75. Doctors and nurses Nurse-practitioners are nurses with advanced qualificatio

Question

75. Doctors and nurses Nurse-practitioners are nurses with advanced qualifications who often act much like primary-care physicians. Are they as effective as doctors at treating patients with chronic conditions? An experiment was conducted with 1316 patients who had been diagnosed with asthma, diabetes, or high blood pressure. Within each condition, patients were randomly assigned to either a doctor or a nurse-practitioner. The response variables included measures of the patients' health and of their satisfac- tion with their medical care after 6 months.4 Which are the blocks in this experiment: the differ- ent diagnoses (asthma, and so on) or the type of care (nurse or doctor)? Why? Explain why a randomized block design is preferable to a completely randomized design here. (a) (b)

Explanation / Answer

(a) In an experiment to test any difference in effictiveness of the treatment administered by doctors and nurse practitioners in patients with chronic conditions,

The treatments to be tested here are two : Treatment by 1.Nurse practitioners

2.Doctors

Here, the blocks (3 in number) in this experiment are formed on the basis of the type of chronic condition;i.e. the blocks are the dignosis (Asthma, Diabetes, High blood pressure).

Because, to test the efficiency of treatments, these diagnosis types are the factors that cause heterogeneity in the experimental material i.e. observations of measures of patient's health and of their satisfaction.

Hence in order to obtain reliable and accurate outcomes, the observations must be grouped according to the disease type.So, the efficiency of treatment offered by both groups can be accurately studied in each of these cases.

(b) As mentioned above, the diagnosis for each of the 3 chronic conditions follow very different approches and outcomes.So, if all 1316 random patients suffering from any of the chronic condition are randomly assigned one of the 2 practitioners, the effect due to type of the disease may creep in, directing us to misleading results.

Hence it is essential to verify that these measures are sub-grouped into homogenous blocks so that the treatment variability among the 3 types of diseases are reduced.This blocking ensures that each of the types of practitioners recieve equal proportion of the 3 types.

This ensures, differences between the two groups of practitioners cannot be attributed to disease type.This will direct focus to the sole cause of variability between the approaches adopted by the nurse practitioners and doctors.

Hence a randomized block design is preferable to a completely randomized design.

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