Expert answer:for this case study i did the first part which is finding the numbers(uploaded) but i need someone to do the second part that isSections of the recommendation should include:TitleExecutive summary(a one-paragraph summary of yourrecommendation and its justification)Background: context and importance of the questionThe clinical trialoDescription of the clinical trialoResults of the clinical trial(to include at least 2 tablesand/or figures).Discussion of your recommendationoEthical implications for patientsoEthical implications for doctorsoOther stakeholdersStatistical appendixoData (for replication purposes)oDetails of calculations not included in the report.i have uploaded the case study file it tell you everything you need
pathway.xls
stat_final_study_case2.docx
case_study_2_clinical_pathway_fall_2017.docx
Unformatted Attachment Preview
LOSNON FIMNON LOSPATH FIMPATH
2
49.09
2
52.76
2
48.81
2
52.65
2
49.02
2
51.97
2
49.56
2
53.49
2
47.61
2
51.43
2
49.76
2
53.62
2
47.57
2
50.63
2
48.44
2
51.78
2
49.11
2
52.69
2
47.68
2
50.74
2
47.44
2
50.83
2
46.18
2
49.63
2
49.49
2
50.85
2
49.37
2
51.29
2
48.02
2
52.07
2
48.97
2
53.42
2
48.91
2
52.97
2
49.30
2
51.38
2
48.21
2
52.60
2
48.51
2
52.59
2
49.63
2
53.24
2
48.85
2
51.36
2
48.04
2
52.07
2
49.55
2
52.82
2
48.34
2
52.75
2
48.92
2
50.94
2
49.34
2
53.23
2
49.52
2
51.87
3
46.66
2
52.00
3
46.26
2
52.67
3
46.19
2
53.44
3
47.08
3
49.86
3
47.34
3
48.61
3
45.04
3
49.01
3
47.05
3
47.53
3
44.39
3
47.56
3
47.10
3
49.70
3
46.48
3
50.58
3
45.38
3
47.72
3
46.61
3
49.77
3
46.33
3
46.63
3
45.52
3
49.65
3
47.04
3
49.57
3
45.15
3
47.73
3
45.92
3
49.40
3
45.65
3
49.11
3
46.67
3
48.07
3
45.93
3
49.63
3
45.48
3
47.88
3
44.09
3
49.00
3
45.48
3
48.13
3
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
46.23
43.69
44.15
44.08
42.77
44.20
42.73
42.58
43.15
43.85
43.32
44.00
43.60
42.65
42.67
44.27
42.36
44.06
44.81
44.30
42.51
43.57
43.47
40.41
40.18
40.30
40.99
40.59
41.76
40.06
42.01
40.40
41.30
41.58
41.53
41.75
40.09
40.86
42.05
40.25
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
49.43
48.98
48.03
46.35
48.04
49.06
45.52
46.72
46.47
44.49
46.82
44.93
47.06
44.37
45.64
46.31
45.70
46.27
46.18
44.54
45.10
46.22
44.42
46.11
47.10
46.35
45.03
45.86
45.56
42.95
42.57
42.48
43.21
42.45
43.76
42.29
44.36
42.64
43.25
43.27
43.74
42.02
44.19
43.65
44.34
42.11
43.17
44.30
42.08
Statistical Analysis
The goal of the statistical analysis is to determine the effect of the clinical pathway on two
patient outcomes: length of stay (LOS) and the functional integrity measure (FIM). This involves
comparing the levels and the variability of outcomes of pathway and non-pathway patients.
Please do so by answering the following questions.
1. Create a table of descriptive statistics that summarizes the mean, median, standard
deviation, minimum and maximum for each of the four variables (see case study 1 for
example of formatting)
Mean
Median
Standard
Deviation
Minimum Value
Maximum
Value
LOSNON
(days)
3.31
3.00
FIMNON
(equivalent score)
45.29
45.48
LOSPATH
(days)
3.32
3.00
FIMPATH
(equivalent score)
47.96
47.95
1.10
2.95
1.12
3.50
2
40.06
2.00
42.02
5
49.76
5.00
53.62
2. Create 95% confidence intervals for the mean length of stay of the clinical pathway
group and the mean length of stay of the non-pathway group. Do they overlap?
Variable
N
Mean
3.308
Standard
Deviation
1.102
Standard
Error of Mean
0.116
LOSNON
(clinical pathway group)
LOSPATH
(non-clinical pathway group)
91
100
95% CI
(3.078, 3.537)
3.320
1.118
0.112
(3.098, 3.542)
As can be seen from the 905% confidence interval, the values overlap.
