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Questions: 1. The Relationship between Patient Satisfaction and Inpatient Admissions Across Teaching and Nonteaching Hospitals.?2. Assess the appropriateness of the statistics used by referring to the chart presented in the Module 4 lecture and the resource "Statistical Assessment?3. Discuss the value of statistical significance vs. pragmatic usefulness? Answers: 1. The healthcare system is entangled with the need to increase revenue at the same time attain considerable level of patient satisfaction. This is possible only when the cost of the healthcare system will be maintained. The service providers have been realizing the importance of the association between the patient satisfaction and the volume of patients being admitted that need to be analyzed. The analysis will enhance the expectation of the patients and suppress the compensation. The healthcare service providers are alarmingly concerned with their performance in order to increase the patient satisfaction but keeping in mind that the healthcare market is a competitive one, the providers are carefully competing with the rivals based on quality, enhanced service, reputation and other non-monetary characteristics. (Paiva Andre, 2012) In the article, the author had commenced a study based on a survey of seven teaching and seven non-teaching hospitals were evaluated for a period of five year from 1999 to 2003. The survey was done by mailing a set of questionnaires to the patients who had discharged. The patients who were the study participants involved aspects of demographic diversity, level of income, coverage of insurance, age and other relevant features. The questionnaires of the survey were related to the process of admission, room services, meals, service provided by nurses, method of tests and treatment, personal issues, physician, discharge and on the entire assessment. This questionnaire would help to evaluate the level of satisfaction of the patients by using the five-point Likert type scale. The data of the volume of inpatient admissions were obtained by the interested hospitals who submitted their admission data for the years 1999 to 2003. Then the data on the volume of admission and the survey data of t he patients is utilized in the statistical analysis. The study helped to answer two research questions. One is the nature f the association of patient satisfaction and the volume of inpatient admission in the acute care hospital and other is the relationship between the patient satisfaction and the volume of admission of inpatients in teaching and non-teaching hospitals. (Carlberg, 2011) The statistical analysis exhibited the patient satisfaction as the dependent variable and the admission volume is the independent variable. From the summary table of the statistically analysis, it can inferred that the Spearman rank-order correlation, r is -0.287 where the p-value is 0.018. It shows that there is a significant level of negative correlation between the patient satisfaction and volume of admission in the two types of hospitals. (Graham, 2011) This implies that as the level of the satisfaction increases, the volume of the admission in the hospitals will decrease. Mann-Whitney U test determines the significance of the analysis. The null hypothesis is that the teaching and the non-teaching group is identical and alternative hypothesis is significant difference between the two groups. Since the value of n is 35 as the analysis is done on seven hospitals and over a period o five years. The test is done by the z-statistics which is calculate to be -4.064 and this value is gr eater than the tabulated value of z, so the null hypothesis is rejected and the alternative hypothesis is accepted. Here the p value is less than 0.001 which proves that the analysis is statistically significant. (Spiegel Stephens, 2011) In terms of individual calculation of the Spearman correlation, the value of r is 0.581 and p-value is less than 0.001 which imply that the patient satisfaction and admission volume in teaching hospitals have significant and positive correlation. On the contrary, the value of r is -0.097 and the p-value is 0.579 which proves that the relationship between the patient satisfaction and the volume of admission in non-teaching hospital is statistically insignificant and a negative one. (Kollo, 2013) The reasons behind the differences in the level of patient satisfaction in the teaching and non-teaching hospitals can be attributed to the organization differences in both the type of hospitals. In the teaching hospitals the organizational structure is complex but there is the scope for training and enhancement of medical knowledge whereas the scope in the non-teaching hospitals is limited as they concentrate mainly on the care and treatment to the patients. This might seem as the correlation must be positive with the non-teaching hospitals as they totally concentrate on the quality service of the patients but it does not change with the changes in the medical environment which limits the opportunities. Another aspect is the duration of the stay of patients in the teaching hospitals are more than that of the o-teaching hospitals which can affect the satisfaction level of the patients and increase the admission rates in the teaching hospitals. (Schoenfelder, Klewer Kugler, 2011) 2. The summary of the data analysis reveal the frequencies, means, medians and the standard deviations with which the characteristics of the hospitals were measured with respect to the satisfaction level of the patient and admission volume. To determine the shape and the distribution of the relevant data used in the analysis skewness and kurtosis were measured. The data used cannot be conclusively stated that its distribution is normal as the sample size acted like a constraint in this regard. So to avoid the complexities, non parametrical statistical test was selected to commence the data analysis. The relationship between the satisfaction of patients and the hospitalization rates were conducted through the