Analysis of the Volume of MSK Services in Area A and B

The management report is about the analysis of the categories of the MSK service offered in area A and B. The analysis is based on regression analysis integrated with a pie chart to determine the statistic significance of the population volume. The report also involved the analysis of the total cost of every service about the total population as presented by each area and age group. Moreover, the total service cost of every area was determined by population. Therefore, an area that had the highest population was experienced the highest cost. However, the calculation of the total cost was suitable for evaluating the effect of rebalancing, which can only be implemented by CCG and MSK service.  Additionally, a pie chart was used to compare the volumes of the total population and total costs experienced by the two areas.

Introduction

In the UK, Healthcare system is funded by taxpayers, and it is normally free at the point of uptake. For that reason, the decisions on how to use the money are made by the CCGs (Clinical Commissioning Groups). They also make decisions on how the NHS money can be spent in well-defined geographical areas.  The medical services that are offered by NHS are subsidized, and medical prescriptions may be free when situations warrant.

Moreover, specifics policies concerning healthcare vary among Scotland, Northern Ireland, Wales, and England. The department of healthcare in the UK oversees the functions of NHS, which in turn maintain the records of patients with the aim of ensuring the confidentiality and compliance with the regulatory standards of healthcare.  Moreover, the functions of NHS cannot be successful without the help of Clinical Commissioning Groups. These groups are responsible for the performance of NHS concerning quality delivery and how healthcare money is spent in specific geographical areas. Therefore, the management report will be aimed at helping the CCG with the decisions regarding the formation of the MSK service in the next five years.

Background

The MSK service is an organization for people with musculoskeletal problems. The service consists of three main parts. These parts are described as follows:

Day-cases, which involve an individual being admitted to the hospital for a few hours, especially for more minor operations and do not require that particular individual to stay overnight.

In-patients, which involve an individual being admitted to the hospital and stay for one or two nights while waiting for bigger operations.

Physio-treatment, which involve one or more 30mniutes to one-hour appointments with p[physiotherapists

In most occasions, MSK patients are treated in the three ways mentioned above. However, some patients might require two different approaches of treatments in one year. In that case, the results for analysis will be based on the data collected for the MSK patients who have received treatment in the last 12 months.

The aim of the Analysis

The analysis and management report is based on five issues. These issues are listed as follows:

The first issue is to perform a preliminary analysis of the volumes of the three types of MSK services in the two areas (A and B).

To provide the three types of services involved with different amount of resources and unit costs.

To illustrate that younger people are usually suitable for the less intense methods of treatment while their older counterpart is in need of the intense methods of treatment.

Evaluation of the performance of area A and B when the two areas consider rebalancing of the MSK service.

To investigate how the increase of the physio service in area A by fifteen percent and not 7.5 percent will affect its healthcare performance.

Results and Data Analysis

As mentioned before, the results of this study were based on how MSK patients were treated in the last 12 months two areas (Area A and Area B) of the United Kingdom.

Issue 1

According to table 1, the number of patients who were seeking physio treatment was more than day-case and inpatient treatment. The total number of patients that were seeking physio treatment from MSK service in area A was 6399, which is 79% of the total patient population in that area.  Overall volumes of three types of MSK service in the two areas are statistically viable as illustrated in the summary output of the regression analysis of the two patient populations.

Table 2:  Illustration of the output obtained from the regression analysis of the statistics significant of the overall volumes of the different mixes of patients

SUMMARY OUTPUT

Regression Statistics

Multiple R

0.99904

R Square

0.99808

Adjusted R Square

-3

Standard Error

198.6947

Observations

1

Table 3: Illustration of the statistical significance of the data volume

ANOVA

df

SS

MS

F

Significance F

Regression

3

20527953

6842651

519.9636

#NUM!

Residual

1

39479.6

39479.6

Total

4

20567433

Coefficients

Standard Error

t Stat

P-value

Lower 95%

Upper 95%

Lower 95.0%

Upper 95.0%

Intercept

4.5E-294

4.5E-294

X Variable 1

-8E-271

8.2E-271

X Variable 2

203.9615

160.6862

1.269315

0.4248

-1837.75

2245.674

-1837.75

2245.674

X Variable 3

0.975924

0.042799

22.80271

0.027901

0.432116

1.519732

0.432116

1.519732

RESIDUAL OUTPUT

PROBABILITY OUTPUT

Observation

Predicted Y

Residuals

Standard Residuals

50

6432

1

221894.5

-215463

-2

Percentile

Y

Figure 6: 3D chart illustrating the distribution of patients in area A and B

The population of area B was greater than that of area A by (8309-7887) = 422.  Similarly, the lowest service category was inpatient category, which a total population 402 for area A and 465 for area B. The percentage distribution for the whole population is illustrated in the pie chart shown below.

