. The practitioner notes any unusual presentations that could help focus the assessment
    process.

    Symptom analysis
    Presenting symptoms need to be explored with further questions. One useful mnemonic for gathering this
    information is COLDSPA.

    Character: How does it feel, look, smell, sound?
    Onset: When did it start?
    Location: Be specific. Where is it? Does it radiate?
    Duration: How long does it last? Does it recur?
    Severity: How do you rate your pain on a scale from 0 (no pain) to 10 (worst pain I’ve ever had)?
    Pattern: What makes it better? What makes it worse? What have you done and did it help?
    Associated factors: What other symptoms do you have? How much does it interfere with your usual

    activities?

    Another mnemonic is OLDCARTS: onset, location, duration, character, aggravating or associated factors,
    relieving factors, temporal factors, and severity.

    Information can also be gleaned from the review of systems. A final step is to ask about the patient’s or
    caregiver’s perception of the meaning of the symptom(s). The practitioner then clusters the information into
    logical groups based on prior knowledge of symptom clusters associated with specific diagnoses or body
    systems. At the conclusion, the history of the presenting concerns should give the practitioner a good idea of the
    most likely differential diagnoses. These hypotheses may be further strengthened during the physical
    examination.

    Performing a physical examination
    This section may be performed as a complete physical examination or as a focused or localized examination that
    emphasizes the body or organ systems most likely affected by the patient’s presenting symptoms.

    Formulating and testing a hypothesis
    The practitioner then formulates a hypothesis based on expertise and knowledge of possible pathological,
    physiological, or psychological processes. Further interpretation of evidence refines the hypothesis to a working
    or probable diagnosis. Hypothesis generation begins during the assessment of the patient’s age, gender, race,
    appearance, and presenting problem. Age is often the most significant variable in narrowing the probabilities of
    a problem. Hypothesis generation forms the context in which further data are collected. This context includes
    the setting in which care is delivered, such as in a hospital, in an outpatient setting, or in another community­
    based setting where more than a single individual could be affected. Clinical decision making can be filled with
    uncertainty and ambiguity. Because available evidence is almost never complete, hypothesis formation involves
    some element of subjective judgment.

    The hypothesis must then be tested and assessed for the following characteristics.

    • Coherence: Are the physiological links, predisposing factors, and complications for this disease present
    in the patient?

    • Adequacy: Does the suspected disease encompass all of the patient’s normal and abnormal findings?
    • Parsimony: Is it the simplest explanation of the patient’s findings? The surest way to make this

    determination is to ask the patient or the caregiver the reason for seeking care and the current
    understanding of the problem and possible treatment options. This is a crucial step because patients
    must find the treatment recommendation acceptable.

    • Diagnostic probability: Is the diagnosis confirmed by radiographic or laboratory tests? A rational
    diagnostic hypothesis is one that, if confirmed by the select tests, limits the need for additional
    confirmation.

    http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0001-print-1559848704.xhtml 6/6/2019

    • Eliminate a competing hypothesis: What other diseases could explain the patient’s symptoms?

    To confirm the hypothesis, the practitioner establishes a “most likely” diagnosis as a basis for a treatment
    plan and evaluates the outcome. The goal of a clinical decision is to

    http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0001-print-1559848704.xhtml 6/6/2019

    choose an action that is most likely to result in the health outcomes the patient desires. This step of the
    decision­making process involves personal preference as to whether the benefits outweigh the harms involved,
    whether the cost is reasonable, and whether the most desired outcomes are short or long term.

    Practitioners make extensive use of heuristics, or rules of thumb, to guide the inductive or inferential process
    of diagnostic reasoning. Heuristics are generally accurate and useful rules to make the task of information
    gathering more manageable and efficient—rules such as familiarity, salience, and resemblance to a patient who
    has a known disease. On occasion, however, heuristics can be faulty, particularly if the presentation is atypical
    or the condition is rare. The practitioner must always be open to a low probability of a serious diagnosis.
    Heuristics can have negative effects when stereotypes or biases influence judgment. For example, assuming that
    a patient is heterosexual can lead to errors in clinical reasoning and differential diagnosis when evaluating the
    symptom of rectal pain.

    Expert versus novice practitioners
    Students of advanced assessment have a variety of backgrounds, with many coming from specialized areas of
    clinical practice. Such students could have difficulty broadening the scope of their observations and clinical
    possibilities. In any case, nonexperts tend to be nonselective in data gathering and in the clinical reasoning
    strategies they use. Experts, however, are able to focus on a problem, recognize patterns, and gather only
    relevant data, with a high probability of a correct diagnosis. The goal for a novice practitioner is to aim for
    competence and expertise.

    A competent practitioner will execute the following steps:

    1. Identify the most important cues. These cues are obtained largely through thorough symptom analysis
    (e.g., COLSDPA or OLDCARTS), functional assessment, and history to assess the patient’s beliefs and
    understanding or explanatory model of the illness. Research evidence shows that a person’s beliefs or
    explanatory models of an illness or a symptom include a cause, an opinion about the timeline (acute
    or chronic), consequences of the condition (minor or life threatening), and some type of verbal label
    used to identify the cluster of symptoms or sensations (e.g., “the flu,” “the blues”). Practitioners need
    to distinguish between the presence of disease, which has a biological basis, and illness, which is the
    human experience of being sick that could have little correlation with the objective evidence available.

    2. Understand and perform advanced examination techniques. These techniques can include special
    maneuvers and closer observation of fine details during the physical examination, more in­depth
    interviews using valid and reliable instruments to assess the patient’s risk for a specific diagnosis, and
    “gold standard” diagnostic tests for the identification of a specific disorder.

    3. Test differential or competing diagnoses. A differential diagnosis results from a synthesis of subjective and
    objective findings, including laboratory and diagnostic tests, with knowledge of known and
    recognized patterns of signs and symptoms. When using the “rule­out” strategy, the practitioner
    looks for the absence of findings that are frequently seen with a specific condition; the absence of a
    sensitive finding is strong evidence against the condition being present. When using the “rule­in”
    strategy, the practitioner looks for the presence of a finding with high specificity (low false­positive
    and high true­negative values); the presence of this finding is strong evidence that the condition is
    present.

    4. See a pattern in the information gathered. A pattern or cluster of findings can emerge from the subjective
    and objective data. This pattern could be evident during one patient encounter, or it could depend on
    a pattern of signs and symptoms that develops over time. Often an expert practitioner can eliminate
    competing diagnoses only after the initial treatment prescribed is ineffective or after the symptoms
    either disappear sooner than expected or persist longer than expected.

    Developing clinical reasoning
    Clinical reasoning is a situational, practice­based form of reasoning that acknowledges the many variables that
    are present in an actual clinical situation, such as environmental and social factors involving the patient, family,
    community, and a team of health care providers. Clinical reasoning involves developing a brief summary in
    which patient­specific details are translated into appropriate diagnostic terminology. This process requires a

    http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0001-print-1559848755.xhtml 6/6/2019

    background of scientific and evidence­based knowledge about general cases and a practical ability to evaluate
    the relevance of the evidence behind general scientific and technical knowledge and how it applies to a
    particular patient. In doing so, the clinician considers the patient’s particular clinical trajectory; her or his
    concerns, values and preferences; and her or his particular vulnerabilities (e.g., having multiple comorbidities)
    and sensitivities to care interventions (e.g., known drug allergies and past responses to therapies) when
    formulating clinical decisions or conclusions.

    Negotiating goals and expectations of a patient encounter
    It is important, especially in an ambulatory care setting, to identify the patient’s goals, expectations, and
    resources to determine what needs to be achieved during an encounter. A patient who seeks care because of a
    bothersome symptom could be more interested in having the symptom relieved by a particular date than in
    knowing the cause or diagnostic explanation for the symptom. Other patients might want reassurance that a
    symptom or sign is not a serious condition and yet do not expect treatment to alleviate the sensations they are
    experiencing. An explicit discussion between the practitioner and patient is necessary to establish what the
    goals and focus of an encounter will be. Goals can be mutually negotiated to assure clinicians that serious
    conditions can be “ruled out” and to assure patients that their needs and desires are acknowledged.