3. Calculate and interpret a 95% confidence interval for the difference in the mean length
of stay of pathway and non-pathway patients.
Difference
Estimate for difference:
95% CI for difference:
T-Test of difference = 0 (vs ≠)
μ (LOSPATH) – μ (LOSNON)
0.012
(-0.305, 0.330)
T-Value = 0.08
P-Value = 0.939
DF = 187
Based on the table above, there is a 95% probability true mean difference between the two
variables lie between -0.305 and 0.330. Since the interval does includes zero, it means that
there is no significant difference between the two variables which is also shown with the very
high p-value (which means that the null hypothesis stating the equality of means cannot be
rejected).
4. Create 95% confidence intervals for the mean FIM score of the pathway group and for
the mean FIM score of the non-pathway group. Do they overlap?
Variable
N
Mean
FIMNON
FIMPATH
91
100
45.288
47.964
Standard
Deviation
2.952
3.497
Standard Error of
Mean
0.304
0.350
95% CI
(44.673, 45.903)
(47.270, 48.658)
As can be seen from the values of the two variables, there is no overlapping that is observed.
5. Calculate and interpret a 95% confidence interval for the difference in the mean FIM
score of pathway and non-pathway patients.
Difference
Estimate for difference:
95% CI for difference:
T-Test of difference = 0 (vs ≠)
μ (FIMNON) – μ (FIMPATH)
–2.676
(-3.597, -1.755)
T-Value = -5.73
P-Value = 0.000
DF = 187
The table here shows that there is a 95% probability that the true difference between the means
of the two variables lie between -3.597 and -1.755. Since the interval does not include zero, it
means that there is a significant difference between the two variables which is also evident with
the very low p-value (which means that the null hypothesis stating the equality of means is
rejected).
Recommendation
A clinical pathway provides specific steps to follow in treating a given condition, based on
medically accepted best practices. In order to prove this, the hospital has undergone a clinical
trial. Patients who need some knee surgery were randomly assigned to two groups. The first
group undergone a treatment that follows a clinical pathway while the other group did not. To
measure the outcome of this, there are two measures used. The first is the average length of stay
of a patient and the second one is the FIM (Functional Integrity Measure) which is a scoring
system that has a scale from 0 to 100. A score of 0 would mean that the person is dead and a
score of 100 means that the person is in a very good physical condition. With 100 patients taken
to undergo a clinical pathway procedure and 91 people with no clinical pathway, the following are
the results of the clinical trial.
Mean
Median
Standard
Deviation
Minimum Value
Maximum
Value
LOSNON
(days)
3.31
3.00
FIMNON
(equivalent score)
45.29
45.48
LOSPATH
(days)
3.32
3.00
FIMPATH
(equivalent score)
47.96
47.95
1.10
2.95
1.12
3.50
2
40.06
2
42.02
5
49.76
5
53.62
LOSNON: length of stay of group who did not undergo a clinical pathway
FIMNON: FIM score of group who did not undergo a clinical pathway
LOSPATH: length of stay of group who did not undergo a clinical pathway
FIMPATH: FIM score of group who underwent a clinical pathway
The results show that on average, patients who went to a clinical pathway had an average length
of stay of 3.32 days while those patients who did not undergo a clinical pathway had an average
length of stay of 3.31 days. In terms of FIM score, patients who had a clinical pathway procedure
had an average score of 47.96 with a median score of 47.95 while those patients who did not
undergo a clinical pathway procedure had an average score of 45.29 with a median of 45.48.
To evaluate these numbers further, a statistical test is used to assess if the clinical pathway
procedure resulted to a better result. A simple 95% confidence interval is used in order to establish
the interval where the true value of the difference between the means can be found with 95%
confidence.
Difference
Estimate for difference:
95% CI for difference:
Conclusion:
Difference
Estimate for difference:
95% CI for difference:
Conclusion:
LOSNON vs LOSPATH
μ (LOSPATH) – μ (LOSNON)
0.012
(-0.305, 0.330)
Difference of means between the two groups is not significant
FIMNON vs FIMPATH
μ (FIMNON) – μ (FIMPATH)
–2.676
(-3.597, -1.755)
Difference of means between the two groups is significant
As shown, there is no significant difference between groups that underwent a clinical pathway
procedure and groups that did not undergo a clinical pathway procedure in terms of the length of
stay of these patients. However, when measured in terms of FIM, it can be seen that those who
underwent a clinical pathway procedure resulted to a significantly higher score. This means that
these patients are in a better physical condition than those who did not went through the clinical
pathway procedure.
