MSCI101 Coursework Exercise 2018 Management report for MSK service Name: Jason Lam Library Card Number: 34718397 I have read the coursework declaration form and I accept the University rules on cheating and plagiarism. I state that the work submitted is my own and does not contain any unacknowledged work from other sources. As the author of the submitted work I am prepared to undertake an oral examination of its contents Executive Summary The primary purpose of this report is to use the data which have been analysed, to provide advice to CCG on the five issues identified. From the results we have recorded and analysed, we can now recommend the best operational methods to CCG. Introduction This report is aiming to help CCG management to have an optimal plan for the coming years with the MSK services they provide. Providing the analysis we are constructing, we can then support our conclusion with evidence Issue 1 Overall Volume (provided) Physio Daycase Inpatient Total Area A 6399 1086 402 7887 Area B 6432 1412 465 8309 Total 12831 465 867 16196 Table 1.1 Percentage of different cases in Area A and B Physio Daycase Inpatient Total Area A 81.13% 13.77% 5.1% 7887 Area B 77.41% 16.99% 5.60% 8309 Total 12831 2498 867 16196 Table 1.2 From Table 1.2, we can see that main spread of the data for both area A and B is located under the physio column, approximately 81% and 77% respectively. With daycare, area A has recorded 13.77% and area B has recorded 16.99% which shows that area B has more Daycases then area A in terms of their total volume. Furthermore, in terms of inpatient cases, both areas have approximately the same percentage which means area B should have more inpatient cases as then area A as it has a higher total amount of cases. Expected numbers of different cases in Area A and B Physio Daycase Inpatient Total Area A 6248.339 1216.456 422.2048 7887 Area B 6582.661 1281.544 444.7952 8309 Total 12831 2498 867 16196 Table 1.3 Chi-Squared Test Chi-squared statistic = sum of (observed values– expected values)2 / expected values = (6399-6248.339)2/6248.339 + (1086-1216.456)2/1216.456 + (402422.204)2/422.204 + (6432-6582.661)2/6582.661 + (1412-1281.544)2/1281.544 + (465-444.795)2/444.795 = 36.232 The result of the chi-squared test is greater than 5.991 which means we can reject the null hypothesis as it is statistically significant. Issue 2 In particular, a course of physio treatment costs on average £200, treatment as a daycase costs on average £500, and treatment as an inpatient costs on average £1500. Overall Volume (provided) Physio Daycase Inpatient Total Area A 6399 1086 402 7887 Area B 6432 1412 465 8309 Total 12831 465 867 16196 Table 2.1 Overall Costs of the three types of work in the two areas Area A Physio Daycase Inpatient Total 6399*200 = 1279800 1086*500 = 543000 (22%) 402*1500 = 603000 (25%) 2425800 (53%) Area B 6432*200= 1286400 (48%) 1412*500 = 706000 (26%) 465*1500 = 697500 (26%) 2689900 Total 2566200 1249000 1300500 5115700 Table 2.2 In issue 2, we can see that the total costs of all treatments are £5115700 with the costs of physio treatments being the biggest portion (£2566200) and then the costs of inpatient cases (£1300500) and finally the costs of daycases being the least with only £1249000. If we look at the data in a more detailed ways, we can see that actually in area A costs for physio treatments are lower than in area B, but the percentage of the physio treatments are higher which suggests area A spent most in physio treatments compare to the other two treatments. However, area B also focuses the most on physio treatments as it has the highest portion of costs out of the total cost of area B which showes in both areas physio treatments are the ones that has the highest demand. Issue 3 Numbers of patients aged under 65 undergoing the three types of MSK service (provided) Physio Daycase Inpatient Total Area A 4371 508 126 5005 Area B 4113 791 187 5091 Total 8484 1299 313 10096 Table 3.1 Numbers of patients aged 65 and over undergoing the three types of MSK service (provided) Physio Daycase Inpatient Total Area A 2028 578 276 2882 Area B 2319 621 278 3218 Total 4347 1199 554 6100 Table 3.2 Percentage of the number of patients aged under 65 undergoing the three types of MSK service in Area A and B Physio Daycase Inpatient Total Area A 87.3326% 10.1498% 2.5174% 5005 Area B 80.7896% 15.5372% 3.6731% 5091 Total 8484 1299 313 10096 Table 3.3 