# Data Collection and Analysis

Researchers used rapid-assessment data-collection techniques to identify factors that contributed to cost and to explain some of the variations in cost that occurred among different sites. Rapid-assessment procedures include qualitative, cross-sectional, limited-duration field observations and interviews of small, non-representative study populations. Such procedures usually produce quantifiable data that may suggest economic and/or behavioral trends.

Rapid-assessment methods [28] are most effective when focused on a specific, well-defined issue with a narrow range of (probable) procedural and/or behavioral variation, as is the case for treatment of first-trimester incomplete abortion in hospital settings. For the treatment of incomplete abortion, there are a limited number of intra-hospital variations in time and cost of a given procedure (e.g., MVA or D&C). Where costs vary _betueen_ the two procedures, the differences were expected to be large enough to justify use of rapid-assessmen **t** echniques. Because of the circumscribed nature of the issue under study, and because of the field staffs' familiarity with most of the study sites, a brief observation period and small sample size were considered adequate.

The research design was similar to a study that estimated clinic costs for menstrual regulation patients in Bangiadesh [29]. As in Kay and Kabir's study, project field staff attempted to identify all of the significant resources associated with abortion care. Instead of using estimates as a basis for detennining costs, however, the data-collection protocol caUed for field staff to document, where possible, actual expenditures of time and resource units by accompanying patients from the beginning to the end of their hospital stay.

Field staff began the data-coUection process by interviewing hospital administrators and/or clinicians to learn about the hospitals and their management and staffing situations. This allowed field staff to become more familiar with the sites and to begin to discem the contexts within which patients were treated for incomplete abortion. Field staff also interviewed gynecologists, nurses and patients. They consulted health-system, hospital and patient records to obtain detailed information about admission and discharge procedures, caseload and case management and assessment.

Hospital costs associated with treatment of incomplete abortion -- including salaries and costs of drugs, medical instruments, miscellaneous supplies and hospitalization -- were determined by checking salary tables, drug cost lists, central operations records and health-system budgets. Al of the information (except overhead expenses) obtained from interviews and records was confirmed or modified by subsequently observing the complete treatment process abortion patients undergo from admission to discharge. A detailed account of the major cost determinants appears in Appendix 2.

To ensure that cost calculations would reflect routine variations in staffing pattems and daily caseloads, observations took place over a minimum seven-day period at each site. Data collected were limited to standard D&C procedures and MVA procedures performed with IPAS' Karnan cannulae and syringes.

The study design called for data collectors to observe at least 15 women at each site throughout their entire hospital stay for treatment of incomplete abortion. The researchers considered a sample size of 15 to represent a reasonable number of observations for one person to make during a one-week datacolection period. Also, researchers judged that 15 patient observations would be sufficient to _5_