Clinical Methods
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Clinical Methods Using PDAs for Data Collection Lisa Guadagno, Carla VandeWeerd, Dirk Stevens, Ivo Abraham, Gregory J. Paveza, and Terry Fulmer Advances in handheld computer technology are making data collection faster, easier, and more accurate. In this article, the use of personal digital assistants (PDAs) to collect data for a study on elder neglect is described and evaluated. Methods for integrating this technology into a research study are discussed as are suggestions for increasing the performance of data collectors using these devices. The authors offer some practical solutions for researchers and clinicians planning to use PDAs in their research. © 2004 Elsevier Inc. All rights reserved. HE PURPOSE OF this article is to describe imported directly into databases or statistical pack- T how handheld computers (also referred to as ages at the time of data collection. Data can be personal digital assistants [PDAs]) have been used entered into the PDA and then transferred or “syn- to collect data in emergency departments (EDs) for chronized” to a desktop computer by a variety of a multisite study on elder neglect and to comment means, depending on the needs and restrictions of on the advantages and disadvantages of using the project. Such means typically include a tele- PDAs for patient data collection on this project. phone or Internet through the use of a modem, an From this experience, a number of recommenda- infrared connection, a docking station, or a hard- tions for researchers considering the use of PDAs for data collection are offered. BACKGROUND Lisa Guadagno, MPA, Project Manager, Division of Nursing, In recent years, the use of handheld computer The Steinhardt School of Education, New York University, New York, NY; Carla VandeWeerd, PhD, Research Assistant Profes- PDAs has risen tremendously in the health care sor, The James and Jennifer Harrell Center for the Study of field (Sausser, 2002; Shah, 2001). These units have Family Violence, University of South Florida, Tampa, FL; Dirk been used to enter patient information and track Stevens, MS, Software Engineer, The Epsilon Group, LLC, patients during direct and point of service care, as Charlottesville, VA; Ivo Abraham, PhD, RN, FAAN, Adjunct reference tools and to make medical calculations. Professor, Division of Nursing, The Steinhardt School of Edu- cation, New York University, New York, NY; In health care systems where PDAs are connected Gregory J. Paveza, MSW, PhD, Interim Associate Vice President for Academic to information systems, clinicians may use the Affairs, Lakeland Campus, University of South Florida, Tampa, devices to check laboratory results or write pre- FL; and Terry Fulmer, PhD, RN, FAAN, The Erline Perkins scriptions. The devices have also been used for McGriff Professor and Head, Division of Nursing, The Stein- general data collection, particularly in the case of hardt School of Education, New York University, New York, NY. Supported by grant #1-RO1-AG17588-01 from the National survey research or health assessment (Burnard, Institute on Aging and the National Institute for Nursing Re- 1995; Craig, 2002; Sausser, 2002). In the case of search data collection for research, PDAs can replace Address reprint requests to Terry Fulmer, PhD, RN, FAAN, paper-based instruments that are usually coded and Division of Nursing, The Steinhardt School of Education, New entered into statistical or spreadsheet software after York University, 246 Green Street, New York, NY 10003-6677. E-mail: [email protected] the initial data has been collected. By contrast, © 2004 Elsevier Inc. All rights reserved. researchers can use software for handheld devices 0897-1897/04/1704-0009$30.00/0 that codes and saves data into a form that can be doi:10.1016/j.apnr.2004.09.008 Applied Nursing Research, Vol. 17, No. 4 (November), 2004: pp 283-291 283 284 USING PDAs wire cable (Craig, 2002; Weber, Roberts, & Bev- paper versions of the survey. However, use of the erly, 2000). handheld devices was shown to have less internal reliability than pen and paper surveys. In a con- ADVANTAGES AND DISADVANTAGES trolled experiment, Young et al. (2001) studied the The use of PDAs to collect data has several utility and efficiency of pen-based handheld de- distinct advantages in comparison to traditional vices compared with keyboard based devices for paper and data entry collection techniques. These data collection by nurses. Three nursing-record advantages include decreased errors, increased ef- simulation tasks were undertaken representing (1) ficiency of data entry, quick access to patient in- structured data entry (selecting items from a pull formation, and the portability of the devices (Van down list), (2) structured and textual data entry, Dinter, 2002). Ease of storage, reduction of re- and (3) solely textual data entry, respectively. sponse errors through a variety of programming Nurses in the study reported that the pen-based methods, and the fact that a single device can be device was preferred for