    Evidence-based practice
    Evidence­based practice (EBP) is the integration of clinical expertise with the most current, relevant, and sound
    research evidence to guide clinical practice decisions. Using evidence­based guidelines in practice, informed
    through research evidence, improves patient outcomes. EBP integrates the best research evidence with clinical
    expertise and the patient’s values and preferences and involves the use of simple rules of logic to apply
    evidence from research to an individual patient. Some of these rules include evaluating the validity, reliability,
    and generalizability of the evidence. The levels of evidence range from the “gold standard” of the randomized
    clinical trial to case studies, correlational studies, and expert opinion. Practitioners and patients increasingly
    gather evidence from web­based sources, such as the Cochrane Library, which includes databases of systematic
    reviews of a clinical topic, abstracts of reviews of effectiveness, a controlled trial registry, and review
    methodology. These databases have gathered the “best evidence” related to clinical problems (Evidence­Based
    Practice box). Access to web­based data requires that the practitioner develop skills in health informatics—the
    application of computer technology to health care delivery—to develop skills in searching for and appraising
    evidence in the literature to guide care for a specific patient in a specific clinical context.

    Evidence-based practice boxes
    A feature of the fifth edition of this text is to include Evidence­Based Practice boxes in each chapter. The studies
    cited represent evidence from epidemiologic studies, meta­analyses, systematic reviews, and randomized
    clinical trials that informs and guides primary care practitioners in delivering clinical services.

    Summary
    In the context of primary care practice, the orientation to the patient should be holistic and general and toward
    the most prevalent or common conditions in a particular population group. This orientation requires that the
    expert practitioner develop skills in inductive

    http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0001-print-1559848755.xhtml 6/6/2019

    • 1-2
    • 3-4

    work

    Escalating Health Care Cost due to Unnecessary Diagnostic Testing
    MUHAMMAD AZAM ISHAQUE CHAUDHARY*, AND ASIM NISAR**

    RECEIVED ON 12.05.2016 ACCEPTED ON 16.08.2016

    ABSTRACT

    Focusing on health care systems can improve health outcomes now and in the future. Growing economies

    have serious concerns on the rising cost of health, whereas, in under developed countries like Pakistan,

    it is not emphasized yet at all. The research is conducted to improve a unique aspect of health care

    systems to provide effective, patient-centred, high-standard health care while maintaining the cost

    effectiveness. Research is being qualified in two paradigms qualitative and quantitative. In qualitative

    research, expert’s interviews have been taken to get the basic knowledge of radiology based testing and

    their prerequisites, in quantitative research ordered are being analysed to check the frequency and if

    they are unnecessary or qualified medical necessity guidelines as established in qualitative method.

    Analysis was made on the basis of the trinity relationship of diagnosis, symptoms and respected order to

    determine the necessity of the order to get its impact on cost of the overall health of those patients and

    point out more than 50% unnecessary orders are being performed in two government hospitals. The

    situation is alarming and policy makers should focus on unnecessary ordering to avoid out of pocket

    expenses and improve quality of care. The research helps in successful application of health care system

    modifications and policies pertaining to one aspect of health systems, i.e. cost-effectiveness of health

    care.

    Key Words: Cost-Effective, Health System, Radiology Orders.

    * Department of Engineering Management, Center for Advanced Studies in Engineering, Islamabad.
    * * Asian Institute of Technology, Thailand.

    Mehran University Research Journal of Engineering & Technology, Volume 36, No. 3, July, 2017 [p-ISSN: 0254-7821, e-ISSN: 2413-7219]
    5 6 9

    1. INTRODUCTION

    what resources are required. Health systems and health

    systems research leads to the creation of scaffold that

    must satisfy the demands and needs of its constantly

    dynamic building blocks. Health care is a management,

    treatment and prevention of disease or illness; it also

    refers to the physical well being through health service

    providers and hospitals. How are you? It is that simple

    question which is being asked by every two humans

    when they meet. This simply relates the concern of one

    to another about knowing his/her current physical,

    H
    uman minds have a limited ability to grasp

    and process multiple pieces of information

    simultaneously, but they desire to produce

    more to reap more benefits. A high level of productivity

    requires dropping the quantity/extent of information to

    be analyzed every time to only the most necessary and

    vital data. Developing a regular routine work in advance

    leads to the creation of frameworks, and sticking to it

    consistently wipes away the difficulty of thinking about

    what needs to be done, its sequence, and when and

    Mehran University Research Journal of Engineering & Technology, Volume 36, No. 3, July, 2017 [p-ISSN: 0254-7821, e-ISSN: 2413-7219]
    5 7 0

    Escalating Health Care Cost due to Unnecessary Diagnostic Testing

    mental, financial and social status. We are concerned

    here about the physical and mental health of human

    beings that is one of the top concerns of humanity.

    Nowadays quality of care has become too expensive

    [1]. Not everyone can easily afford it. Health care

    expenditures are growing around the world in an alarming

    rate. The United States spends 17% of their GDP (Gross

    Domestic Product). They are forecasted to reach 20.3%

    of their GDP which equals to $4.4 Trillion dollars [2].

    OECD (Organization for Economic Cooperation and

    Development) countries average spending more than

    7% of their GDP [3]. Such an alarming rise creates many

    risks for the sustainability of the future of health of the

    world. Now the question is where the health care cost

    goes? There are various ways to see health expenditures,

    although it is clear that cost may be increasing due to

    increasing cost of drugs and medicine, increasing rate

    of emergency to inpatient ratio, and excessive laboratory

    testing’s [4]. Due to technological advancement doctors

    start relying on technology to diagnose problem and

    that increases the cost. Our focus is to highlight

    expensive laboratory testing in Pakistan and see if these

    are being ordered right with proper diagnosis along with

    chief complaint or if it is just a wastage of money and

    resources. Such research has never been conducted in

    Pakistan before that may help policymakers to establish

    certain policies pertaining to health systems to improve

    overall health of individuals along with decreased cost

    of care.

    2. LITERATURE REVIEW

    Pakistan is currently 6th most populous country with a

    population of more than 191 million people and an annual

    growth rate of 4% per annum. No satisfactory attention was

    given till the 1970’s. Afterthat a 5 year plan was introduced

    to take care of infrastructural growth, but it was still limited

    to the government employees and the total spending was

    only 1% of the GDP. The rest was an out of pocket expense

    [5]. According to WHO (World Health Organization), they

    defined Health as a state of absence of any disease and a

    complete wellbeing “physically and mentally” [6]. Health

    system is defined in several ways. “WHO’s defines “Health

    Systems” as “All activities with the primary objective to

    promote reinstate or maintain health”. All such activities are

    usually grouped into six classes that include service delivery

    as well as, the health workforce, including health information

    system related Medical products, vaccines and technologies,

    health system financing and governance with right kind of

    leadership [7]. The another way of defining Health systems

    is based on the actors contributing to the system. Van

    Atteveld et. al. [8] reviewed 144 studies on health care and

    global health research. They concluded that most of the

    studies lacked analytical models mostly descriptive,

    economic approach dominated, and there were no

    comparison among different systems.

    Alliance for health policy and system research studied and

    listed 41 health system frameworks developed till now [6]

    few have been developed for better knowledge, comparisons

    among different frameworks their performance [9].

    Researchers believe that nowadays medicine has prompted

    communication among each other and different nations

    readily borrow ideas from another country’s experiences.

