Technological advances in data entry and verification: is teleform for you?

Acceptability and Feasibility of Physical Activity Assessment Methods for an Appalachian Population

Nowhere is improving understanding and accurate assessment of physical activity more important for disease prevention and health promotion than among health disparities populations such as those residing in rural and Appalachian regions. To enhance accurate assessment of physical activity and potentially improve intervention capacity, we conducted a mixed-methods study examining the acceptability and feasibility of self-report physical activity questionnaires, pedometers, and accelerometers among rural Appalachian children, adolescents, and adults. Most participants reported positive experiences with all three physical activity assessment tools. Several acceptability ratings differed by age group and by sex within each age group. With very few exceptions, no significant differences in acceptability were found by race, education, employment status, health status, BMI categories, income levels, or insurance status within age groups or overall. Several factors may impact the choice of the physical activity assessment method, including target population age, equipment cost, researcher burden, and potential influence on physical activity levels. Children and adolescents appear to have more constraints on when they can wear pedometers and accelerometers. While pedometers are inexpensive and convenient, they may influence physical activity levels, rather than simply measure them. Accelerometers, while less influential on behavior, consume extensive resources, including high purchase costs and researcher burden.

Automated versus manual audit in the emergency department

PURPOSE

The purpose of this paper is to compare data collected by automated form processing with manual data collection for clinical indicators (CIs) in paediatric emergency medicine.

DESIGN/METHODOLOGY/APPROACH

Paediatric patients presenting with croup, asthma, bronchiolitis, head injury and gastroenteritis in August 2006 were identified by ICD 9 coding and a traditional manual audit was performed by two data collectors. Data were collected on a total of 16 CIs for these five illnesses. Manual audit data were then compared to information collected for this same patient population using TELEform, an automated forms processing (AFP) system that had been employed for over two years.

FINDINGS

Teleform data were only available for 24 patients compared to information for 127 patients identified by ICD 9 coding and manual audit. Teleform data overestimated compliance with clinical guidelines by 17 percent giving an overall departmental agreement with CIs of 90.6 percent compared to 73.5 percent in the manual audit. Additionally, manual audit demonstrated that when the clinical guideline was incorporated into the clinical record, compliance was 92.5 percent compared to 51.3 percent when it was not.

ORIGINALITY/VALUE

This single center study demonstrates that data collected by AFP such as TELEform, overestimate emergency department performance regarding CIs compliance. Departments that use automated data collection tools need to establish relationships between such data and data collected via more traditional auditing methods.

Dealing With a Deluge of Data: An Assessment of Adverse Event Data on North Central Cancer Treatment Group Trials

Purpose

Adverse events (AEs) are monitored in clinical trials for patient safety, to satisfy reporting requirements, and develop safety profiles. Recently, much attention has been placed on the reporting of serious AEs (SAEs) that are either life threatening or lethal in clinical trials. However, SAEs comprise a small subset of all AE data collected for trials; the majority of AE data collected are routine AEs (RAEs) regarding non–life-threatening events. We assessed the utility of the RAE data collected, relative to the volume.

Patients and Methods

We surveyed the RAE data from 26 North Central Cancer Treatment Group coordinated trials.

Results

A total of 8,318 (11%) of 75,598 of RAEs required queries. Of these, 86% were protocol-required RAEs, 83% of RAEs required per protocol were within normal limits (eg, platelets) or not present, and 61% of extra AEs were mild. One fifth of RAEs were considered unlikely to be related or unrelated to treatment. Overall, 3% of events were severe, life threatening, or caused death. Only 1% of RAE data reported required expedited reporting (eg, via Adverse Event Expedited Reporting System). Results indicate that 72% of RAEs would be eliminated if only the maximum severity per patient and type were required. These results were validated in a large phase III trial.

Conclusion

The majority of RAEs identified, transcribed, and entered are not clinically important. Our data suggest that reducing the number of AEs monitored will affect substantially neither overall patient safety nor compromise evaluation of regimens undergoing testing. We present several considerations for such a reduction in data collection, as well as a policy that we have used to address the deluge of RAE data.

A comparison of visual analogue and numerical rating scale formats for the Lung Cancer Symptom Scale (LCSS): does format affect patient ratings of symptoms and quality of life?