Figure 7: Illustration of the relationship between the three categories (Physio, day-case, and inpatient).

According to the data analysis on the pie chat illustrated above, the highest population was the physio service followed by day-case and inpatient service. The percentage of volumes in these three categories are 79%, 16%, and 5% respectively.

Issue 2

Table 4: illustrating the costs analysis of different services for area A

Service Treatment

Cost per Service

Patient Population

Total

Physio

£200

6399

£1,279,800

Inpatient

£1500

402

£603,000

Day-Cases

£500

1086

£543,000

Total  COST

-

7887

£ 2425800

Table 5: illustration of the cost analysis of all of the treatment services in area B

Service Treatment

Cost per Service

Patient Population

Total cost

Physio

£200

6432

£1,286,400

Inpatient

£1500

465

£697,500

Day-Cases

£500

1412

£706,000

Total

-

8309

£ 2689900

According to table 6 and 7, the total cost for all of the treatment services in area B is greater than that of area B. The difference in the total cost is given by (£ 2689900 - £ 2425800) = £264100.  The difference was contributed by the high number of patients in area B. Even in the different categories of MSK service, area B still had the highest population.

Figure 8: a pie-chart illustrating the total costs of all of the categories in area A and B

Table 6: sample calculation of the total cost of every category of the total population of both area A and B

Physio

Day-case

Inpatient

Total population

12831

2498

867

The single cost in ₤

200

500

1500

Total cost

2566200

1249000

1300500

Figure 9: illustration of the total cost for every category of the total population of area A and B combined

Based on the values presented in the pie-chart shown above, physio treatment had the highest cost when compared to day-case, and inpatient treatment. The huge amount was specifically contributed by the high population of physio treatment patients in the two areas.

Issue 3

According to the data available in the MSK service database, young people have proven to be suitable for the less intense methods of treatment than the older people who need more intense methods of treatment. For that reason, age-group was a considerable variable behind the current difference in the treatment mix of the two areas.  However, the population of the younger people seeking for medical attention was bigger than that of older people.

Part 1: Regression analysis of the patients’ age group less than 65 years

Table 7: summary of the statistical significance of the data

SUMMARY OUTPUT

Regression Statistics

Multiple R

0.998083

R Square

0.99617

Adjusted R Square

-3

Standard Error

205.5239

Observations

1

Table 8: Illustration of the regression analysis for statistical significance data

ANOVA

Df

SS

MS

F

Significance F

Regression

3

10987333

3662444

260.1164

#NUM!

Residual

1

42240.05

42240.05

Total

4

11029573

Coefficients

Standard Error

t Stat

P-value

Lower 95%

Upper 95%

Lower 95.0%

Upper 95.0%

Intercept

1.1E-295

1.092E-295

X Variable 1

1.3E+150

1.319E+150

X Variable 2

-213.183

166.4022

-1.28113

0.421935

-2327.52

1901.158

-2327.52

1901.15796

X Variable 3

1.108731

0.068745

16.12813

0.039422

0.235241

1.982221

0.235241

1.98222124

RESIDUAL OUTPUT

PROBABILITY OUTPUT

Observation

Predicted Y

Residuals

Standard Residuals

50

4371

1

-168420

172791.4

2

Percentile

Y

Part 2: Regression analysis of the patients’ age group of 65 years and above

Table 9: summary of the statistical significance of the data

SUMMARY OUTPUT

Regression Statistics

Multiple R

0.999991

R Square

0.999981

Adjusted R Square

-3

Standard Error

5.769809

Observations

1

Table 10: Illustration of the regression analysis for statistical significance data

ANOVA

Df

SS

MS

F

Significance F

Regression

3

1754369

584789.8

52698.49

#NUM!

Residual

1

33.2907

33.2907

Total

4

1754403

Coefficients

Standard Error

t Stat

P-value

Lower 95%

Upper 95%

Lower 95.0%

Upper 95.0%

Intercept

7.3E-292

7.2945E-292

X Variable 1

-8E-271

8.2133E-271

X Variable 2

41.42151

5.208813

7.952198

0.079638

-24.7627

107.6058

-24.7627

107.6057626

X Variable 3

0.856972

0.003733

229.5615

0.002773

0.809539

0.904405

0.809539

0.904405164

RESIDUAL OUTPUT

PROBABILITY OUTPUT

Observation

Predicted Y

Residuals

Standard Residuals

50

2028

1

25961

-23933

-2

Percentile

Y

According to the two regression analysis of the age group data, age is an important factor to be considered by age-group is an important variable because it is determined by human beings, which in turn determine the number of population to seek for healthcare services.