    According to their own cultural setting they alter and modify

    ideas. But due to procedural variations among them and

    different structures of individual nations, developing an

    appropriate analytic framework that is good for everyone is

    yet to be done. There is no particular system or framework

    that covers all aspects of healthcare. The background of

    each healthcare system has its own dependence on several

    actors and environment which fails to create a basis for all

    [10]. Common health fund recently published a study by

    comparing 18 different health systems around the world but

    are still unable to provide any specific system that fits for all

    [11]. In a recent comparison of health care systems around

    the world, it was evident that caring needs are touching high

    Escalating Health Care Cost due to Unnecessary Diagnostic Testing

    Mehran University Research Journal of Engineering & Technology, Volume 36, No. 3, July, 2017 [p-ISSN: 0254-7821, e-ISSN: 2413-7219]
    5 7 1

    expectations and viz a viz cost containment is also required

    including laboratory services for a sustainable growth in

    health care services [12].

    The question frequently raised in health policy debates is,

    “Will health systems be financially sustainable in future?” It

    is usually termed as the ability of the governments and others

    to sufficiently finance health care in the face of growing cost

    pressures, with the following three most commonly cited

    challenges named as population ageing, innovation or new

    technologies and quality of care which is consumer

    expectations around the world. Although the idea of

    ‘financial sustainability’ comes into view to be vital to health

    policy debates, but still it has not been part of most health

    system objectives, including those of the WHO’s health

    system performance framework” [6].

    The problem of financial sustainability can be broadly

    characterized in the following three ways which includes

    increased health expenditure due to demand and supply of

    health services, technological progress, demographic

    changes and consumer expectations. Some believe limited

    resources or an inability of government or unwillingness

    to generate sufficient resources to meet its health system

    obligations which might be due to financial crisis [13].

    Substantial research has been done by different institutes

    and researchers on why health care costs are raising across

    the globe. The factors that get most attention are connected

    with the increasing volume of services used. These include

    the following parameters coupled with rising income and

    expectations are technology advancement, population

    ageing and changing utilization patterns. Although it

    depends upon country as per their clinical setting,

    operating methods, and specific case evaluated, studies

    have evidently reported that up to 40% of lab testing can

    be considered as wasteful [14-17].

    It is evident from the analysis and projections that the

    population ageing contributes comparatively less to rising

    health care costs in comparison to technological

    modernization (10% less of the growth in health care costs)

    [18-20]. Health care expenditures are rising in at alarming

    rate. Advancement in technology is one of the key factors in

    raising heath care cost which is laboratory orders [21]. From

    2005-2010 it is evident that laboratory testing cost increased

    by 29% of the total health care cost in United States [22]. Fig.

    1 shows Health expenditures as a share of GDP of OECD

    countries.

    FIG. 1. HEALTH EXPENDITURE AS A SHARE OF GDP OECD COUNTRIES 2015 [23]

    Mehran University Research Journal of Engineering & Technology, Volume 36, No. 3, July, 2017 [p-ISSN: 0254-7821, e-ISSN: 2413-7219]
    5 7 2

    Escalating Health Care Cost due to Unnecessary Diagnostic Testing

    Getting quality of care is the right of every human in this

    world but nowadays cost of health care is becoming a raising

    issue as quality of care is directly proportional to the cost of

    health care. This relationship forced policy makers, and

    researchers to devise a strategy of lowering the costs. Now

    some suggest to see health care professionals other than

    doctors, and put emphasis on telemedicine, and believe that

    a cure is better than care [24].

    Because of rising healthcare costs, USA took few steps to

    control the rising cost of healthcare. Successful efforts were

    made for the mandatory use of electronic health records,

    along with introducing physicians quality reporting system,

    and creating medical necessity policies as to check and

    perform an analysis whether the service is planned to deliver

    medically required/ necessary for the patient or it is not

    required. Emanuel elaborates that simply by reducing

    avoidable health complications, there could be more than

    10% of saving per year [25].

    3. RESEARCH GAP

    Currently top spending nations are following utilization

    pattern to regulate care needs and see whether the service is

    required or not. This concluded to be creating local coverage

    policies, but it happens when some specific area or people

    start providing that kind of services. There is a requirement

    to check and analyze the patterns on laboratory orders and

    specifically high cost orders that are made to contain cost in

    health care. This research specifically focuses on Pakistan

    to check if unnecessary tests have been ordered as compare

    to the rest of the world and devise a strategy to stop

    unnecessary testing and create check and balance to reduce

    wastage of money and resources.

    4. RESEARCH METHODOLOGY
    AND DATA ANALYSIS

    Research is being qualified in two paradigms qualitative and

    quantitative. In qualitative research, expert’s interviews have

    been taken to get the basic knowledge of radiology based

    testing and their prerequisites. Question were being asked

    with respect to the specialty and create a basic understanding

    of why imaging orders have been placed and study all those

    procedures in which medical decision making are involved.

    Research methodology of the paper is be described as

    shown in Fig. 2.

    FIG. 2. RESEARCH METHODOLOGY FLOW DIAGRAM

    Escalating Health Care Cost due to Unnecessary Diagnostic Testing

    Mehran University Research Journal of Engineering & Technology, Volume 36, No. 3, July, 2017 [p-ISSN: 0254-7821, e-ISSN: 2413-7219]
    5 7 3

    We initiated the research with a simple question that whether

    in Pakistan the radiology orderings are based on medical

    necessity or not? In order to get the answer of the question

    the research methodology selected was qualitative and

    quantitative. The qualitative research was conducted

    through interviewing physicians about the radiology

    orderings and its basics that can be seen from Fig. 3. The

    quantitative research helped us to compile relevant and

    specific data and analyze it for findings that can be seen

    from Fig. 4.

    On the basis of qualitative research, quantitative research

    was carried out in which retrospective data of radiology

    investigation was collected for six months from two reputed

    government hospitals of Islamabad and Rawalpindi.

    Methodology used to understand and investigate the domain

    and problem respectively is shown in Fig. 3.

    Light blue ordering techniques were selected as primary

    source of investigation because of the fact that these are

    most ordered procedures are costly as well.

    After qualitative research data collection was carried out to

    investigate whether unnecessary tests was being ordered

    or not. This methodology is described as shown in Fig. 4.

    The underlined research methodology helped us to gather

    data pertaining to the distinct radiology orders. Total number

    of orders which had considerable information documented

    were 2395.All the imaging studies were being ordered by

    different physicians including x-ray, ultrasound, MRI

    (Magnetic Resonance Imaging) and CT (Computed

    Tomography) scan and other laboratory orders but only

    MRI and CT scan were included in this study. These radiology

    orders were charted on the basis of cost as these were the

    FIG. 3. QUALITATIVE METHOD FLOW DIAGRAM

    Mehran University Research Journal of Engineering & Technology, Volume 36, No. 3, July, 2017 [p-ISSN: 0254-7821, e-ISSN: 2413-7219]
    5 7 4

    Escalating Health Care Cost due to Unnecessary Diagnostic Testing

    most expensive laboratory diagnostic orders. First total

    number of MRI and CT scan were identified other than

    emergency patients. Only inpatient and outpatient facility

    were taken in this study. The reasons of prescribing MRI/

    CT scan were identified. Analysis was made and following

    were the results. Table 1 shows total MRI/ CT scan stats.

    Data shows that CT scans were ordered more on female

    whereas more MRI ordered on males. Total 166 MRI/CT

    Scan orders were analyzed. These are all being ordered

    in outpatient and inpatient facility. None of the order

    were based on monitoring was analyzed. Then analysis

    were made on the basis of symptomology in each gender

    as shown in Table 2 to identify reason of unnecessary

    orders.

    Table 2 shows diagnosis/complaints on which various

    orders have been made, but out of 166 orders data,

    showed that 99 orders were placed due to user defined

    complaints without prior physician’s clinical evaluation

    to justify the test requirement and medical necessity.

