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IPP Screening Audit IPP Meeting May 31, 2006 Preeti Pathela ([email protected])

IPP Screening Audit IPP Meeting May 31, 2006 Preeti Pathela ([email protected])

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Page 1: IPP Screening Audit IPP Meeting May 31, 2006 Preeti Pathela (ppathela@health.nyc.gov)

IPP Screening Audit

IPP MeetingMay 31, 2006

Preeti Pathela ([email protected])

Page 2: IPP Screening Audit IPP Meeting May 31, 2006 Preeti Pathela (ppathela@health.nyc.gov)

In stratified random sampling from a population of size N, what sample size n is necessary to determine a proportion ¶ to within the maximum allowable difference D with confidence P?

To answer this, we want to use the following parameters:

N= Each project area’s population size

D= The maximum allowable difference (or margin of error)

¶= Estimated proportion screened

P= Confidence level (or alpha)

Question of interest:

Page 3: IPP Screening Audit IPP Meeting May 31, 2006 Preeti Pathela (ppathela@health.nyc.gov)

Take the smallest subgroup of STD and smallest subgroup of FP (in other words, the STD or FP project area with the smallest eligible population (N)), and calculate their required sample size (n) based on the parameters we set.

Whatever percentage the n is of that area’s N will be applied to all the other subgroups of STD or FP.

Eligible population for: STD: females under 30 yrsFP: females under 25 yrs for initial or annual exam

Getting the sample size

Page 4: IPP Screening Audit IPP Meeting May 31, 2006 Preeti Pathela (ppathela@health.nyc.gov)

Using information provided, project areas included were:

STD: NJ, NYS, NYC

• NYS had the smallest eligible population• Range of estimated number screened was

83.8% - 95.7%

Family planning: NJ, NYS, and NYS [USVI FP provided eligible population, but it was so small that it would have greatly increased the sample size for all other areas].

• NYC had the smallest eligible population• Range of estimated number screened was

74.0% - 91.1%

Implementation

Page 5: IPP Screening Audit IPP Meeting May 31, 2006 Preeti Pathela (ppathela@health.nyc.gov)

• NYS clinics 2005: N=4,792• D: Set at .03

We’re allowing a maximum allowable difference of 3% around the proportion estimate

• ¶: Set at .90We’ll estimate that of all eligible women in the population has an MD visit, 90% are screened for Ct.

• P: Set at .95We’ll estimate our proportion (within +3%) with 95% confidence; in other words, if we repeated this exercise 100 times, 95 of those times we would find that the true proportion of women screened is between 87%-93%.

• If the true proportion is lower than 87%, we will perform a statistical test (z-score) to assess if the difference between the estimated and observed proportions is statistically significant.

Parameters used (STD)

Page 6: IPP Screening Audit IPP Meeting May 31, 2006 Preeti Pathela (ppathela@health.nyc.gov)

356 is 7.4% of 4,792 (NYS STD clinics’ N).

Thus, we want to take a 7.4% sample from all other project areas.

Subgroup N

NYS STD 4792

NYC STD 7448

NJ STD 5301

n (=N*7.4%)

362

551

394

Calculated sample size and sample sizes for all other groups

Using a power and sample size calculator:

n= 356

Page 7: IPP Screening Audit IPP Meeting May 31, 2006 Preeti Pathela (ppathela@health.nyc.gov)

• NYC clinics 2005: N=5,621• D: Set at .05

We’re allowing a maximum allowable difference of 5% around the proportion estimate

• ¶: Set at .85We’ll estimate that of all eligible women in the population has an MD visit, 85% are screened for Ct.

• P: Set at .95We’ll estimate our proportion (within +5%) with 95% confidence; in other words, if we repeated this exercise 100 times, 95 of those times we would find that the true proportion of women screened is between 80%-90%.

• If the true proportion is lower than 80%, we will perform a statistical test (z-score) to assess if the difference between the estimated and observed proportions is statistically significant.

Parameters used (FP)

Page 8: IPP Screening Audit IPP Meeting May 31, 2006 Preeti Pathela (ppathela@health.nyc.gov)

191 is 3.4% of 5,621 (NYC FP clinics’ N).

Thus, we want to take a 3.4% sample from all other project areas.

Subgroup N

NYC FP 5621

NYS FP 45133

NJ FP 68410

n (=N*3.4%)

191

1535

2326

Calculated sample size and sample sizes for all other groups

Using a power and sample size calculator:

n= 191

Page 9: IPP Screening Audit IPP Meeting May 31, 2006 Preeti Pathela (ppathela@health.nyc.gov)

• Once you have a sample size, you can draw the random sample based on how the medical records are put in order (by date of visit, alphabetically by name, etc.)

• Microsoft Excel

• Random number table3680 2231 8846 5418 0498 5245 7071 2597

If you wanted to sample two records from records numbered 1 to 48 we would read off the digits in pairs:36 80 22 31 88 46 54 18 04 98 52 45 70 71 25 97

If we wanted to sample two records from a much longer list with 140 records in it we would need to read the digits off in groups of three:368 022 318 846 541 804 985 245 707 125 97

Choosing a random sample

Page 10: IPP Screening Audit IPP Meeting May 31, 2006 Preeti Pathela (ppathela@health.nyc.gov)

• In a random sample every member of the population has an equal chance of being chosen, which is not the case with a systematic sample, but it is almost always accepted as being random.

• Suppose you want to sample 8 charts from a population of 120 charts. 120/8=15, so every 15th chart is chosen after a random starting point between 1 and 15. If the random starting point is 11, then the charts selected are 11, 26, 41, 56, 71, 86, 101, and 116.

Choosing a systematic sample