Chapter III: METHODOLOGY

This research study consisted of a quantitative retrospective chart review obtained in a rural area health care clinic in the Mississippi Delta. A descriptive, research design was chosen in order to protect human subjects while providing insight into the prevalence of vitamin D deficiency in older adults. A total of three hundred charts belonging to older patients of all racial and ethnic backgrounds who were seen between the ages of 30-70 years were obtained. The primary interest to the researchers in this study was to evaluate and identify when vitamin D supplements should be implemented into the patients plan of care after concluding when vitamin D levels are drawn and which method of treatment is to be prescribed. This chapter will outline the setting of the research project, the sample, protection of human subjects, and the implementation of the project.

Setting for the Research Project A quantitative, retrospective chart review was performed in a rural clinic in the Mississippi Delta. Three hundred charts were reviewed with one hundred charts being obtained by each researcher via random sampling to obtain a more scientific result that could be used to represent the entirety of the population. The clinic is situated within the towns city limits. Data collection was conducted throughout the facility during operating hours from Mondays through Sundays in order to accommodate the schedules of our subjects.

Sample of the Research Project

A systematic random sample was utilized to collect data on 300 charts from a population of older adults between the ages of 30 to 60 years of age. Charts were audited in a single session by each of the researchers assigned to the clinic in order to prevent duplication of data from a single chart. In the clinic, charts were audited in the following manner. Four charts were taken from each letter of the alphabet. The first two charts of each letter of the alphabet were audited. Additional charts were selected from the remaining charts starting at the first of the alphabet until a total of one hundred charts were obtained. This systematic manner was implemented in order to remove sampling biases and to provide an organized way to pull data manually. The charts were labeled by chronological order rather than using alphabetization. Randomization was implemented by starting at one end of the row. Every chart that met inclusion criteria for the research conducted was documented until one hundred patient charts were reviewed. During this time, measures were implemented to ensure no one from the clinic removed any of the charts included in this study.

The clinic consisted of both private-pay clientele and clients who used Medicare, State Health Insurance and self-pay. This clinic was selected in order to provide diversity of payer source.

Protection of Human Subjects Procedures were followed according to the graduate program at a university in a rural southeastern state prior to the collection of study data. The Institutional Review Board (IRB) from the university reviewed the project and issued written approval for the study to proceed. In addition to the adherence of the Institutional Review board, the clinic provided written consent to

allow researchers to conduct this study. Information for the study was obtained in accordance with the Health Insurance Portability and Accountability Act (HIPPA) without any identifying client information such as patient names, medical record numbers, social security numbers or location. A password protected data tool was used to store all pertinent information used in the study. The device used to store data collected in this research was not used for any other purposes outside of the realm of the research project. Medical records were not removed from the facility. Moreover, identifying information was not revealed regarding the name of the clinic or personnel who worked in any area of the clinic. All information was provided by the clinic staff, and all medical records were reviewed within the confines of the clinic.

Implementation of the Project A comparative, descriptive research design was used to evaluate practice patterns. Systematic random sampling was used to collect retrospective data from a total of three hundred charts of older adults between the ages of 30 to 60 years of age. The charts were divided equally amongst the researchers with one hundred charts collected per each researcher. The same data collection tool designed for this research was used consistently in the clinic setting. Each chart was reviewed to determine if vitamin D levels had been tested during the clients annual health assessment at any point between the ages of 30 to 60 years of age. However, care must have been provided within the past five years. Payer source information was documented for each client and included self-pay, private insurance, and Medicare. Gender and date of birth were also documented on the data collection tool. A professional statistician was used to analyze and facilitate accurate statistical results. Analysis of Variance (ANOVA), t-test, and chi square were used to analyze the nominal data collected.

Summary of Methodology The study was performed as a retrospective chart review using three hundred medical charts, equally divided amongst each researcher. The charts of random male and female clients between the ages of 30 to 60 were utilized for this study. Data was obtained using a systematic manner, systematic random sampling, in order to prevent bias and duplication. The charts were assessed for information regarding the deficiency of vitamin D between the ages of 30 to 60 years; the age of the client at the first screening and source of payment provided at the time of visit were considered. The clinic used a 25-hydroxyvitamin D, or 25(OH) D test, to assess deficiency levels of vitamin D. Data was analyzed using ANOVA, t-test, and chi square. The participating clinic provided the study findings for the purpose of quality assurance. The benefit of this research to primary care providers included information on how to identify when vitamin D supplements should be implemented into the clients plan of care and the method of treatment to correct the vitamin D deficiency found.