Percentage of patients aged 65 and over undergoing the three types of MSK service in Area A and B Physio Daycase Inpatient Total Area A 70.4166% 20.0555% 9.5766% 2882 Area B 72.0633% 19.2977% 8.6389% 3218 Total 4347 1199 554 6100 Table 3.4 Expected numbers for patients aged under 65 Physio Daycase Inpatient Total Area A 4205.8656 643.9674 155.1668 5005 Area B 4278.1343 655.0325 157.8331 5091 Total 8484 1299 313 10096 Table 3.5 Expected numbers for patients aged 65 or over Physio Daycase Inpatient Total Area A 2053.7793 566.4783 261.7422 2882 Area B 2293.2206 632.5216 292.2577 3218 Total 4347 1199 554 6100 Table 3.6 Patients aged under 65 Chi-squared statistic = sum of (observed values– expected values)2 / expected values = (4371-4205.866)2/4205.866 + (508-643.967)2/643.967 + (126-155.167)2/155.167 + (4113-4278.134)2/4278.134 + (791-655.033)2/655.033 + (187-157.833)2/157.833 =80.662 The chi-squared result is greater than 5.991 which suggests we can reject the null hypothesis as it is statistically significant. Patients aged 65 and over Chi-squared statistic = sum of (observed values– expected values)2 / expected values = (2028-2053.78)2/2053.78 + (578-566.48)2/566.48 + (276-261.74)2/261.74 + (2319-2293.22)2/2293.22 + (621-632.52)2/632.52 + (278-292.26)2/292.26 =2.53 The chi-squared result is less than 5.991 which suggests we can’t reject the null hypothesis as it is not statistically significant. To see how much money per annum that Area A would save if it were able to move its pattern of services to the pattern in use in Area B Patients aged under 65 Observed Area A Area B Total Physio 4371 4113 8484 Daycase 508 791 1299 Inpatient 126 187 313 total 5005 5091 10096 number Table3.7a Percentage of patients aged under 65 Area A Area B Total Physio 87.33% 80.79% 84.03% Daycase 10.15% 15.54% 12.87% Inpatient 2.52% 3.67% 3.10% Total 100.00% 100.00% 100.00% Table 3.7b Expected number of patients aged under 65 in area A Expected number Physio 5005*80.79% 4043.5395 Daycase 5005*15.54% 777.777 Inpatient 5005*3.67% 183.6835 Total 5005 Table 3.7c Cost for patients aged under 65 in area A Expected number Treatment costs ($) Expected total cost 4043.5395 200 808707.9 777.777 500 388888.5 183.6835 1500 275525.25 1473121.65 Table 3.7d Total Cost Area A Physio Daycase Inpatient Observed total cost 874200 254000 189000 1317200 Table 3.7e Saving=1317200-1473121.65 = (155921.65) Patients aged 65 and over Area A Area B total Physio 2028 2319 4347 Daycase 578 621 1199 Inpatient 276 278 554 total 2882 3218 6100 Area A Area B total Physio 70.37% 72.06% 71.26% Daycase 20.06% 19.30% 19.66% Inpatient 9.58% 8.64% 9.08% total 100.00% 100.00% 100.00% Table 3.8a Percentage of patients aged 65 or over Table 3.8b Expected number of patients aged 65 or over in area A Expected number Physio 2882*72.06% 2076.866998 Daycase 2882*19.30% 556.1597265 Inpatient 2882*8.64% 248.9732753 Total Table 3.8c Costs for patients aged 65 and over in area A 2882 Expected number Treatment cost ($) Expected total costs 2076.866998 200 415373.3996 556.1597265 500 278079.8633 248.9732753 1500 373459.913 1066913.176 Table 3.8d Total Costs Physio (2028*200) Area A Daycase (578*500) Inpatient (276*1500) 405600 289000 414000 Total 1108600 Table 3.8e Saving= 1108600-1066913.176 = 41686.82411 Area A total saving= 41686.82411+ (-155921.65) = -114234.8259 Instead of area A being able to save money, it will actually increase its costs by an extra £114234.83. From the results shown on all the table above, we can see that age-group is an important lurking variable. Issue 4 Relationship between the percentage in Physio and the percentage in daycase and Inpatient 10 5 0 0 2 4 6 8 10 12 -5 % increase in physio and % decrease in daycase and inpatient -10 -15 -20 Table 4.1 Percentage in physio treatments Predicted % increase in physio and % decrease in daycase and inpatient The regression line shown on the graph has the equation of y = 0.7555x – 2.6402. This means that if we are looking into how much daycases and inpatient services are decreasing by when area A increases its physio treatments by a 7.5%, we just have to substitute 7.5 into the regression line equation. y = 0.7555*7.5 - 2.6402 y = 3.026 This brought us to a conclusion that daycases and inpatient services will decrease by 3.026% if physio treatments in area A are going to increase by 7.5%. Number of patients going to be using all 3 services after the increase of 7.5% in