    Although very less document evident exists, at the

    time of order reason were not clearly written or

    identified. Rest 67 orders have rational of being

    prescribed.

    5. RESULTS

    Most of conclusion/findings of the study showed normal

    study which creates an alarming situation and proof the

    concept of unnecessary orders have been performed in

    Pakistan as well. As stated above, researchers believe

    40% of laboratory testing is unnecessary but in case of

    Pakistan data shows more than 50% of testing is

    unnecessary. As shown in Fig. 5, data showed that out of

    166 studies, 77 studies findings were normal and 17

    findings were unknown because of some technical issue

    or tests not performed well. According to experts these

    77 studies which ere found normal can be further reduced

    by careful clinical examination.

    As shown in Fig. 6 maximum number of orders have

    been made on user defined complaints. During interviews

    most doctors said that when pateints vist them in service

    doctor most of them answered as patient visit us in

    severe painan order of MRI and or CT scan was most

    commonly ordered.

    redneG nacSTC IRM latoT

    elameF 85 62 48

    elaM 24 04 28

    latoTdnarG 001 66 661

    TABLE 1. MRI/CT SCAN ORDERED STUDIED

    FIG. 4. QUANTITATIVE METHOD FLOW DIAGRAM

    Escalating Health Care Cost due to Unnecessary Diagnostic Testing

    Mehran University Research Journal of Engineering & Technology, Volume 36, No. 3, July, 2017 [p-ISSN: 0254-7821, e-ISSN: 2413-7219]
    5 7 5

    From Figs. 5-6 results shows that more than 50% of the

    diagnostic orders made were unnecessary (combining the

    normal findings and unknown findings together), this all

    adds extra burden to financial cost. Country like Pakistan

    if we analyze last seven years i.e. (since 2007-2008 Rs. 60

    billion to 2013-2014 Rs. 102 billion) have been allocated

    for the health sector, which is merely equal to 1% of their

    GDP. Recently Government of Pakistan has also allocated

    Rs. 2/- Billion under Prime Minister National Health

    Program to become a welfare state without having any

    policies in place and check and monitoring of quality of

    care. By analyzing above findings there is a need of expert

    system be designed to formulate policies to stop

    unnecessary testing and save cost. Orders should be

    prescribed as per medical necessity guidelines and if

    proper documentation and history of the patient

    formulates the basis of order then test should be

    performed, otherwise it should be referred to the review

    process. This way unnecessary radiation exposure can

    be reduce and out of pocket expenses can also be

    minimized.

    6. RESEARCH LIMITATIONS

    Medical necessity applies to all aspects of practicing

    medicine but the scope of this research limits its boundaries

    by focusing only on medical necessity of imaging orders.

    redneG smotpmyS TC IRM latoT

    elameF

    ehcakcaB 02 1 12

    noisivdehsinimiD 1 1

    ssenizziD 2 1 3

    ehcadaeH 2 1 3

    niaptnioJ 7 1 8

    aerArabmuLniniaP 2 2

    hsaR 1 1

    htaerBfossentrohS 1 1

    smelborPyranirU 2 2

    tnialpmoCdenifeDresU 12 02 14

    denoitneMtoN 1 1

    latoTelameF 85 62 48

    elaM

    ehcakcaB 70 80 51

    noitapitsnoC 1 1

    hguoC 0 0

    ssenizziD 2 2

    dnaHnIniaP 1 1

    amuarT 1 1

    tnialpmoCdenifeDresU 13 72 85

    ssenkaeW 1 1

    denoitneMtoN 3 3

    latoTelaM 24 04 28

    TABLE 2. MRI/CT SCAN ORDER DIAGNOSIS DETAILS

    Mehran University Research Journal of Engineering & Technology, Volume 36, No. 3, July, 2017 [p-ISSN: 0254-7821, e-ISSN: 2413-7219]
    5 7 6

    Escalating Health Care Cost due to Unnecessary Diagnostic Testing

    FIG. 5. MRI/ CT SCAN RESULTS FINDINGS

    FIG. 6. SYMPTOMOLOGY GRAPH W.R.T MRI AND CT SCAN
    ORDERS

    7. CONCLUSIONS

    The rapid growth in the medical sciences has kept things

    difficult for the human beings to cope up with the changing

    domain knowledge. From very basic of surgery to basic

    body checkup, medical practices have taken a new turn.

    The core reason is the ongoing research throughout the

    world that is adding valuable information about human

    body. With the changing medical practices, it is imperative

    that the associated procedures must also evolve. There

    are various phases of evolution that have taken place in

    medical practices, however, the need of a standardized

    medical practice has still remained a key challenge. In

    earlier days, physicians generally relied on the physical

    check up to determine the root cause of any disease.

    With the advancement in technology and availability of

    modern day equipment, the reliance has generally reduced

    on physical checkups. Rather all the physicians generally

    rely on medical tests for determining the root cause of a

    disease. This research opens a new era of cost

    containment in health care industry. Policy makers and

    healthcare financial analysts will get benefited from it to

    lower down the cost of providing care by developing

    knowledge base decision support system. Health care

    insurances will also get benefited from the research to

    evaluate the healthcare claims. This is one of the biggest

    reason that no insurances are covering health care

    benefits as without check and balance, anyone can order

    any kind of expensive or inexpensive testing without

    documenting a proper diagnosis. More than 50% of orders

    that have been made will be an eye opening situation for

    the policy holders. Any test that have been ordered must

    comply medical necessity guidelines, and be placed after

    clinical examination which will reduce unnecessary

    exposure to the radiations and healthcare cost. Experts

    have the opinion that a clinical perspective of medical

    necessity is very rare, it merely goes with the

    organizational culture desire and most often influenced

    by the physicians and lied in the health care compliance

    context. It is very important here to understand that if a

    service rendered to a patient that is not medically

    demanded, it can save money if some framework or

    policies have been implemented to monitor the care

    delivery process. Cost effectiveness of the health care

    system needs to be prioritized throughout the world,

    especially in developing countries like Pakistan, where

    more than 50% of people are below the poverty line.

    Escalating Health Care Cost due to Unnecessary Diagnostic Testing

    Mehran University Research Journal of Engineering & Technology, Volume 36, No. 3, July, 2017 [p-ISSN: 0254-7821, e-ISSN: 2413-7219]
    5 7 7

    Morbidity and mortality rate can be reduced by

    emphasizing on treatment rather than unnecessary

    investigation.

    8. FUTURE RESEARCH

    Future research can be carried out on unnecessary

    prescription and other laboratory orders to improve health

    care in Pakistan and decrease cost of care. Such research

    analysis forms the basis for policy makers to design effective

    policies for better health care.

    ACKNOWLEDGEMENTS

    Authors are highly thankful to Higher Education

    Commission of Pakistan, for the provision of scholarship

    for higher education and research. Authors are grateful

    to anonymous reviewers, for reviewing the paper along

    with editorial board and providing valuable feedback.

    Authors also acknowledge the hospitals and doctors who

    shared clinical data and played a key role to successfully

    complete this research.

    REFERENCES

    [1] Blomqvist, A.G., and Carter, R.A.L., “Is Health Care

    Really a Luxury?”, Journal of Health Economics,

    Volume 16, No. 2, pp. 207–229, April, 1997.

    [2] Sisko, A., Truffer, C., Smith, S., Keehan, S., Cylus, J.,

    and Poisal, J.A., “Health Spending Projections Through

    2018: Recession Effects add Uncertainty to the

    Outlook”, Health Affairs, Volume 28, No. 2,

    pp. 346-357, March, 2009.

    [3] Vandersteegen, T., Marneffe, W., Cleemput, I., and

    Vereeck, L., “The Impact of No-Fault Compensation

    on Health Care Expenditures: An Empirical Study of

    OECD Countries”, Health Policy, Volume 119, No. 3,

    pp. 367–374, March, 2015.

