Reference no: EM131094264

Assignment - Introduction

This portion of the practice asks you to apply your quantitative analysis skills to addressseveral questions about spending for end-of-life care for Medicare decedents with chronic illness during their last two years of life (deaths occurring 2001-2005). The Assignment 4 Excel file includes data related to spending, general information about hospitals, resource inputs, and patient experience during end-of-life care.  A list of the variables included in the data file and their definitions are included on the third page of this document.

Question 1: Review the data in the Excel file as well as the information about the dataset on the next page. 

1. Divide the sample into two halves based upon one of the variables within the data set (e.g., you might want to divide the sample based on outpatient spending low vs. high - you'd simply sort the data on the outpatient spending variable and then split the group [somewhat arbitrarily] into roughly two halves based on this single variable).

2. Choose a second variable of interest.  For example, you might want to see if there is a difference in the reimbursement per patient day between the facilities with high outpatient spending and those with low outpatient spending. 

3. Complete some basic descriptive statistics related to your variables so that you can describe the variables and interpret some descriptive differences between the two groups.  Include at least one frequency table and one chart in your analysis. 

4. Based upon the two groups - high and low - complete a one-sample t-test to see if there is a significant difference between the two groups based on the second variable that you choose.  Use the hypothesis testing steps that we reviewed in class and utilized in Assignment.

5. Show your work for Question 1 in a new tab in the Excel file, leaving the "raw data" in the first tab, the "Data" tab.

6. In a separate Word file, provide basic descriptive statistics, including your frequency table and chart, regarding your data in a single paragraph.  Your write-up should be similar to how you would see the descriptive statistics narrative in a typical journal article.

7. In this same Word file, write out your hypothesis testing steps (from #4 above) and provide an inferential analysis for your t-test.

Question 2: Use this data set to address the following question:

How much of the variation in total Medicare spending (Spending_TotalMedicare) can be explained by a combination of a) type of physician involvement (medical specialists (EoL_MS), vs. primary care physicians (EoL_PCP), b)total ICU days per decedent (EoL_ICU_Days), c) total hospice days per decedent (EoL_Hospice_Days), d) number of home health visits (EoL_HHVisits); and e)CMS quality score (CMS_CompositeQualityScore.

Based on this question, you should:

For Question 2, complete your Excel work in a new tab in the same Excel file you used for Question 1, but in a new tab that you will label as Question 2.  For your narrative work below, complete this work in the same Word file that you used for Question 1.  (So, you will submit one single Excel file and one single Word file for Assignment.)

1. Conduct univariate statistics on the variables of interest.  Convey your results in a few paragraphs and appropriate tables as would be found in a Results section of a journal article.

2. State an explicit overall hypothesis to test bivariate relationships.

3. Conduct appropriate analyses to test your hypotheses. 

4. Indicate the specific questions that are addressed with your analyses(in addition to the overall hypothesis).

5. Concisely interpret your results.

6. Convey your results in a few paragraphs and appropriate tables as would be found in a Results section of a journal article.

7. Choose two of the outcome variables from the regression model and generate a correlation analysis of these two variables, including a scatterplot and Pearson's correlation value.  Interpret your results in just a couple of sentences.

8. Run a multiple regression to address the above question.  Conduct bivariate statistics on the variables of interest.

9. Note any limitations or concerns that you might have (if any) in conducting your analyses and describe what could be done to address these limitations.     

Data Set Information

This data set, End of life care for Medicare decedents with chronic illness 2001 to 2005.sav, was derived from CMS data. Data reflect Medicare spending and resource utilization for decedents with chronic illness during their last two years of life (deaths occurring 2001-2005). The data set includes information from 1,737 acute care hospitals across the country. Specific variables are Medicare spending, Medicare Part B spending; reimbursement for hospitals (facilities), reimbursement for physician visits, resource inputs per 1000 decedents, and patient experience of end of life. Variables reflecting CMS hospital compare technical process-of-care quality measures include: composite quality score, acute myocardial infarction (AMI) scores,  congestive heart failure (CHF) scores, and pneumonia scores (this set of variables includes data for all patients, 2005).