physio treatments in area A = 6399*(100%+7.5%) + 1086*(100%-3.026%) + 402*(100%-3.026%) = 6878.925 + 1053.137 + 389.835 = 8321.897 = 8322 patients Overall costs needed for all the services after the increase of 7.5% in physio treatments in area A = 6878.925*200 + 1053.137*500 + 389.835*1500 = £2487106 The saving that CCG could make after the increase of 7.5% in physio treatments in area A Total costs stated above is £2425800 New costs after increasing the physio treatments by 7.5% is £2487106 This means that the saving CCG could make after the increase of 7.5% in physio treatments in area A is 2425800 – 2487106 = (£61306) This also means that if CCG increase the physio treatments in area A by 7.5%, they won’t be able to increase its savings, instead it would increase its costs. However, in this set of data, there is two outliers which suggests the accuracy and the reliability of the result is questionable and may not be as accurate. Issue 5 As stated above, the regression line shown on the graph has the equation of y = 0.7555x – 2.6402. This means that if we are looking into how much daycases and inpatient services are decreasing by when area A increases its physio treatments by a 15%, we just have to substitute 15 into the regression line equation. y = 0.7555*15 - 2.6402 y = 8.6848 This brought us to a conclusion that daycases and inpatient services will decrease by 8.6848% if physio treatments in area A are going to increase by 15%. Number of patients going to be using all 3 services after the increase of 15% in physio treatments in area A 6399*(100% + 15%) + 1086*(100% - 8.692%) + 402*(100% - 8.692%) = 7358.85 + 991.602 + 367.057 = 8717.509 Overall costs needed for all the services after the increase of 15% in physio treatments in area A = 7358.85*200 + 991.602*500 + 367.057*1500 = £2518156.242 The saving that CCG could make after the increase of 15% in physio treatments in area A Total costs stated above is £2425800 New costs after increasing the physio treatments by 15% is £2518156.242 This means that the saving CCG could make after the increase of 15% in physio treatments in area A is 2425800 – 2518156.242 = (£92356.242) This also means that if CCG increase the physio treatments in area A by 15%, they won’t be able to increase its savings, instead it would increase its costs. However, in this set of data, there is two outliers which suggests the accuracy and the reliability of the result is questionable and may not be as accurate. With area A wanted to invest into more physio treatments in order to reduce cost and the demand of daycases and inpatient we can find out the deficit per person in respect to increasing physio treatments by 7.5% and 15%. If physio treatments are to increase by 7.5%: = -61306.467 / 8321.897376 = (£7.367) If physio treatments are to increase by 15%: = -92356.242 / 8717.509 = (£10.594) When comparing these two results, we can tell that the deficit per person in area A by increasing the investment of physio treatments by 7.5% is lower. Therefore I would advise area A to increase by 7.5% instead of 15%. However, the investment they are making now is better than both of these strategies; It means they should also put their current plan under consideration before making any decisions. Conclusion To conclude, in issue 1 we can tell that physio treatments are demanded the most by the audience. The number observed from the chi-squared test shown that it is statistically significant. In issue 2, two areas spend most of their costs in different areas. In issue 3, we found out that age-group is an important lurking variable. We also found out that there is a deficit instead of savings when Area A used the pattern of service in Area B. In issue 4, we found out that there is a deficit if CCG increased its physio treatments in Area A by 7.5%; And there would be an even bigger deficit if CCG increased its physio service in Area A by 15%. Recommendation We have found out that operating like area B in area A would not increase area A’s financially, so I would not advice CCG to use the area B’s operation in area A. We % and ave also found out that increasing the physio treatments by either 7.5% and 15% will only increase the overall costs which implies the way area A is working now could be the optimal solution among the three options. Therefor I would recommend to put the current plan under consideration as financially it has the best results.