Data Analysis Report: ORAI Impact on DEXA Scan Referrals

This report presents a data analysis of a study investigating the impact of the Osteoporosis Risk Assessment Instrument (ORAI) on DEXA scan referral rates in primary care medical offices. The study involved 66 contributors from Cranford and 112 from Elizabeth, utilizing both nominal and scale data. Statistical methods included descriptive statistics, one-sample T-tests, and non-parametric tests to analyze variables such as age, gender, and ethnicity. The analysis aimed to determine if ORAI usage increased DEXA scan referrals, and the results indicated a statistically significant relationship between the two. The study found increased referral rates after ORAI implementation, particularly in the Cranford and Elizabeth offices. Limitations included Type I and II errors, and the study highlighted the importance of considering factors like chronic illnesses and lifestyle in assessing fracture risk. The report also underscores the need for further research, including the use of FRAX to improve patient care and ensure appropriate DEXA scan recommendations, especially for the elderly population.

Data Analysis
Post Test Phase
Sample size:
Sixty-six contributors from Cranford area, one hundred and twelve contributors from
Elizabeth site
Statistics Used:
Both nominal and scale data have been used. The graphic statistics such as frequency,
percentages and crosstabs, parametric one-sample T-test with a 95% confidence interval to
examine the quantitative values (detailed store) and non-parametric tests were employed to
castoff the “null” hypothesis.
“Null” hypothesis at the substantial level 0.05:
1. The dissemination of the diverse values across scored and denoted are
correspondingly prospective (reject; not likely).
2. The dispersal of the detailed score (raw store) is alike across classifications of stated
(rejected; not the same)
On the other hand, the null hypothesis describes that “Dexa scan recommended rates
would be similar; had no variances after ORAI”. In one case, T-test is utilized to
assist to reject the null set and search out whether ORAI is adequate enough to utilize
in the primary care medical offices. It is significant enough to alert primary care
providers that practice of ORAI intensifies DEXA scan referral rates in prime care
medical offices and outpatient clinics.
Age, gender and ethnicity are the qualitative and nominal data variables are entered
into the IBM SPSS Statistics data analysis program. It is utilized for collaborative
statistical data analysis. Such software program has been investigated data sets
(labeled variables without quantitative worth) by expending categories like frequency,
percentage, and crosstabs to decide whether or not there are any variations,
comparisons or other interactions between variables.
This project has gathered qualitative-nominal data - on a binary, yes/no matrix. It
reflects that the patients questioned could only offer a yes or no response to the
questions asked and were incapable to offer a value that varied by degree of force. For
instance, one question in this study has been asked if patients have taken cortisol
steroids “for a protracted period?” The patients were supposed to answer with just yes

or no. The data collector and educational hand-outs helped the patient to define what
“a protracted period” would be.
Labels/Names and Values
There are seventeen nominal data variables from the analysis such as complexion,
gender race, weight, family history, dairy, height, and exercise. The score made by the
contributors characterized as “scored” centered on whether or not they gathered
twelve or more points. Only one quantitative variable (detailed score) and is
deliberated by making use of the one-sample T-test with a 95 % confidence break of
the variance. The outcomes identified are: centered on the substantial 2-tailed (lower
and upper values), the sample size was 178, the mean was 9.02, t was 28.909,
standard deviance was 4.2 and standard error mean was 0.31. This project separated
referral rates. The referral rates were intended by separating them into 2 classes and
characterized as to whether or not the contributors were referred.
Values:
The contributors were provided with the numerical value of “1” in order to decide the
criteria or met with it like numeric value “1” is stated to white fair skin tone and “2”
for all other contributors who are not capable of meeting the criteria. SPSS inevitably
marked them with either number 1 or 2 contingent on the values being dignified.
Graphs
SPSS has a role in putting the outcomes into graphs, categorizing the patient loch by gender,
height, ethnicity, diet, weight, exercise, family history, rest lifestyle elements, and discrete
medical antiquity. It is not restrained to the former cracks, dental diseases, steroid usage,
long-lasting diseases and whether the females are pre or post-menopausal.
Cross-tabs
Both qualitative and quantitative sores came from medical offices and were investigated in
contradiction of Dexa Scan referrals by utilizing the crosstabs analysis methods in a duration
of one month period. Cross tabulation is a part of the SPSS procedure which takes into
account several variables, representing the relationship in the tabular form for the better ease
of the analysis. This research has cross tabularized multiple variables to pursuit substantial
statistical outcomes like investigating the recommendation rates of menopausal women in
percentages who ingest dairy products with those that refrain from dairy.
Error Analysis