    [4] Muennig, P., and Mark, B., “Cost-Effectiveness Analysis

    in Health: A Practical Approach”, John Wiley & Sons,

    2016.

    [5] Mashhadi, S.F., Hamid, S., Roshan, R., and Fawad, A.,

    “Healthcare in Pakistan–A Systems Perspective”,

    Pakistan Armed Forces Medical Journal, Volume 66,

    No. 1, pp. 136–142, 2016.

    [6] WHO, “The World Health Report 2000: Health Systems:

    Improving Performance”, World Health Organization,

    2000.

    [7] WHO, “The Tallinn Charter: Health Systems for Health

    and Wealth”, WHO, Regional Office for Europe, 2008.

    [8] Van Atteveld, L., Broeders, C., and Lapre, R.,

    “International Comparative Research in Health Care: A

    Study of the Literature”, Volume 8, No. 1, pp. 105-136,

    August, 1987.

    [9] Hoffman, S.J., Rottingen, J.A., Bennett, S., Lavis, J.,

    Edge, J., and Frenk, J., “A Review of Conceptual Barriers

    and Opportunities Facing Health Systems Research to

    Inform a Strategy from the World Health Organization”,

    WHO, 2012.

    [10] Mechanic, D., and Rochefort, D.A., “Comparative

    Medical Systems”, Annual Review of Sociology,

    Volume 22, No. 1, pp. 239–270, 1996.

    [11] Elias, M., Wenzl, M., Osborn, R., and Sarnak, D., “2015

    International Profiles of Health Care Systems”,

    The Commonwealth Fund, 2016.

    [12] Lawall, K., “A Comparison of Health Care Systems in

    the Western World”, Theses and Dissertations, May,

    2016.

    [13] Ulf-G, G., and Jonsson, B., “International Comparisons

    of Health Expenditure: Theory, Data and Econometric

    Analysis”, Volume 1, Part A-B, Handbook of Health

    Economics, Ed. Elsevier, pp. 11–53, 2000.

    [14] Baird, G., “The Laboratory Test Utilization Management

    Toolbox”, Biochemia Medica, Volume 24, No. 2,

    pp. 223-234, 2014.

    [15] Bates M.D., David, W., Boyle, D.L., Rittenberg, M.A.E.,

    Kuperman, M.D.P., Gilad, J., Ma’Luf, N., and Menkin

    B.A.V., “What Proportion of Common Diagnostic Tests

    Appear Redundant?”, The American Journal of Medicine,

    Volume 104, No. 4, pp. 361-368, April, 1998.

    Mehran University Research Journal of Engineering & Technology, Volume 36, No. 3, July, 2017 [p-ISSN: 0254-7821, e-ISSN: 2413-7219]
    5 7 8

    Escalating Health Care Cost due to Unnecessary Diagnostic Testing

    [16] Huck, A., and Lewandrowski, K., “Utilization

    Management in the Clinical Laboratory: An Introduction

    and Overview of the Literature”, Clinica Chimica Acta,

    Volume 427, pp. 111-117, January, 2014.

    [17] McConnell, T.S., Berger, P.R., Dayton, H.H., Umland,

    B.E., and Skipper, B.E., “Professional Review of

    Laboratory Utilization”, Human Pathology, Volume 13,

    No. 4, pp. 399–403, April, 1982.

    [18] Cutler, D.M., and McClellan, M., “Is Technological

    Change in Medicine Worth It?”, Health Affairs,

    Volume 20, No. 5, pp. 11-29, September, 2001.

    [19] Dormont, B., Grignon, M., and Huber, H., “Health

    Expenditure Growth: Reassessing the Threat of Ageing”,

    Health Economics, Volume 15, No. 9, pp. 947-963,

    2006.

    [20] Seshamani, M., and Gray, A., “Time to Death and Health

    Expenditure: An Improved Model for the Impact of

    Demographic Change on Health Care Costs”, Age and

    Ageing, Volume 33, No. 6, pp. 556-561, 2004.

    [21] Kim, J.Y., Dzik, W.H., Dighe, A.S., and Lewandrowski,

    K.B., “Utilization Management in a Large Urban

    Academic Medical Center”, American Journal of Clinical

    Pathology, Volume 135, No. 1, pp. 108-118,

    January, 2011.

    [22] “Questionable Billing for Medicare Part-B Clinical

    Laboratory Services Report (OEI-03-11-00730) 07-08-

    2014” [Online]. Available: http://oig.hhs.gov/oei/reports/

    oei-03-11-00730.asp. (Last Assessed on Mar 03, 2016).

    [23] OECD, “Focus on Health Spending’s OECD Health

    Statistics 2015″, Organization for Economic Cooperation

    and Development, 2015.

    [24] Mason, J., Freemantle, N., Nazareth, I., Eccles, M.,

    Haines, A., and Drummond, M., “When Is It Cost-

    Effective to Change the Behavior of Health

    Professionals?”, Journal of the American Medical

    Association, Volume 286, No. 23, pp. 2988-2992,

    December, 2001.

    [25] Emanuel, E.J., “Where are the Health Care Cost

    Savings?”, Journal of the American Medical Association,

    Volume 307, No. 1, pp. 39-40, January, 2012.

    work

    CASE STUDY:
    5-year-old Asian girl of normal weight with obese parents who is home schooled.

    Assessment Tools, Diagnostics, Growth, Measurement, and Nutrition in Adults and Children

    Students will:

    Evaluate validity and reliability of assessment tools and diagnostic tests

    Analyze diversity considerations in health assessments

    Apply concepts, theories, and principles related to examination techniques, functional assessments, and cultural and diversity awareness in health assessment

    Apply assessment skills to collect patient health histories

    The Assignment One


    Assignment (3–4 pages, not including title and reference pages):


    Include the following:

    Provide an explanation of the health issues and risks that are relevant to the child you selected. Describe additional information you would need in order to further assess his or her weight-related health. Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information. Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight.

    Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.

    An explanation of the health issues and risks that are relevant to the child you were assigned.

    Describe additional information you would need in order to further assess his or her weight-related health.

    Identify and describe any risks and consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.

    Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information.

    Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight.

    work

    Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

    As an advanced practice nurse, you will likely encounter patients who will present with symptoms affecting the gastrointestinal (GI) tract. Of special note, is the consideration that most symptoms concerning the GI tract are non-specific and therefore, diagnosing diagnoses of the GI tract require thoughtful and careful investigation. Similarly, hepatobiliary disorders may also mirror many of the signs and symptoms that patients present when suffering from GI disorders.

    How might you tease out the specific signs and symptoms between these potential disorders and body systems? What drug therapy plans will best address these disorders for your patients?

    This week, you examine GI and hepatobiliary disorders. You will review a patient case study and consider those factors in recommending and prescribing a drug therapy plan for your patient.

    Evaluate diagnoses for patients with gastrointestinal and hepatobiliary disorders

    Justify drug therapy plans based on patient history and diagnosis

    Learning Objectives

    Students will:

    Please find below the scenario for this week’s assignment:

    Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:

    Synthroid 100 mcg daily

    Nifedipine 30 mg daily

    Prednisone 10 mg daily

    Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms, such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe a treatment that targets the cause rather than the symptom.

    Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Assignment, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.

    To Prepare

    Review the case study assigned by your Instructor for this Assignment

    Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.

    Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors, such as pregnancy, drugs, or a psychological disorder.

    Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

    By Day 7 of Week 4

    Write a 1-page paper that addresses the following:

    Explain your diagnosis for the patient, including your rationale for the diagnosis.

    Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

    Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

    Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.

    work

    Assessment of the Heart, Lungs, and Peripheral Vascular System

    This week, you will evaluate abnormal findings in the Chest and Lungs. In addition, you will appraise health assessment techniques and diagnoses for the heart, lungs, and peripheral vascular system.

