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Exploratory and Outcomes Data Analysis

Alison Douglas

College of Health Professions and Wellness, Jacksonville State University

NU711: Biostatistics and Translating Evidence

Dr. Betsy Gulledge

October 31, 2021

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Exploratory and outcomes data analysis complete the final steps in project data

management. During the exploratory process, data is examined, and the instruments and

practices utilized in data collection give the project meaning and purpose (Sylvia & Terhaar,

2018). The exploratory phase looks at each variable independently in a non-biased manner to

garner an understanding of the subject, event, or population studied (Sylvia & Terhaar, 2018).

Once the exploratory phase is complete, data will have meaning, thus building the foundation of

a data analysis plan (Sylvia & Terhaar, 2018). Contrastingly, the outcomes data analysis uses

statistical examination to verify the resulting success hypothesized in the original plan (Sylvia &

Terhaar, 2018).

The purpose of descriptive studies is to describe features of certain occurrences or

selected variables, including information that connects or influences outcomes for a project or

study design (Melnyk & Fineout-Overholt, 2015). Descriptive variables need to include variable

name, description of the variable, data source, possible value range, level of measurement, and

collection time frame (Sylvia & Terhaar, 2018). Persons or context categorically divides

descriptive variables related to the individuals or populations studied. Examples of variables

specific to a person include birthdate, gender, race, diagnosis, income, and educational level.

Examples of variables specific to context include the location of unit, city, state, time of day,

procedural count, radiation exposure, and the number of medication doses (Sylvia & Terhaar,

2018).

Descriptive variables may also explain an event’s nature and further divide into two

categories: the event or context. Examples of variables specific to the event may include the date,

time, location, procedural method, or equipment brand. Likewise, examples of event context

variables could include a patient identifier, nurse, physician, or family members present (Sylvia
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& Terhaar, 2018). Descriptive variables play a crucial role in painting the picture of the study

subject. For example, the nurse’s DNP project is a retrospective study assessing intravenous

fluid (IVF) resuscitation timing in septic patients. The descriptive variables of the project include

adults in a rural hospital emergency room suffering from sepsis to include the time of arrival to

the emergency department, diagnosis or sepsis alert, time of IVF initiation, the quantity of fluid

administered, patients blood pressure before and after therapy, need for vasopressors, ventilation,

and transfer to the intensive care unit. The study’s goal is to understand how the timing of IVF

resuscitation affects hospital length of stay.

As descriptive variables describe a population or event characteristic, a project question

or evaluative process improvement needs outcome variables. Outcome variables, therefore,

measure the structure, process, and results of the project outcome (Sylvia & Terhaar, 2018).

Project outcome results are consequential to the details surrounding calculations of the dependent

variables and often expressed as a mean or percentage. The outcome variables explain how the

result is measured or enumerated; therefore, specifics about the descriptive variables are crucial

in determining how and what type of statistical test is needed to measure the project outcome in

question (Sylvia & Terhaar, 2018). Results of outcome variables are often time-sensitive, which

is a factor that is important to the determination of key-dependent variables that an intervention

will influence. It is also imperative to assess the statistical significance and meaning for

determining outcome variables. For example, statistical power is higher the more subjects a

study includes due to the detected difference between study samples. Contrastingly, a smaller

sample size project often yields underpowered statistical significance (Melnyk & Fineout-

Overholt, 2015).
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Outliers in research are disseminated as extreme values and are decided based on how far

away their value is from the mean. Values below the curve within three standard deviations from

the mean are considered typical values of the distribution. Therefore a value that falls higher than

the standard deviation of three could be considered an outlier (Sylvia & Terhaar, 2018). The

responsibility of a Doctor of Nursing Practice (DNP) requires decisions on the classification of

outliers; as such, a more appropriate way of managing outliers is to center the decision on the

dissemination of the value versus the average or mean of the value (Sylvia & Terhaar, 2018).

Hence, the classification of data remains of utmost importance, with the mean having higher

sensitivity than the median when considering the position of outliers. Considering the mean and

median, the DNP must evaluate each independently and how both correlate when understanding

the meaning of the study (Sylvia & Terhaar, 2018). Outliers can give meaningful information to

a project when assessing validity; for this reason, the DNP needs to explore and consider the

purpose for the outlying value. If the outlier is a valid value, it will provide purpose to the project

when relaying the results and added to the manuscript (Sylvia & Terhaar, 2018).

Descriptive variables help the DNP interpret project results (Bevans, 2021), and outcome

variables measure the project’s structure, procedure, and outcome (Sylvia & Terhaar, 2018).

Through exploratory data analysis, descriptive and outcome variables provide comprehensive

reasoning and validation of the statistics selected and how successful outcomes are measured.

Outcome variables, therefore, measure the structure, process, and results of the project outcome

(Sylvia & Terhaar, 2018). This process of exploratory data analysis positively affects patient care

outcomes through valid reasoning giving meaning to investigated data researched, and sets a

foundation of evidence for providers to build upon their care.

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Confounding variables are circumstances that hinder the relationship between dependent

and independent variables (Zach, 2021). The confounding variable leads to fallacious findings

causing two major issues creating a false sense of cause-and-effect and hiding concrete cause-

and-effect between the dependent and independent variables (Zach, 2021). In chapter fourteen of

Sylvia and Terhaar, a case study of “groups within the older community-dwelling patients with

diabetes,” morbidity is a possible confounding variable when comparing the association between

intervention and outcomes. A cross-tabulation of morbidity revealed higher morbidity (74%) in

the intervention group when contrasted (64.7%) to the comparison group (2018). The case

further studies differences in variables, where linear regressions in confounding morbidity levels

of pre-HbA1C to post-HbA1C and several pre-and post-admissions logistic regression of post-

period admission incidences (Sylvia & Terhaar, 2018).