The report represented that there is no fault occurred at the time of data revolution from
spread-sheets to the software and the contributors attained the most scores from the latter
section of ORAI where the significance of long-lasting ailments, post-menopausal
prominence, long term steroid usage played an excessive role.
The report reflected that data analysis defined the substantial variance between the
anticipated values versus the experiential one. The pre and post-test and doctor’s office’s
DEXA scan referral rates altogether. The data analysis concentrates on the procedures of
central tendency comprising the mean, and median. It is more generally used frequencies
versus measures of variable utilized only for rule data or measurable data at the time of the
calculation of the “Detail Score” like variance, standard deviation, the kurtosis, skewness,
minimum and maximum variables. On the other side, a numerical scale is intended by higher-
level descriptive statistical technique than modestly using frequencies and percentages.
The null hypothesis has been disproved by data analysis means that there is no statistical
consequence (same or likely) between DEXA scan referral rates along with the execution of
ORAI instruments. It demonstrates a statistically substantial relationship between the two
variables. The null hypothesis should be prohibited and a substitute should be used reflecting
that there are implications demonstrated between the scores and the referral rates. They are
not dispersed similarly or they are not similar.
Statistical Data
Demographics
The demographics of the project represent that 52.8 percent of the populace was
women whereas male represented 47.2%. Among these, 42.1 % were fair toned and 57. 9
percent were other rivalries. It was viewed that 44.9 % had white skin color and the
remaining had a suntanned or dark skin color. The outcome was received in 6.7% of the
populace was under 125 pounds and 93.3 percent was overhead 125 pounds on the measure.
Afterward, only 14.6 % of the populace said yes to family antiquity of breakages. On the
other side, more than 53.9 % confesses sighted their seniors at home with a deformed back
look.
Chronic Illnesses Data Analysis
It was viewed that populace had generally long-lasting diseases irrespective of the
demographics and lifestyle.
¾ of the female contributors had menopause.
Just 27% scored sufficient to be referred among all these populace to be stated and
among them just 23.6% stated.

Findings
The project views whether the contributor score over prearranged cut-off points or
not, whether they had immediate osteopenia or OP analysis and whether there are subordinate
clauses. The final result was analyzed after all the data was gathered. It proved that one of the
objectives was clearly met and surpassed by a substantial degree at the statistical p-value .02
which is lesser than the alfa substantial value at .05. I assisted to enhance DEXA scan
recommendation rates. On the other side, in the Cranford office, before the origination of the
study, there were just six referrals within the twenty-four-month duration. After the study
conducted, data was exposed that there were three referrals in 1-month duration along with
the statistical increase of 1200 %. There were six referrals in the six month period before the
study commencement at Elizabeth office. Once the study was concluded, recommendations
rise to ten recommendations in one month period along with the statistical rate increased to
1000%.
The second goal of the project indicated instant OP/osteopenia diagnosis and also met
because of over 70% of the contributors had long-lasting diseases which were deliberated as
the ancillary causes of OP and osteopenia. According to the scores, individuals have some
other causes like epilepsy, RA, DM type II, thyroid problems, and long-lasting liver ailments
other than the genuine bone thickness mineral deficiencies. The above discussion meant that
the persons who arise to primary care workplaces are more apprehensive about their long-
lasting diseases than OP or osteopenia. It was found that the care providers had no phase to
monitor people as they mostly recommend medication along with taking care of the people
with further diseases. Though, the foremost objective and the ancillary causes of
OP/osteopenia are encountered along with the instant analysis of OP/ osteopenia was not
dignified. It was because of the project scope which is not enabled the investigator to go back
into the charts and to potential data analysis. It necessitates an additional proposal to IRB to
encompass the latitude of the project along with further analysis of the outcomes.
The investigator learned that the older patients having the highest scores on the ORAI
scale were preferred less commonly than the fresher ones. This learning was offered by
Crosstabulation. For instance, 50 contributors out of 178 contributors scored over 12 points
on ORAI. 27 of these were stated which means 23.6% were stated. It has been identified to be
the acute conclusion to decide to comprise Chi-square. It represents that present screening
process for elderly people is ineffective. It leads to much fewer recommendations than what
is essential. It has been identified by comparing to the late middle age or younger. The
consequence is realized in the form that added health establishments should utilize the