Because of the significant increase in FIM scores, it is recommended to adopt the clinical pathway
procedure. However, there should be restrictions on its use. The ‘traditional’ procedure should
still be used in cases where human life is already at stake. It is still very important not to
‘mechanize’ decisions for these cases and leave the doctor on site to decide in his virtue of
autonomy and self-knowledge. However, for most general cases that are statistically proven that
are not ‘life-threatening’, then the adoption of a clinical pathway is recommended for the
improvement of the physical condition of the patients.
Case Study 2: Evaluation of a Clinical Pathway
Econ 2100
The Decision
Kaiser Permanente is considering the adoption of a treatment method called a clinical
pathway. A clinical pathway provides specific steps to follow in treating a given
condition, based on medically accepted best practices. When no clinical pathway is
used, each doctor treats a given condition according to his or her training, experience
and best judgment.
To decide whether the clinical pathway improves outcomes, the hospital has undertaken
a clinical trial. Patients needing knee replacement surgery were randomly assigned to
two groups. One group’s treatment followed a clinical pathway, the other group’s did
not. Two outcome measures were taken. The first was the average length of stay in
the hospital. Shorter hospital stays are associated with improved outcomes for patients.
The second outcome measure is called a FIM score. FIM stands for “functional integrity
measure,” and is a scale running from 0 to 100 that measures the state of health of the
whole person. A score of 0 means the person is dead; a scale of 100 means the person
is in extremely good physical condition. Taken together, the measures help the hospital
determine whether use of the clinical pathway improves patient well-being.
Data
The results of the clinical trial are found in a dataset entitled pathway.xlsx. This can be
found on the course website in the Case Studies module. The data set contains four
variables:
1. LOSNON: the length of the hospital stay in days for a non-pathway patient
2. FIMNON: the functional integrity measure for a non-pathway patient
3. LOSPATH: the length of the hospital stay in days for a pathway patient
4. FIMPATH: the functional integrity measure for a pathway patient.
Statistical Analysis
The goal of the statistical analysis is to determine the effect of the clinical pathway on
two patient outcomes: length of stay (LOS) and the functional integrity measure (FIM).
This involves comparing the levels and the variability of outcomes of pathway and nonpathway patients. Please do so by answering the following questions.
1. Create a table of descriptive statistics that summarizes the mean, median,
standard deviation, minimum and maximum for each of the four variables (see
case study 1 for example of formatting).
2. Create 95% confidence intervals for the mean length of stay of the clinical
pathway group and the mean length of stay of the non-pathway group. Do they
overlap?
3. Calculate and interpret a 95% confidence interval for the difference in the mean
length of stay of pathway and non-pathway patients.
4. Create 95% confidence intervals for the mean FIM score of the pathway group
and for the mean FIM score of the non-pathway group. Do they overlap?
5. Calculate and interpret a 95% confidence interval for the difference in the mean
FIM score of pathway and non-pathway patients.
Recommendation
Based on your analysis, write a brief (600 words, +/- 10%) recommendation to the
Kaiser Permanente administration. First, briefly describe the clinical trial you have
conducted and its results. Present the results of your clinical trial in a minimum of two
graphs/tables. In presenting your data, keep in mind that your goal is to convey the
information efficiently. Less is more! One well-designed table can say more than 3
pages of Excel output.
Second, based on the outcome of the clinical trial, do you recommend the adoption of a
clinical pathway? What ethical considerations form the basis of your recommendation?
Refer to one of more of the values discussed in Appendix A to guide your analysis.
What objections might patients have to this recommendation, and what is your response
to those objections? What objections do you anticipate from doctors to the
recommendation, and what is your response to those objections? Are there other
ethical stakeholders whose values should be taken into consideration here? If so, how
would you justify your recommendation to those stakeholders?
Audience
The audience for your report is the upper-level management of Kaiser Permanente.
They are intelligent, curious, and thorough, but may not have formal training in statistics.
Explanations of statistical results should be accurate and clear, while avoiding statistical
jargon. You may use statistical terminology in the appendix to the recommendation.
Deadlines
Answers to the five statistical analysis questions are due in class on Tuesday
November 28. The statistical analysis will be discussed on in class on that day, and
will be count for 20% of your case study grade. The final written report is due on-line
Friday December 1. Anticipate that writing the report will take at least as much time as
analyzing the data; prepare accordingly. The final report will count for 80% of your case
study grade.