    Assignment 1: Digital Clinical Experience: In this DCE Assignment, you will conduct a focused exam related to chest pain using the simulation tool, Shadow Health. Consider how a patient’s initial symptoms can result in very different diagnoses when further assessment is conducted.

    In a Focus note, include General Assessment, Heart, Lungs and Affected System. Use Scholarly references, Peer-reviewed articles, Research Articles, Professional Organization Recommendations and Walden’s Library or your current textbook. When documenting your Focus note, refer to SOAP note Template, this will ensure you include all required information. Review Rubric before submission.

    Subjective Documentation in Provider Notes

    Subjective narrative documentation in Provider Notes is detailed and organized and includes:

    Chief Complaint (CC), HPI, Current Medications, Allergies, Past Medical History, Family History, Social History and Review of Systems (ROS)

    ROS: covers all body systems that may help you formulate a list of differential diagnoses. You should list each system as follows:

    General: Head: EENT: etc.

    Objective Documentation in Provider Notes –

    Physical exam: Document in a systematic order starting from head-to-toe, include what you see, hear, and feel when doing your physical exam using medical terminology/jargon. Document all normal and abnormal exam findings. Do not use “WNL” or “normal”.

    You only need to examine the systems that are pertinent to the CC, HPI, and History.

    Diagnostic result – Include any pertinent labs, x-rays, or diagnostic test that would be appropriate to support the differential diagnoses mentioned

    work

    2/15/2021 Cardiovascular | Completed | Shadow Health

    https://app.shadowhealth.com/assignment_attempts/9117273 1/3

    Cardiovascular Results | Turned In
    Nursing 562/562L Advanced Health Assessment – Spring 2021, N562

    Return to Assignment (/assignments/433794/)

    Documentation / Electronic Health Record

    Document: Provider Notes

    Student Documentation Model Documentation

    Your Results Reopen (/assignment_attempts/9117273/reopen)
    Lab Pass (/assignment_attempts/9117273/lab_pass.pd

    Overview

    Transcript

    Subjective Data Collection

    Objective Data Collection

    Education & Empathy

    Documentation

    Document: Provider Notes

    Support
    This study source was downloaded by 100000770473191 from CourseHero.com on 01-13-2022 05:36:06 GMT -06:00

    https://www.coursehero.com/file/81017911/Shadow-Health-Tina-Jones-Cardiovascular-Documentationpdf/

    2/15/2021 Cardiovascular | Completed | Shadow Health

    https://app.shadowhealth.com/assignment_attempts/9117273 2/3

    Student Documentation Model Documentation

    Subjective

    Mr Jomes ios a 28-year old african american femal presentign with
    3-4 eposodes of her heart, “beatign too fast” for 5 to 10 minutes per
    episode over the last month. She describes the palpitations as a
    “thumping” in her chest, that makes her feel anxious and
    uncomfortable. The episodes anre not associated with a specific
    activity, but has noticed it occurs on her way to class in the
    mnorning. She denies any chest pain and states the palpitations
    resolve when she calms down and breathes.She states this is the
    first time she has had any heart trouble, and denies any previous
    cardiac testing or surgeries. Pt states she is allergic to cats and dust,
    which can trigger her asthma. She is compliant with her asthma
    dmedications and has not experienced a recent attack. Patient is
    allergic to penicillin, denies allergy to latex or foods. Pt takes flovent
    and proventil for her asthma and denies other medications of
    suppliments. Diagnosed with diabetes a few years ago. She states
    she has been stressed lately with work at a copy center as a
    suprvisor and school. She reports a typical diet and consumes about
    4 diet cokes and and energy drink or two in the morning.

    She attributess feeling tired to school and work. She is comfortanle
    with her current weight, and reports no weight changes. denise fever,
    chills, dizzyness, reports known hypertension not controlled by
    medication, no murmurs , experiences ocassional dyspnea on
    exertion climbing stairs or when hurrying. She reports one recent
    hospitalization for a foot injury.

    Ms. Jones is a pleasant 28-year-old African American woman wh
    presented to the clinic with complaints of 3-4 episodes of rapid h
    rate over the last month. She is a good historian. She describes
    these episodes as “thumping in her chest” with a heart rate that
    “way faster than usual”. She does not associate the rapid heart r
    with a specific event, but notes that they usually occur about onc
    per week in the morning on her commute to class. The episodes
    generally last between 5 and 10 minutes and resolve spontaneou
    She does not know her normal heart rate or her heart rate during
    these episodes. She denies chest pain during the episodes, but
    does endorse discomfort of 3/10 which she attributes to associa
    anxiety regarding her rapid heart rate. She denies shortness of
    breath. She denies any association of symptoms with exertion. S
    has no known cardiac history and has never had episodes prior t
    this last month. She has not attempted any treatment at home an
    states that she is only coming to the clinic today because her fam
    has expressed concern regarding these episodes.

    Social History: Ms. Jones has a job at a copy and shipping store
    is a student at Shadowville Community College. She states that
    has been feeling more “stressed” lately due to her school and wo
    She has been feeling tired at the end of the day. She denies any
    specific changes in her diet recently, but notes that she has not b
    drinking as much water as her normal. Breakfast is usually a muffi
    or pumpkin bread, lunch is a sandwich, dinner is a homemade m
    of a meat and vegetable, snacks are French fries or pretzels. Ove
    the past month she has increased her consumption of diet soda
    “energy” drinks due to her feelings of tiredness. She generally dr
    2 energy drinks before class to “keep her focused” but states tha
    they also make her “jittery”. She denies use of tobacco, alcohol,
    illicit drugs. She does not exercise.

    Review of Systems: General: Denies changes in weight, but
    complains of end of day fatigue. She denies fevers, chills, and ni
    sweats. She complains of intermittent dizziness.
    • Cardiac: Denies a diagnosis of hypertension, but states that sh
    has been told her blood pressure was high in the past. She chec
    at CVS periodically. At last check it was “140/80 or 90”. She den
    known history of murmurs, angina, previous palpitations, dyspne
    exertion, orthopnea, paroxysmal nocturnal dyspnea, or edema. S
    has never had an EKG.
    • Respiratory: She denies shortness of breath, wheezing, cough,
    sputum, hemoptysis, pneumonia, bronchitis, emphysema,
    tuberculosis. She has a history of asthma, last hospitalization wa
    age 16 for asthma, last chest XR was age 16.
    • Hematologic: She denies history of anemia, easy bruising or
    bleeding, petechiae, purpura, or blood transfusions.

    Objective

    Ms hjones appears in no acute distress, able to speak in =ull
    sentences with a wide appropriate variety of vocabulary and is
    cooperative. She maintaines appropriate eye contact throught the
    exam and sits with good posture, no ticks or twitches.

    CV: PMI is brisk and tapping, 2 cm diameter, HR RRR s1 s2 present,
    no murmurs rubs gallops clicks. All pulses +2 bilaterally without
    bruits or thrills. No JVD capilary refil <3 sec in all extremities. No
    peripherial edema. EKG NSR without St elevation or depression or
    other significant findings.

    Resp: Chest symmetrical, breathign at ease, regular depth, rise and
    fall noted. No acessory muscle use or other signs of distress. Breath
    sounds clear in all fields without advantisious sounds.

    • General: Ms. Jones is a pleasant, obese 28-year-old African
    American woman in no acute distress. She is alert and oriented.
    maintains eye contact throughout interview and examination.

    • Cardiovascular: PMI is non-displaced, brisk and tapping, diame
    2 cm. Regular rate and rhythm, S1 and S2 present, no murmurs,
    rubs, gallops, clinics, precordial movements. Pulses 2+ and equa
    bilaterally in upper extremities and lower extremities without thril
    No temporal, carotid, abdominal aorta, femoral, iliac, or renal bru
    No JVD. Capillary refill < 3 seconds. No peripheral edema. EKG w
    regular sinus rhythm, no ST changes. ABI is 0.97.

