DDHA 9901 Week 8 Provenance Critique Example

Where Every Figure in a Classmate's Antibiotic Delivery Case Came From: A Peer Critique Organized by Source, Asking Three Questions of Each

Student Name

Walden University

DDHA 9901: Practice-Based Problem Identification

Instructor Name

Month Day, Year

Where Every Figure in a Classmate's Antibiotic Delivery Case Came From: A Peer Critique Organized by Source, Asking Three Questions of Each

The Draft and the Method

My classmate Rafael's draft argues that first doses of intravenous antibiotics reach inpatient units too slowly at his composite hospital after the pharmacy centralized its operations. The problem may well be real. This critique tests where each figure and claim came from. It is organized by source rather than by section of his draft, and for each claim it asks three questions: whether the source observes the phenomenon at all, whether it covers the period claimed and whether the field it reports is defined the way the sentence assumes.

Source 1: The Pharmacy Dispensing System

Claim quoted: "First doses of intravenous antibiotics arrive on the unit a median of 94 minutes after the order."

Does the source observe the phenomenon? Only partly. The draft takes "delivered time" from the dispensing system, but Rafael's own appendix describes that time stamp as the moment a courier scans the dose leaving the pharmacy, not the moment it reaches the unit. The interval measured runs from order to departure from the pharmacy. Arrival on the unit, which is what the sentence claims, is not observed.

Does it cover the period? Yes, for the six months stated.

Is the field defined as assumed? No; "delivered" means dispatched. The sentence should say "leave the pharmacy a median of 94 minutes after the order," or the draft should add a source that records arrival, such as the unit's medication administration record, which shows when the first dose was given. Weiskopf and Weng (2013) describe correctness and concordance as separate dimensions of data quality, and this is a case where a field is correct for its own purpose and wrong for the purpose the draft gives it.

Source 2: The Nurse Survey

Claim quoted: "Nurses report delays daily."

Does the source observe the phenomenon? It observes perceptions of it. Twenty-three nurses answered a five-question survey about whether antibiotics arrive late. That is evidence about experience, which is useful, but not evidence of frequency.

Does it cover the period? The survey was taken in one week and asked about "recently," so it cannot support a claim about a pattern over months.

Is the field defined as assumed? "Daily" was a response option, not an observation. The sentence should read "most of the 23 nurses surveyed described delays as a daily occurrence."

Source 3: The Comparison Before and After Centralization

Claim quoted: "Delays increased after the pharmacy moved to a centralized model in January."

Does the source observe the phenomenon? The dispensing data observe order-to-departure intervals.

Does it cover the period? No. The extract in the appendix begins in April, three months after centralization. There are no data from before January, so the draft cannot show an increase. This is the most serious gap, because the "after centralization" framing carries the argument. Either data from the previous year must be obtained or the claim must be removed.

Is the field defined as assumed? The same dispatch-time issue applies.

Source 4: The Sepsis Flag

Claim quoted: "Patients with sepsis wait longest."

Does the source observe the phenomenon? It observes a flag. The draft uses the record's sepsis alert field, which records that an automated alert fired, not that a patient had sepsis. Iezzoni (1997) warned that data collected for one purpose carry their purpose with them, and an alert field reflects the alert's rules, including false alarms.

Does it cover the period? Yes.

Is the field defined as assumed? No. The sentence should say "patients for whom a sepsis alert fired," and any claim about sepsis itself would need a confirmed diagnosis.

Claim Resting on Nothing Traceable

Claim quoted: "The national standard is that first doses be given within 60 minutes."

No source is cited, and none appears in the reference list. The figure may correspond to sepsis treatment guidance, which applies to a specific population and is not a general standard for all first doses. Rafael should locate the guideline he has in mind, state which patients it applies to and limit the comparison to them. As written, the sentence presents an unattributed number as a universal benchmark.

Summary of Edits

The draft's core finding, that first doses leave the pharmacy a median of 94 minutes after the order, is supported for the six months covered. The claims about arrival on the unit, an increase after centralization, sepsis and a national standard are not yet supported by the sources cited. Kahn et al. (2016) emphasize that data should conform to the definitions analysts assume, and nearly every gap here is a definitional one. Fixing them would make the case smaller and much harder to dispute.

References

Iezzoni, L. I. (1997). Assessing quality using administrative data. Annals of Internal Medicine, 127(8, Pt. 2), 666-674. https://doi.org/10.7326/0003-4819-127-8_Part_2-199710151-00048

Kahn, M. G., Callahan, T. J., Barnard, J., Bauck, A. E., Brown, J., Davidson, B. N., Estiri, H., Goerg, C., Holve, E., Johnson, S. G., Liaw, S.-T., Hamilton-Lopez, M., Meeker, D., Ong, T. C., Ryan, P., Shang, N., Weiskopf, N. G., Weng, C., Zozus, M. N., . . . Schilling, L. (2016). A harmonized data quality assessment terminology and framework for the secondary use of electronic health record data. eGEMs, 4(1), Article 18. https://doi.org/10.13063/2327-9214.1244

Weiskopf, N. G., & Weng, C. (2013). Methods and dimensions of electronic health record data quality assessment: Enabling reuse for clinical research. Journal of the American Medical Informatics Association, 20(1), 144-151. https://doi.org/10.1136/amiajnl-2011-000681