analysis of the correlation coefficient of the Spearman Rank order. Here seven hospitals of teaching and non-teaching type each were selected and the analysis or the data collected from the interested hospitals were based on a five year record during 1999-2003. In the next sectio n the Mann Whitney U-test was performed to understand the dissimilarity between the subsample of teaching and non-teaching hospitals. The connection between the patient satisfaction level and the level of hospitalization was discovered using the analysis of the independent and the dependent variable. (Kobayashi, Mark Turin, 2012) 3. The study was based on the association between the patient satisfaction score and the volume of admission was conducted. The data used for satisfaction of the patients were derived from the patients who were discharged from the hospitals. The data was collected through the survey of set questionnaires that were analyzed through the five-point likert scale. The data for the admission volume where collected from the hospitals through their records. Both the data were complied to form the basis of the statistical analysis. The correlation coefficient gave a different story to the different analysis. So the Mann Whitney U-test was performed. Here also due to the complexity in the sample size and the data distribution, non-parametrical statistical analysis was done. The z statistics was calculated and proved to be greater than the tabulated value of z with the relevant degrees of freedom. (Sprinthall, 2012) This proves that the analysis is statistically significant. Here the null hypot hesis is the identical relation between the non teaching and the teaching hospital. The statistical significance is judged when the calculated value of z exceeds the tabular value then the hull hypothesis is rejected and the alternative hypothesis is accepted. Also the p-value is less than 0.001 which means that the lower the value of p, the higher the chances of the association and this is why it is called statistically significant. The hypothesis is the notion that the researcher is analyzing to prove. In this regard it is proved that there are differences in the teaching and the non teaching hospitals. The statistically significance of the data analysis proves that there is a significant difference between the satisfaction scores of the patients and the admission rates in the teaching hospitals with the same when the non-teaching hospitals are considered. Furthermore it can be said that when the correlation analysis were conducted individually, it was proved that there remained a certain level of differences between the dependent and the independent variables in the teaching and the non teaching hospitals. (Horton Kleinman, 2011) Pragmatic usefulness or validity is a measurement tool that acts like a predictor regarding certain features of the variables used in the statistical analysis. (wiseGEEK, 2015) The pragmatic approach reveals the responsiveness of the measure that used to explain the criterion or characteristics of the analysis. Another approach is the concurrent validity. The pragmatic validity is measured through the correlation coefficient of the variables. In this case the higher the value of the correlation coefficient, the more pragmatic validity is confirmed. (RE, 2015) The correlation done between the satisfactions of patients with the combined data of the admission rates reveal that the value of r is -0.287 which establishes a negative correlation but the value is not high. Again when the correlation was conducted between the satisfaction scores of patients and the admission rates in teaching hospitals where the value of r is 0.581 which is positive and the value is relatively high. Lastly, the correlation between the satisfaction scores of the patients and the volume of admission in the non-teaching hospitals was conducted and the value of r is -0.097 which is negative and relatively low value. Thus for the first and the third case, pragmatic validity or usefulness cannot be justified, whereas for the second case the pragmatic validity is justified. The result is somewhat different in the case of the statistical significance measure. But the pragmatic validity is not a popular or relevant measure, so it is wise to consider the results of test of significance. (WALTON LAYTON, 2012) References Carlberg, C. (2011).Statistical analysis. Indianapolis, Ind.: Que. Graham, A. (2011).Statistics. London: Hodder Education. Horton, N., Kleinman, K. (2011).Using R for data management, statistical analysis, and graphics. Boca Raton: CRC Press. Kobayashi, H., Mark, B., Turin, W. (2012).Probability, random processes, and statistical analysis. Cambridge: Cambridge University Press. Kollo, T. (2013).Multivariate statistics. Singapore: World Scientific Pub. Co. Paiva, T., Andre,. (2012). Evaluating aesthetics of the nasolabial region in children with cleft lip and palate: professional analysis and patient satisfaction.PPA, 781. doi:10.2147/ppa.s36656 RE, G. (2015).What does it mean to be pragmatic? Pragmatic methods, measures, and models to facilitate research translation. - PubMed - NCBI.Ncbi.nlm.nih.gov. Retrieved 14 May 2015, from https://www.ncbi.nlm.nih.gov/pubmed/23709579 Schoenfelder, T., Klewer, J., Kugler, J. (2011). Analysis of factors associated with patient satisfaction in ophthalmology: the influence of demographic data, visit characteristics and perceptions of received care.Ophthalmic And Physiological Optics,31(6), 580-587. doi:10.1111/j.1475-1313.2011.00869.x Spiegel, M., Stephens, L. (2011).Statistics. New York: McGraw-Hill. Sprinthall, R. (2012).Basic statistical analysis. Boston: Pearson Allyn Bacon. WALTON, T., LAYTON, D. (2012). Cost satisfaction analysis: a novel patient-based approach for economic analysis of the utility of fixed prosthodontics.Journal Of Oral Rehabilitation,39(9), 692-703. doi:10.1111/j.1365-2842.2012.02314.x wiseGEEK,. (2015).What Is Statistical Significance? (with picture). Retrieved 14 May 2015, from https://www.wisegeek.org/what-is-statistical-significance.htm