    • Respiratory: Chest is symmetrical with respirations; no physica
    abnormalities present on chest wall. Lung sounds clear to
    auscultation without wheezes, crackles, or cough.

    Assessment

    Palpitations seem related to caffeine use and or anxiety and stress.
    Palpitations related to caffeine and/or anxiety

    This study source was downloaded by 100000770473191 from CourseHero.com on 01-13-2022 05:36:06 GMT -06:00

    https://www.coursehero.com/file/81017911/Shadow-Health-Tina-Jones-Cardiovascular-Documentationpdf/

    2/15/2021 Cardiovascular | Completed | Shadow Health

    https://app.shadowhealth.com/assignment_attempts/9117273 3/3

    Student Documentation Model Documentation

    Plan

    Encourage Ms Jones to reduce caffeine use and monitor her signs
    and symptoms keeping a log.
    Obtain EKG to rule out abnormalaites
    Provide education on decreased caffeine consumpton
    Monitor stress and anxiety levels and consiter mental health referral
    as needed
    Provide hypertension and diet education
    Provide education on what to do if Ms Jones experiences
    unresolvoing palpitations and or chest pain – call 911 procede to ER.
    Schedule follow up visit in 4 weeks.

    Encourage Ms. Jones to continue to monitor symptoms and log
    episodes of palpitations with associated factors and bring log to
    next visit.
    • Obtain EKG to rule out any cardiac abnormality and assess for
    symptom-correlated EKG changes. If inconclusive, consider
    ambulatory EKG monitoring and referral to cardiology.
    • Encourage to decrease caffeine consumption and increase inta
    of water and other fluids.
    • Educate on anxiety reduction strategies including deep breathin
    relaxation, and guided imagery. Continue to monitor and explore
    need for possible referral to social work/psychiatry or pharmacol
    intervention.
    • Discuss the need to maintain a stable blood pressure. Encoura
    Ms. Jones to continue to monitor her blood pressure when a cuff
    machine is available.
    • Educate Ms. Jones on when to seek emergent care including
    episodes of chest pain unrelieved by rest, palpitations that do no
    dissipate after anxiety related strategies were implemented, chan
    in vision, loss of consciousness, and sense of impending doom.
    • Revisit clinic in 2-4 weeks for follow up and evaluation.

    Comments

    If your instructor provides individual feedback on this assignment, it will appear here.

    © Shadow Health 2012 – 2021
    (800) 860-3241 | Help Desk (https://support.shadowhealth.com/) | Terms of Service (/static/terms_of_service) | Privacy Policy (/static/privacy_policy) | Patents

    (https://www.shadowhealth.com/patents)

    ®

    This study source was downloaded by 100000770473191 from CourseHero.com on 01-13-2022 05:36:06 GMT -06:00

    https://www.coursehero.com/file/81017911/Shadow-Health-Tina-Jones-Cardiovascular-Documentationpdf/
    Powered by TCPDF (www.tcpdf.org)

    Work

     

    Quality of healthcare data has become an increasingly important strategicin the United Stated healthcare delivery system. Address the following points:

    • How is quality of healthcare data defined? In terms of accuracy, completeness, or relevance?
    • What are the factors that contribute to poor data quality in a healthcare database?
      • 1

      work

      Name:

      Section:

      Week 7

      Shadow Health Digital Clinical Experience Focused Exam: Chest Pain Documentation

      SUBJECTIVE DATA: Include what the patient tells you, but organize the information.

      Chief Complaint (CC): In just a few words, explain why the patient came to the clinic.

      History of Present Illness (HPI): This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. You need to start EVERY HPI with age, race, and gender (i.e. 34-year-old AA male). You must include the 7 attributes of each principal symptom:

      1. Location

      2. Quality

      3. Quantity or severity

      4. Timing, including onset, duration, and frequency

      5. Setting in which it occurs

      6. Factors that have aggravated or relieved the symptom

      7. Associated manifestations

      Medications: Include over the counter, vitamin, and herbal supplements. List each one by name with dosage and frequency.

      Allergies: Include specific reactions to medications, foods, insects, and environmental factors.

      Past Medical History (PMH): Include illnesses (also childhood illnesses), hospitalizations, and risky sexual behaviors.

      Past Surgical History (PSH): Include dates, indications, and types of operations.

      Sexual/Reproductive History: If applicable, include obstetric history, menstrual history, methods of contraception, and sexual function.

      Personal/Social History: Include tobacco use, alcohol use, drug use, patient’s interests, ADL’s and IADL’s if applicable, and exercise and eating habits.

      Immunization History: Include last Tdp, Flu, pneumonia, etc.

      Significant Family History: Include history of parents, Grandparents, siblings, and children.

      Review of Systems: From head-to-toe, include each system that covers the Chief Complaint, History of Present Illness, and History). Remember that the information you include in this section is based on what the patient tells you. You will only need to cover systems pertinent to your CC, HPI (N/A, UNKNOWN is not acceptable, make up the information if you need to). To ensure that you include all essentials in your case, refer to Chapter 2 of the Sullivan text.

      General: Include any recent weight changes, weakness, fatigue, or fever, but do not restate HPI data here.

      Cardiovascular/Peripheral Vascular:

      Respiratory:

      Gastrointestinal:

      Musculoskeletal:

      Psychiatric:

      OBJECTIVE DATA: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History unless you are doing a total H&P. Do not use WNL or normal. You must describe what you see.

      Physical Exam:


      Vital signs: Include vital signs, ht, wt, temperature, and BMI and pulse oximetry.

      General: Include general state of health, posture, motor activity, and gait. This may also include dress, grooming, hygiene, odors of body or breath, facial expression, manner, level of conscience, and affect and reactions to people and things.

      Cardiovascular/Peripheral Vascular: Always include the heart in your PE.

      Respiratory: Always include this in your PE.

      Gastrointestinal:

      Musculoskeletal:

      Neurological:

      Skin:

      Diagnostic Test/Labs: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses with rationale for each one documented OR ones that were mentioned during the SH assignment.

      ASSESSMENT: List your priority diagnosis(es). For each priority diagnosis, list at least 3 differential diagnoses, each of which must be supported with evidence and guidelines. For holistic care, you need to include previous diagnoses and indicate whether these are controlled or not controlled.

      © 2021 Walden University

      Work

      After reading chapter 1, complete the following assignment:

      Write a 50 to 200-word email to your (hypothetical) boss about one of the following unethical activities you have witnessed in your workplace. Your email must be carefully documented, fair, and persuasive–in short, ethical. 

      • cyberbullying
      • surfing pornography websites
      • using workplace technology for personal matters (shopping, dating, buying stocks)
      • falsifying compensatory or travel time
      • telling sexist, off-color jokes
      • concealing the use of company funds for personal gifts for fellow employees
      • misdating or backdating company records
      • sharing privileged information with individuals outside your department or company
      • fudging the number of hours worked
      • lying about family illnesses
      • exaggerating a workplace-related injury
      • not reporting a second job to avoid scheduled weekend work
      • misrepresenting, by minimizing, a client’s complaint. 
      • 5

      work

      StuDocu is not sponsored or endorsed by any college or university

      04 Cardiovascular-Tina Abnormals Graduate Fall 2015

       Health Assessment (Walden University)

      StuDocu is not sponsored or endorsed by any college or university

      04 Cardiovascular-Tina Abnormals Graduate Fall 2015

       Health Assessment (Walden University)

      Downloaded by Rosine Ngwana (rosinelael@gmail.com)

      lOMoARcPSD|11515817

      © Shadow Health® 072015 || ShadowHealth.com

      **For instructor use only**
      Page 1 of 3

      Cardiovascular – TINA JONES™
      ADVANCED HEALTH ASSESSMENT

      In
      st

      ru
      ct

      or
      U

      se
      O

      nl
      y

      Over the last month, Tina has experienced 3 -4 episodes of perceived rapid heart rate. She describes these episodes as

      “thumping in her chest” with a heart rate that is “way faster than usual”. She does not associate the rapid heart rate

      with a specifi c event, but notes that they usually occur about once per week in the morning on her commute to class.
      The episodes generally last between 5 and 10 minutes and resolve spontaneously. She denies chest pain during the

      episodes.