Fracture Risk Assessment Tool (FRAX), mentioned by The WTO (World Health
Organization), to make sure an added suitable rate of recommendation for DEXA images and
precise fracture deterrence techniques for aged patients.
Considering the circumstance in the elderly, the project consequence represented
remarkable upsurge of DEXA scan recommendations in four weeks at these 2 primary care
offices. The risk factors have been identified by the findings such as long-lasting ailment and
post-menopausal generally found in women more than the age of 50, specific lifestyle like
inactive lifestyle, drinking soda, alcohol and carbonic beverages. Such risk elements have
assisted care establishments to form an instant analysis of OP or osteopenia. The elements
also represented DEXA scans recommendations unconditionally assisted the investigator to
detect secondary causes of OP within and between the files of 2 doctors. The project even
underscored the risk evaluation by DM type II, HTN and thyroid glitches of the OP in spite of
the contributor's other risk factors are not confined to the demographic data and assured
lifestyles.
The mass elements distinguished both clinics which could responsible for the major
variation in the increased rates. Such elements comprise variations in the socio-cultural
makeup of the patient crowds for locations comprising income level, civilization, health
attention status, and probability to use or abuse drugs. None of these factors were deliberated
at this moment. Although, irrespective of these elements which could transform the findings
represent a substantial increase in the referral rates for both locations validates that this
project encountered at least 2 out of 3 of its purposes and consequences.
Limitation
Type I & II Errors
Untrue Positive OP Risk Valuation with ORAI
The statistical assessment offers to mean to the worthless variables and breathes life
into the unconscious data. Another aspect of the project was to interpret the findings. The
lowest level of the descriptive analysis method comprising mode, frequencies and
percentages helped investigator to came across with some unfamiliar responses among the
contributors concerning the question. For instance, some contributor’s parent died very young
and they were not even able to see those dropping substantial height or having ruptures
before 45 years of age. Such type of replies to the questions documented as "No! Fractures”
due to constrained picks to response each question which upsurges type II errors
(misleadingly kept null hypothesis).

Some other situations have been also been met by the investigator. For instance,
sometimes it happens that the contributors reflect that they used to exercise but are not doing
at present. In such a situation, their replies were recorded again under the group of "No! I do
not exercise" to be reliable with data analysis and to deliberate their greatest existing level of
exercise.
At the time of revising such sort of vague information, the investigators are likely to
choose answers which assist the concept of OP risk influences than the data lowering the risk
factors of the contributors. Though Cohen's kappa coefficient (κ) is a figure which processes
inter-rater agreement for qualitative and these cannot be calculated because the project does
not have a two-way table along with the variable of the alike type. Each of the variables come
from a changed researcher. Other than this, the investigator reviewed the data appropriately
for any missing values. The further step identified was to appraisal all data along with
deliberating the cogency of each and every entry in SPSS. Afterward, data from responses
have been associated with the formerly gathered data which presented a statistically
substantial augmented referral rate. The risk factors have been established as the secondary
long-lasting disease with high percentages.
Demographic Data
A perception bias has been identified among the people who think that losing height is
quite normal whereas aging versus those think that there is a hunchback look. It is required to
comprehend that one has to lose weight rapidly and at an early age. In such a case, the
perception of the contributors is obligatory to be elucidated regarding the fact that a normal
human loses 1 inch of height in every 10 years. It becomes quite important if a person is
losing 3 inches in 6 months. On the other side, old people after attaining the age of 70, loses
more than 3 inches in rare cases is anticipated. Therefore, such percentages can be a fault or
invalid findings. The projects should be assisted on the reason like why doctors do hesitate to
state populace to DEXA scan due to what is irregular in those who are young converts normal
after definite age. Such findings can reduce the efficiency of standard screening tools which
could have been castoff in a variety of backgrounds irrespective of ages.it is required to make
clear that age connected OP risk assessment tools should be used or ORAI can be used in
order to be individualized.
The Lifestyle Data Analysis
The section of populace lifestyles, chi-square and cross tables significances
represented the points mentioned:
The persons who ingest sufficient dairy products do not use steroids

