Visual depiction of intervention patterns over time enables hypothesis generation and hypothesis testing

Background: Within the last decade, increasing numbers of public health nursing agencies have adopted electronic health records to enhance documentation capacity for program evaluation and fiscal accountability. Widespread use of documentation software in public health nursing has enabled advances in data and practice quality and generated copious amounts of data regarding public health nursing interventions. The interface terminology most often used by PHNs to document assessments and interventions is the Omaha System. New methods are needed to manage and interpret these complex data, to generate and test hypotheses about intervention patterns over time, and evaluate associations between client characteristics, interventions, and outcomes.

Methods: Intervention data were arranged in three different graphing formats to enable interpretation of hidden patterns in the data.

Results: Distribution of target terms by problem. This graph enables ease in visualizing use of paired intervention terms from evidence-based pathways for the entire sample, by agency, and by client risk index in order to achieve a better grasp of overall intervention content in PHN family home visiting. Distribution of intervention categories over time. This graph compares ratios of case-management:surveillance:teaching-guidance-and-counseling by client risk index to show differences in intervention patterns over time by client risk. Kaplan-Meier curves for stabilization. Kaplan-Meier curves depict changes in intervention patterns related to client outcomes.

Conclusions: Each of the graphing methods revealed new knowledge about public health nursing intervention patterns, while simultaneously generating hypotheses to be tested using traditional qualitative and quantitative methods in future research.