      Timeframe: 4 months after establishing primary care (Age: 28)
      Reason for visit: Patient presents complaining of recent episodes of fast heartbeat.

      Module 4 – Cardiovascular

      Develop strong communication skills
      � Interview the patient to elicit subjective health information about her health and health history

      � Ask relevant follow-up questions to evaluate patient condition
      � Demonstrate empathy for patient perspectives, feelings, and sociocultural background
      � Identify opportunities to educate the patient

      Document accurately and appropriately
      � Document subjective data using professional terminology

      � Organize appropriate documentation in the EHR

      Demonstrate clinical reasoning skills
      � Organize all components of an interview

      � Assess risk for disease, infection, injury, and complications

      After completing the assessment, you will refl ect on personal strengths, limitations, beliefs, prejudices, and values.

      Learning Objectives

      I’ve noticed my heart has been beating faster than
      usual lately, and I thought it was something I should
      get checked out.“

      R00.2, Palpitations

      Underlying ICD- 10 Diagnoses

      � Student Performance Index – This style of rubric contains subjective and objective data categories. Subjective

      data categories include interview questions and patient data. Objective data categories include examination
      and patient data.

      Module Features

      Downloaded by Rosine Ngwana (rosinelael@gmail.com)

      lOMoARcPSD|11515817

      © Shadow Health® 072015 || ShadowHealth.com

      **For instructor use only**
      Page 1 of 3

      Cardiovascular – TINA JONES™
      ADVANCED HEALTH ASSESSMENT

      In
      st

      ru
      ct

      or
      U

      se
      O

      nl
      y

      Ms. Jones is a pleasant 28- year- old African American woman who presented to the clinic with complaints of 3 -4
      episodes of rapid heart rate over the last month. She is a good historian. She describes these episodes as “thumping
      in her chest” with a heart rate that is “way faster than usual”. She does not associate the rapid heart rate with a
      specifi c event, but notes that they usually occur about once per week in the morning on her commute to class. The
      episodes generally last between 5 and 10 minutes and resolve spontaneously. She does not know her normal heart
      rate or her heart rate during these episodes. She denies chest pain during the episodes, but does endorse discomfort
      of 3/10 which she attributes to associated anxiety regarding her rapid heart rate. She denies shortness of breath. She
      denies any association of symptoms with exertion. She has no known cardiac history and has never had episodes prior
      to this last month. She has not attempted any treatment at home and states that she is only coming to the clinic today
      because her family has expressed concern regarding these episodes.

      History of Present Illness

      Medications

      1. Fluticasone propionate, 110 mcg 2 puff s BID (last
      use: this morning)

      2. Albuterol 90 mcg/spray MDI 2 puff s Q4H prn (last

      use: “a month ago”)
      3. Acetaminophen 500- 1000 mg PO prn (headaches)
      4. Ibuprofen 600 mg PO TID prn (cramps)

      Vitals

      � Weight (kg) – 87
      � BMI – 30.1
      � Heart Rate (HR) – 90
      � Respiratory Rate (RR) – 16

      � Pulse Oximetry – 99%
      � Blood Pressure (BP) – 145/90
      � Blood Glucose – 140
      � Temperature (F) – 98.9

      � General: Denies changes in weight, but complains of end of day fatigue. She denies fevers, chills, and night
      sweats. She complains of intermittent dizziness.

      � Cardiac: Denies a diagnosis of hypertension, but states that she has been told her blood pressure was high in the
      past. She checks it at CVS periodically. At last check it was “140/80 or 90”. She denies known history of murmurs,
      angina, previous palpitations, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, or edema. She has
      never had an EKG.

      � Respiratory: She denies shortness of breath, wheezing, cough, sputum, hemoptysis, pneumonia, bronchitis,
      emphysema, tuberculosis. She has a history of asthma, last hospitalization was age 16 for asthma, last chest XR was
      age 16

      � Hematologic: She denies a history of anemia, easy bruising or bleeding, petechiae, purpura, or blood transfusions.

      Review of Systems

      Printable “Answer Key” available within the Shadow Health DCE.

      Subjective and Objective Model Documentation

      � Symptoms – Fast heartbeat
      � Diagnosis – Palpitations

      Chief Complaint

      Downloaded by Rosine Ngwana (rosinelael@gmail.com)

      lOMoARcPSD|11515817

      © Shadow Health® 072015 || ShadowHealth.com

      **For instructor use only**
      Page 1 of 3

      Cardiovascular – TINA JONES™
      ADVANCED HEALTH ASSESSMENT

      In
      st

      ru
      ct

      or
      U

      se
      O

      nl
      y

      Abnormal Findings

      Subjective (Reported by Tina)
      � Experienced 3-4 episodes of fast heartbeat and a

      “thumping feeling” in the last month
      � Episodes accompanied by mild anxiety
      � Increased stress related to work and school
      � Increased caff eine consumption from diet soda and

      energy drinks
      � Risk factors for cardiovascular disease: type 2

      diabetes, sedentary lifestyle and family history of
      high cholesterol and hypertension

      Objective (Found by the student performing physical exam)
      � Heart rate in the clinic is not tachycardic: 90 bpm
      � Hypertensive blood pressure reading: 145 / 90
      � Risk factor for cardiovascular disease: Obesity (BSM

      31)

      Assessment

      Palpitations related to caff eine and/or anxiety

      Plan

      1. Encourage Ms. Jones to continue to monitor symptoms and log her episodes of palpitations with associated
      factors and bring log to next visit.

      2. Obtain EKG to rule out any cardiac abnormality and assess for symptom correlated EKG changes. If
      inconclusive, consider ambulatory EKG monitoring and referral to Cardiologist

      3. Encourage to decrease caff eine consumption and increase intake of water and other fl uids.
      4. Educate on anxiety reduction strategies including deep breathing, relaxation, and guided imagery. Continue to

      monitor and explore the need for possible referral to social work/psychiatry or pharmacologic intervention.
      5. Discuss the need to maintain a stable blood pressure. Encourage Ms. Jones to continue to monitor her blood

      pressure when a cuff or machine is available.
      6. Educate Ms. Jones on when to seek emergent care including episodes of chest pain unrelieved by rest,

      palpitations that do not dissipate after anxiety related strategies were implemented, changes in vision, loss of
      consciousness, and sense of impending doom.

      7. Revisit clinic in 2 4 weeks for follow up and evaluation.

      Downloaded by Rosine Ngwana (rosinelael@gmail.com)

      lOMoARcPSD|11515817

      Work

       

      1.  Choose a newborn health challenge such as Down’s syndrome, cleft lip and palate, or absence of digits.

      • a.   How might parents from various cultures feel about the cause of this condition?
      • b. How does this compare with the biomedical understanding?

      2.  An emergency room nurse is taking care of a 5-year-old boy who suffered trauma from a bike accident. His family identifies as Jehovah’s Witnesses. The nurse explains that the boy may need a blood transfusion. The parents express concern because taking blood, including via blood transfusion, is discouraged by their religion, a stance with which they agree.

      • a.   How should the nurse discuss this situation with the parents and the interdisciplinary health care team?
      • b.   What do you think the best course of action should be?
      • c. What are the primary ethical issues related to the refusal of blood transfusions in a child?