Chapter fourteen uses several statistical tests, first the p-value; by way of the chi-square

in the case study, the chi-square test associates categorical variables (Sylvia & Terhaar, 2018).

Chi-square has divided categories the goodness of fit-test and a chi-square fit-test. The goodness

of fit-test verifies the sample correlates to the population, and a chi-square fit test contrasts two

independent variables in a table to compare how the data measures (Nigam, 2018). A chi-square

is nominal where yielding low values translate to data that fits, where the opposite of a high

value translates that data does not fit. The null hypothesis concludes that variable X and variable

Y are independent of one another, and the hypothesis alternate of variable X and variable Y are

not independent (Nigam, 2018). The chi-square within the chapter fourteen case study is 0%,

where the groups are expected to total a predicted amount of less than five (Sylvia & Terhaar,

2018).
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Second, the case study uses an independent t-test. A t-test compares the mean or average

of two studies samples and is a preferred use for discrimination when the limits of a population

are unknown. The t-test has three sub-categories: an independent sample t-test equating the mean

of two subjects, a paired t-test equating means within the same subject at differing times, and a

sample t-test that examines the average of a single subject against a known subject average

(Nigam, 2018). In the case study, those patients with high-morbidity had a higher average of pre-

HbA1C to post HbA1C increase (0.41) when compared to the low-morbidity group (0.09);

however, the statistical significance was lacking (Sylvia & Terhaar, 2018). The high-morbidity

group revealed pre-admission to post-admission increase (0.07), and in comparison, the low-

morbidity group revealed a decrease (0.29); therefore, the t-test demonstrates that morbidity had

an impact on outcomes related to admission but not HbA1C (Sylvia & Terhaar, 2018).

Third, another test utilized in the case study is the Mann-Whitney U test which tests

variance in position of scores of two independent subjects (Sylvia & Terhaar, 2018). The

intervention group’s average HbA1C during the post-admission period juxtaposed the

comparison group (7.86 to 8.30) in the case study. The Mann-Whitney U test showed statistical

significance with the variance of HbA1C with a p-value of 0.009 (Sylvia & Terhaar, 2018).

The importance of the p-value (or probability value) is that of statistical significance

where the test assumes no variance exists between the experiment, intervention, and control of a

study. Where p-value signifies event probability when no actual difference is assumed, a

statistically significant result is a p-value of 0.05 (Melnyk & Fineout-Overholt, 2015); this is also

known as alpha or significance level (Sylvia & Terhaar, 2018). When interpreting the p-value, a

value of fewer than 0.05 means there is a less than five percent chance that an error reported

regards a statistically significant variance between groups compared (Sylvia & Terhaar, 2018).
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A null hypothesis assumes no relationship between two variables exists, or the

acceptance of what the study is trying to prove did not occur. The p-value then describes the

likelihood that the data observed occurs randomly (a true null hypothesis). A p-value

measurement should fall between zero and one. Accordingly, the smaller the p-value, the null

hypothesis should be rejected because the evidence is significant (McLeod, 2019). Therefore,

when assessing the case study in chapter fourteen, the p-value from the Pearson chi-square test

yielded a 0.044, demonstrating that the dissemination of diabetic patients with high morbidity in

the intervention group versus the comparison group is statistically different (Sylvia & Terhaar,

2018).

The outcomes for all populations in the chapter fourteen case study revealed that the

intervention group had an increased percent for high and very high risk of morbidity related to

the comparison group. Most illnesses were comparable; however, cancer was higher in the

comparison group (17.4% versus 9.1%), and diabetic retinopathy was higher in the intervention

group (12.5% versus 6.5%). Those in the study with high morbidity showed an increase in

HbA1C levels during the pre- to post-admission testing. The low morbidity group showed a

decrease during this time, and a statistical significance result revealed a p-value of 0.001. The

study proved that morbidity affects outcomes related to admission and not outcomes related to

HbA1C levels (Sylvia & Terhaar, 2018). Therefore a decision made as the provider may be to

observe diabetic patients more closely with higher morbidity risks, as this would affect patient

admission outcomes and increase mortality. The provider might also hold off on HbA1C testing,

as outcomes did not change related to the lab value. Omitting the lab would impact the patient

monetarily and cancel the need for unnecessary extraneous testing. To conclude, patient care
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ultimately needs to be led by evidence-based practice; as DNPs, our diligence in disseminating

great practice hinges upon the rigor applied to exploratory and outcomes data analysis.
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References

Bevans, R. (2021, March 2). Understanding types of variables. Scribbr.

https://www.scribbr.com/methodology/types-of-variables/

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and

healthcare: A guide to best practice (3rd ed.). Wolters Kluwer.

McLeod, S. A. (2019, May 20). What a p-value tells you about statistical significance. Simply

Psychology. https://www.simplypsychology.org/p-value.html

Nigam, V. (2018, November 1). Statistical tests – When to use which? Towards Data Science.

https://towardsdatascience.com/statistical-tests-when-to-use-which-704557554740

Sylvia, M. L., & Terhaar, M. F. (2018). Clinical analytics and data management for the DNP

(2nd ed.). Springer Publishing Company.

Zach. (2021, February 19). What is a confounding variable? Definition and example. Statology.

https://www.statology.org/confounding-variable/#:~:text=%20Confounding%20variables

%20are%20problematic%20for%20two%20reasons%3A,the%20true%20cause-and-

effect%20relationship%20between%20variables.%20More%20