As mentioned, area A should adopt the pattern of area B because it will work with the saving of the treatment cost. Area A has the highest number of patients than area B possible because it offers quality healthcare services at the same cost. Perhaps, clients from area A were seeking healthcare services from area B. Therefore, according to the total costs area, A will have to save an amount equivalent to; (£ 2689900 - £ 2425800) = £264100. 

Issue 4

Figure 5: A line graph illustrating the relationship between Phsyio and DC&IP regarding percentage increase

According to the graph illustrated above, phsyio service was performing better than DC&IP combined. This because an increase in the value of physio and a decrease in the cost of DC&IP creates space for patients who did not go for day-case and inpatients services because of their prices. Moreover, affordability is an issue in any medical service. Clients will always go for what they can manage regarding cost. However, an increase in the physio service by 7.5 % will reduce the population of patients seeking for that service because of the new cost.

Table 10: Table illustrating the residual and probability output of the regression analysis of the percentage increase of physio and DC&IP treatment

RESIDUAL OUTPUT

PROBABILITY OUTPUT

Observation

Predicted Y

Residuals

Standard Residuals

Percentile

Y

1

1.288123

2.311877

0.577078

2.5

-16

2

1.514759

0.285241

0.0712

7.5

-1.1

3

-1.58261

4.182611

1.044039

12.5

0

4

0.683758

-0.68376

-0.17068

17.5

0.1

5

3.554491

1.745509

0.435704

22.5

0.2

6

-0.44943

0.549427

0.137145

27.5

0.9

7

-0.14724

0.347244

0.086677

32.5

0.9

8

1.590305

0.009695

0.00242

37.5

1.6

9

-2.03588

0.935884

0.23361

42.5

1.8

10

0.759303

2.240697

0.55931

47.5

1.8

11

2.723489

-0.92349

-0.23052

52.5

1.9

12

3.781128

1.418872

0.354171

57.5

2.6

13

2.496852

1.703148

0.42513

62.5

2.8

14

3.101217

-1.20122

-0.29984

67.5

3

15

3.705582

1.594418

0.397989

72.5

3.4

16

4.61213

-1.81213

-0.45233

77.5

3.6

17

-0.29834

-15.7017

-3.91936

82.5

4.2

18

2.496852

0.903148

0.225439

87.5

5.2

19

-2.33807

3.238067

0.808268

92.5

5.3

20

2.043579

-1.14358

-0.28545

97.5

5.3

Figure 6: Sample analysis obtained from the excel format

Figure 7: Graphical presentation of the residual plots

Figure 8: Graphical presentation of the normal probability plot

Issue 5

Increasing the level of physio service of area A by 15% will help with improved service delivery because currently, the population of area A is in need of that service. On that note, the initial plan of increasing the service by 7.5% was meant to help CCG management with the level of savings. Therefore, an increase of 15% will result in greater savings than an increase of 7.5%.  However, rebalancing of the MSK service should be given priority. Different patients seek different medications. Not all patients will go for MSK physio service. Some will want affordable inpatient and day-case MSK services.

Conclusions and Recommendation

In this report, it shows that the two areas A and B were offering all of the three categories of MSK service to a considerable population. However, there was an issue of rebalancing of the three medical services. For instance, the cost for physio treatment was £200, while for the day-case and inpatients were £500 and £1500 respectively. The total medical cost for the patients seeking for physio treatment services was greater than that of day-case and inpatient services because it was affordable. For that reason, MSK service needs to rebalance the cost of its medical service even if the population of patients seeking such kind of services is low.  

Furthermore, it is the responsibility of the MSK and CCG management to create a system that will attract more clients. This implies that clients will go for medical services that are affordable unless it is necessary. Moreover, age-group is a factor that should be considered when implementing the cost of medical services. The management should determine which age group is most likely to seek physio, day-case, or inpatient services. Overall, it was observed that the largest population was seeking for physio services and it was majorly contributed by the patients of age 65 and below. On the other hand, the largest percentage of patients of age 65 and above was seeking inpatient services.