PROBLEM AND PURPOSE

The Lung Cancer Symptom Scale (LCSS), a site-specific health-related quality of life measure for patients with lung cancer, was originally developed using a Visual Analogue Scale (VAS) format. However, the VAS format is not readily compatible with data management and software programs using scanning. The primary aim of this study was to evaluate the convergence of ratings obtained with a Numerical Rating Scale (NRS), with an 11-pt response category format, to those obtained with a VAS format. The intent was to determine the degree of agreement between two formats to generalize the existing psychometric properties for the original measure to the new presentation.

DESIGN/SETTING

This methodological study evaluated the feasibility, reliability, and validity of a NRS format for the LCSS. The study was conducted at two cancer centers in New York City. PATIENTS/PROCEDURES: Sixty-eight patients with non-small cell lung cancer (NSCLC) completed both versions of the LCSS along with demographic and feasibility questions on a single occasion. The VAS form was administered first, followed by the NRS form to prevent bias. The intraclass correlation coefficient (ICC), Lin's concordance correlation coefficient (CCC), and Bland-Altman plots were used to evaluate agreement and to characterize bias.

RESULTS

Cronbach's alpha for the NRS format total score was 0.89 for the 68 patients with NSCLC. Agreement was excellent, with both the ICC and CCC > or = 0.90 for the two summary scores (total score and average symptom burden index) for the LCSS. Only five of the nine individual items showed this level of strict agreement. An agreement criterion of > or = 0.80 (representing excellent) was observed for seven of the nine individual items (all but appetite loss and hemoptysis). Mean differences tended to be slightly lower for the VAS format compared to the NRS format (more so for the appetite and hemoptysis items), with evidence of scale shift for the same two items. The summary measures showed good concordance as measured by the ICC and CCC, but did display mean differences (VAS - NRS) of -2.7 and -3.1, respectively.

CONCLUSIONS

Overall, the NRS format for the LCSS suitable for scanning has good feasibility, reliability (internal consistency), and convergent validity. The complete set of concordance evaluation measures supports the reproducibility of VAS scores by NRS scores, particularly for the two summary scores.

Data Collection in a Multisite Project: Teleformtm

Data collection, entry, validation, and management are salient time- and resource-consuming dimensions of all research projects. This is especially true for multisite studies, which pose unique, additional challenges because of their research design requirements. To save time and reduce the number of manual data entry errors, automated processing systems are becoming more widely used. Our research team chose Teleform for data entry and collection for the Smoking Cessation or Reduction in Pregnancy Trial study. This article presents our experience with this new technology.

Developing a multi-institutional nursing report card

As regulatory and public interest groups demand information on the quality of patient care outcomes produced by their hospitals and care providers, nurse administrators are establishing processes for the effective and efficient definition, retrieval, and reporting of patient outcomes thought to be nursing-sensitive. The authors describe the administrative infrastructure and the data management processes used by one large integrated healthcare system to establish a nursing report card and maintain it for several years.

Teleform: a blessing or burden?

Burgeoning technology has created numerous alternatives for even the most mundane aspect of research, that is, data entry. Our research team is conducting a large NIH NINR clinical trial, and data entry and management are important aspects of this study. Our research team needed to decide whether to use manual data entry or a scannable form of data entry. This article describes some of the advantages and disadvantages related to our decision to use scannable data entry Teleformtrade mark.

Research from afar: considerations for conducting an off-site research project

An off-site research project is defined as a research study having a conduction location and data-collection site from which the principal investigator is geographically separated. Off-site research projects will likely increase because they afford greater access to larger research subject pools relevant to research questions and allow participation research at a site from which research would otherwise not be conducted. The critical elements proposed to make an off-site study successful include system negotiations, attending to personnel issues, fostering communication, encouraging subject participation, optimizing data collection and management, considering privacy issues, and ensuring optimal research team performance. An example of a specific off-site study involving a major midwest research university in one state and a large United States Navy training center in another state is discussed, and essential elements in establishing off-site research are highlighted.

Validation of automated forms processing. A comparison of Teleform with manual data entry

We have used the computer program Teleform for automated forms processing (AFP) and have compared error rates, time consumption, and expenses with those of single or double manual data entry. For choice fields the error rate for AFP was very low and comparable to double manual data entry, while for numeric recognition the error rate was higher than for both single and double manual data entry. AFP reduced processing time, but we found that a very large number of forms need to be processed in order to recover the initial investment. A considerable amount of time and computer expertise was required for implementation of AFP.