Variable Name	Variable Label
General information of hospitals.
ProviderID	Provider ID
HospitalName	Hospital Name
Zipcode	Zip Code
City	City
State	State
NewOwnership	Combined Hospital Ownership Type
Number_Death	Number of deaths among chronically ill patients assigned to hospital
Percent_InpatientDays	Percent of enrollees' medical inpatient days at hospital to which they were assigned
Medicare spending per decedent by site of care during the last two years of life
Spending_TotalMedicare	Total  Medicare spending
Spending_Inpatient	Medicare spending  in Inpatient sector
Spending_Outpatient	Medicare spending  in Outpatient sector
Spending_SNF_LTC	Medicare spending  in SNF/Long-term care sector
Spending_HH	Medicare spending  in Home health (HH) sector
Spending_Hospice	Medicare spending  in Hospice sector
Spending_Ambulance	Medicare spending for Ambulance
Spending_DME	Medicare spending  for Durable Medical Equipment (DME)
Spending_Other	Medicare spending for Others
Medicare Part B spending by type of service per decedent during the last two years of life
PartB_Spending_Total	Medicare Total Part B spending
PartB_Spending_EvalMgtServices	Medicare Part B spending for  Evaluation & management services
PartB_Spending_Procedures	Medicare Part B spending for Procedures
PartB_Spending_Imaging	Medicare Part B spending for Imaging
PartB_Spending_Tests	Medicare Part B spending for Tests
PartB_Spending_Other	Medicare Part B spending for Others
The Medical Care Costs: Disaggregation of hospital (facility) reimbursements per decedent into contributions of volume and price during the last two years of life
Reimb_Hospital	Hospital reimbursements per decedent
Number_HospitalDays	Hospital days per decedent
Reimb_PerPatientDay	Reimbursements per patient day
RatioUS_HospitalReimb	Ratios to U.S. average hospital reimbursement
The Medical Care Cost: Disaggregation of payments for physician visits per decedent into contributions of volume
Payments_PhyV	Payments for physician visits per decedent
Number _PhyV	Physician visits per decedent
PaymentsPerPhyV	Payments per physician visit
RatioUS_PhyVPayment	Ratios to U.S. average physician visits payments
Resource inputs per 1,000 decedents during the last two years of life
Beds_Hospital_1K	Hospital beds
Beds_ICU_1K	Total Intensive care beds
Beds_MedicalSurgical_1K	Medical & surgical unit beds
Beds_SNF_1K	SNF beds
FTE_TotalPhyLabor_1K	Standardized FTE physician labor: Total
FTE_MS_1K	Standardized FTE physician labor: Medical Specialist
FTE_PCP_1K	Standardized FTE physician labor: Primary Care
FTE_RatioMS_PC_1K	Standardized FTE physician labor: Ratio MS/PC
FTE_RequiredRNs_1K	RNs required under proposed federal standards
The patient experience of end-of-life (EoL) care
EoL_ Hospital_Days	Hospital days per decedent
EoL_ ICU_Days	Total ICU days per decedent
EoL_MedicalSugical_Days	Medical & surgical unit days per decedent
EoL_SNF_Days	SNF days per decedent
EoL_Total_PhyVi	Total Physician visits per decedent
EoL_MS	Medical Specialist (MS) visits per decedent
EoL_PCP	Primary Care Physician visits per decedent
EoL_RatioMS_PC	Ratio of Medical Specialist to Primary Care Physicians per decedent
EoL_HHVisits	Home health agency visits per decedent
EoL_Percent_Death_Hospital	Percent of deaths occurring in hospital
EoL_Percent_Death_ICUAdm	Percent of deaths that included an ICU admission
EoL_Percent_Enrolled_Hospice	Percent enrolled in hospice
EoL_Hospice_Days	Hospice days per decedent
EoL_Percent_PtSee10MoreDiffDocs	Percent of patient seeing 10 or more different physicians
EoL_Number_DifferDocs	Number of different physicians seen per decedent
EoL_Total_AverageCopay	Total Average co-payments per decedent during the last two years of life
EoL_AverageCopay_PhyServices	Average co-payments per decedent during the last two years of life for Physician services
EoL_AverageCopay_DME	Average co-payments per decedent during the last two years of life durable medical equipment (DME)
CMS Hospital Compare technical process quality measures (all patients, 2005)
CMS_ CompositeQualityScore	Composite quality score
CMS_ AMIScore	AMI score
CMS_ CHFScore	CHF score
CMS_ PneumoniaScore	Pneumonia score

Note: Variables ending with "_1K" reflect "Resource inputs per 1,000 decedents". Variables were labeled with "per decedent" toreflect values of X per decedent.

Attachment:- Data.rar