The persons who ingest sufficient dairy products do not consume alcohol and do not
smoke. The gum disease and tooth decay rates are found comparatively less in both cases and
in both the genders.
The project revealed that one-third of the populace do not even exercise required and
this same data has been found in the people who drink more than five cups of coffee, soda,
and tea.
On the other side, it has been observed that persons who do not have a good lifestyle
comprising exercise and ingestion of dairy products admit suffering from one of the long-
lasting ailments that can cause OP.
At this movement, PCP can be missing age concerning data which varies in each and
every lifetime. Here unexposed risk factors seem to be normal and non-significant.
Place of Male versus Female in Data Analysis
The project represented that male populace over the age of fifty are deliberated to be
of dark or tan skin, weighing over 125 pounds, repudiates record of family fractures along
with generally witnessing folks lose height after the age of 45 years. Such people are even
likely to confess consuming dairy products and practicing exercise without the consumption
of the drinks and smoke. In such a case, persons denied gum ailments along with the
consumption of the steroids. The consumption of steroid in the males was found more than
females. Consequently, they judged less to DEXA scan than the female ones.
The findings of the project also represented that female in the stage of menopause
drinks less tea, coffee and soda compared to 3 times more anticipate being referred in the
males. It is because of the perception of women that these should be at the risk.
When both the genders are compared, males are not anticipated to score high even
then they do not drink tea, coffee, and soda. The males are discovered to have fewer risk
causes and score less than twelve points on ORAI if sufficient dairy products are consumed.
The females in the menopause identified to do more exercise and use less of the steroids than
younger ones. Both of the genders regardless of the age represented to have several long-
lasting diseases and visit the family doctor for the medical issues than just taking OP
defensive measurement principally.
Add on, the females not exercising and in menopause are prospective to have 4 times
more recommendations than the male ones. The males who are not exercising are found to be
scoring less than twelve points and mentioned almost three times less than the females who
are exercising in the relevant category.

The males and females are very improbable to consume steroids and drink dairy, tea,
coffee, and soda in the same period of time. The females who are skinny and fair, do not
drink and consume dairy products are more prospective to be in menopause and mentioned
more than men in the same crowd. Both male and female who exercise and had no FH of
fractures score fewer than twelve points and are less probable to be mentioned.
Limitations
The limitations have been revealed by the project like female contributors prefers to go to
OBGYN and Rheumatologists or any other experts than coming to primary care offices for
the long-lasting disease. Most of the contributors speak Spanish in Elizabeth site and the
prescription is written in only English language. It creates to substantial loss of the
information from this populace. Add on, the medical history comprising long-lasting diseases
section does not comprise other sexually conveyed illnesses, HIV or are an illness which can
capture the small percentage of the hidden populace.
Recommendations and Discussion
Economic/Cost Benefits of Your Project
This project has grabbed the attention of the age concerning OP risk influences which appears
to be a well-organized measure. This project has discovered that using screening tools are
unsuccessful after 65-70 years of ages. These are not even defensive at that stage of low bone
mass volume and breakage rates become significant. These should be deliberated all together
with secondary factors in its place broadcast for OP risk factors. Consequently, growing
DEXA scans by least 20% should decrease significant vertebral along with the hip fracture
rates in elderly males who are 65 years and more after exploiting extra FRAX scale
moderately than ORAI instrument; occasioning in less nursing home care, and smaller
hospital visits.
The persons with the injuries and fractures instigated by weak bones should be detached from
other reasons of falls and fractures owed to trauma. As an additional approach, a person
having good age and scoring high on any defensive OP risk valuation tool should be directly
educated on the deterrence of falls and fractures. Some additional actions should be taken to
visit orthopedics, podiatrists, eye doctor, neurologists, cardiologists if any kind of heart
inactivity is felt, DM type II, glaucoma, gait and balance glitches, seizures, long-lasting
diseases. Long-lasting diseases should be treated well. Their caregivers should be reinforced
and cultivated in order to prevent the falls and fractures at home, comprising which type of
measures should be undertaken to hygiene the hallways. The elder people are required to go

for the physical therapy and reinforce the upper and lower body muscles mass along with the
leg muscles in order to keep the body alignments balanced.
The persons at the risky stage and are younger than 65 years are required to be
evaluated by a risk valuation tool. They can even state to DEXA scan which will bounce PCP
a significant consequence.
Impact on healthcare quality and safety
The enhanced DEXA scans have resulted in a variation in the medical offices from
what is presently suggested. It does not look to have any assistance for elder patients at all.
Several times, it was mentioned that OP diagnosis assumed too late and not capable of
preventing any major bones fractures in males along with the high costs. Monitoring persons
with ORAI after attaining the age of 65 will not be operative in averting OP. it will even not
restore health along with preventing any fracture surely. It can cause to negligence in the care
and can lead to the malpractices. It can even lead to weakened functions and prominent to a
superior chance of disability in life and expensive to the employees.
Policy implications
The policies such as Medicare payment supports to the people above the age of 65
who are out of the pocket costs. Although, Medicare and concerning federal and isolated
insurance plans have changing severe rules and exposure policies and repayments to PCPs
(Morden et al., 2014, pp. 2307-2311 ). Consequently, the project was applied at other clinics
and a great number of the patients were referred on time before the occurrence of the fracture.
It raised the consciousness of the issue along with the requirement of losing the severe
recompense policies.
Covering a wide range of patients’ former than the suggested practice will upsurge
clinical income and fetch more patients with OP to their primary care offices back.