accuracy and ease over used for many different respondents have also been the keyboard for tasks 1 and 2, but for task 3, the cited as main advantages of PDAs (McBride, keyboard was preferred. The authors postulate that Anderson, & Bahnson, 1999). Among the disad- choosing to use a pen-based device or a keyboard- vantages are the possibility of losing data if the based device to collect data should depend on the device breaks, the potential for staff discomfort data input method of the software being used. with the technology and the need for special train- Some researchers have found that collecting data ing, the existence of occasional compatibility prob- with handheld devices yields similar results to pen lems, and the potential for users to get inadver- and paper methods. tently locked out of the devices depending on the security mechanisms in place. Finally, the rapid pace of new handheld technologies may cause the device and/or software to become outdated during Some researchers have found that the life of the project (Sausser, 2002). The use of collecting data with handheld devices PDAs to collect data has several distinct advan- yields similar results to pen and paper tages in comparison to traditional paper and data methods. entry collection techniques. As handheld technology becomes more sophis- The use of PDAs to collect data has ticated, user friendly, and cost-effective, the use of several distinct advantages in com- PDAs to collect data will be most likely increase. In this process of adapting technology to aid in parison to traditional paper and data research, it is important for researchers understand entry collection techniques. the reliability of using the technology to collect data compared with pen and paper methods and the steps that can be taken in programming PDAs to aid in the collection of reliable data. RELIABILITY OF DATA COLLECTED USING PDAS Some researchers have found that collecting STUDY DESCRIPTION data with handheld devices yields similar results to As part of an ongoing, multisite study on elder pen and paper methods. In a randomized study, neglect by caregivers, PDAs have been used to McBride et al. (1999) compared pen and paper collect patient data in 4 EDs: 2 in New York City survey methods to handheld computer methods for and 2 in Tampa, FL, from March 2001 to May data collection in an orthopedic outpatient clinic. 2003 (Fulmer, Paveza, Abraham, & Fairchild, The authors found that data collection by handheld 2000). As part of the protocol, eligible patients computers was comparable to that by pen and who agreed to participate and sign informed con- paper, with no statistically significant mean differ- sent were interviewed and assessed for neglect by ence in the scale scores between the handheld and clinical screeners using the Elder Assessment In- GUADAGNO ET AL. 285 Figure 1. Elder Assessment Instruments (EAI). strument (EAI) (Fulmer, Street, & Carr, 1984; Ful- Screeners for the study were trained in the use mer & Wetle, 1986, Fulmer, Paveza, Abraham, & of the Palm Pilot, EAI, and American Medical Fairchild, 2000). The EAI (Fig 1), a 44-item Likert Association’s “Diagnostic and Treatment Guide- scale assessment instrument was developed to lines for Elder Abuse and Neglect” (Aravanis, measure possible neglect over 7 subcategories: Adelman, Breckman, Fulmer, Holder, & Lachs, general assessment, neglect assessment, usual life- 1992) over a 6-hour training session. Screeners style, social assessment, medical assessment, emo- assessed patients and used the data gathered tional/psychological neglect, and a summary as- from the EAI to formulate a subjective clinical sessment. Response choices for these items range judgment of neglect or no neglect. Data col- from “very good” to “very poor” or “no evidence” lected were cued and entered into Palm Pilots to “evidence.” A disposition section provides an and forwarded to a database housed on a remote area for notes regarding the follow-up plan for the server as well as to the Neglect Assessment patient. The interrater reliability for this instrument Team (NAT) for review. An interdisciplinary is .83, and the content validity is .83 (Fulmer, NAT, consisting of a geriatrician, geriatric nurse Street, & Carr, 1984; Fulmer & Wetle, 1986). This practitioner, and social worker with expertise in instrument along with basic demographic variables elder mistreatment, received data from the ED and questions to assess eligibility requirements screens weekly and reviewed the cases to con- were the basis for a Palm Pilot (Palm, Inc, Santa firm or disconfirm the original diagnosis. Clara, CA) (now called PalmOne)–guided inter- view, which was programmed and installed onto TECHNICAL DESCRIPTION the handheld devices and used by screeners to The main goals for the technical implementation assess for elder neglect in the EDs. of the Palm application were (1) to provide an easy 286 USING PDAs appropriate cognitive capacity to participate. Cal- culation of the Mini Mental Status Examination score was registered automatically by the Palm software (Fig 3).