Appendix A: Ethical Considerations
To formulate your recommendation, you will interpret the results of the clinical trial
within a guiding ethical framework. The following framework was developed by Nathan
Colaner, one of the business ethic instructors in the Albers School. As a
business/economics major, you are required to take UCOR 2910: “Ethical Reasoning in
Business.” Depending on when you took it, and who your professor was, you may have
used different terms or a different framework to think about ethical values. But you likely
can at least appreciate these five basic ideas about what contributes to human wellbeing. And even if you have not taken the course yet, you can still make sense of these
values.
One complication is that an ethical person will want to apply these values at different
levels, namely at the level of individuals, at the level or organizations, and at the level of
society. This means that each of the five values prompts different kinds of questions:
• Autonomy: A person’s ability to make her own decisions and to control her own life
(as the ethicists say, to be an ‘end in herself’) implies that she must be free to do so,
and not be used as a means to an end that she did not choose (most closely
associated with deontology).
o Eg. Individual level: “Am I mistreating this person so that I can get what I
want?” “Am I free to take the course of action I believe is best in this
situation?”
o Eg. Organizational level: “Are we mislabeling our product as “good for the
environment” with the hope that our customers will choose to purchase it?
o Eg. Socio-economic level: “Does our policy violate the right of some of our
citizens to make their own choices?”
• Equality: A person must not be regarded or treated as inferior to or superior to other
people
o E.g. Individual level: “Do my actions show that I believe that my interests are
more important than this other person’s interests?”
o E.g. Organizational level: “Does everyone of similar work experience on our
sales team have a fair chance at that promotion?”
o E.g. Socio-economic level: “Does our society have social structures that make
success more difficult for one group than another?”
• (non) Suffering: Perhaps our most basic moral instinct is that suffering (whether
physical or emotional) is bad because its takes away from a person’s happiness
(most closely associated with utilitarianism).
o Eg. Individual level: “Does this hurt?” “Are my words offensive to this other
person?”
o Eg. Organizational level: “When our employees complain about harassment,
do we have policies that allow us to address their concerns quickly and
respectfully?”
o E.g. Socio-economic level: “Does our government use symbols that are
hurtful for some of our citizens?”
• Trust: When people cooperate, they form trust, and living in a high- trust
environment makes possible many of the things we associate with a good life. So
trust is the goal, and cooperation is the way to get it (most closely associated with
contractarianism)
•
o E.g. Individual level: “Are my actions compromising the possibility that this
person would trust me in the future?”
o E.g. Organization level: “If I betray someone on the team I manage, will that
harm my ability to be an effective leader in the future?”
o E.g. Socio-economic level: “Does this policy make it less likely that some
people will go to the police?”
Virtue: (Excellence): An individual has a character, and many ethical traditions
agree that a person is better off when her character is virtuous (“virtuous” and
“excellence” are translations of the same Greek word). However, by doing unethical
things, I may harm or corrupt my own character by forming unethical habits. So
character excellence is the goal, and forming ethical habits by doing ethical actions
is the way to get it (most closely associated with virtue ethics). This ethical theory
also translates to the levels of society and organization, but on those levels we use
the word “culture” more often than the word “character” – but the general concept is
the same.
o E.g. Individual level: “If I falsify the numbers on this report in order to make it
look like I met my yearly goals, will lying become part of who I am?”
o E.g. Organization level: “Does the culture of our organization make it more
likely that our employees will do the right thing?”
o E.g. Socio-economic level: “What kind of society do we want to have?”
Appendix B: Formatting
Your recommendation should be formatted in such a way as to be easily read and
referred to.
• Sections of the policy brief are labeled in bold lettering and there is a space
between each section.
• Section names reflect the content of the section (e.g. “Results of the clinical
trial”). The Executive Summary will simply be titled “Executive Summary.”
• Bullet points are used where appropriate to list points of information
• The font is a widely-used, 12-point font of your choosing (Arial or Times
variations work well).
Sections of the recommendation should include:
• Title
• Executive summary (a one-paragraph summary of your
recommendation and its justification)
• Background: context and importance of the question
• The clinical trial
o Description of the clinical trial
o Results of the clinical trial (to include at least 2 tables and/or
figures).
• Discussion of your recommendation
o Ethical implications for patients
o Ethical implications for doctors
o Other stakeholders
• Statistical appendix
o Data (for replication purposes)
o Details of calculations not included in the report.
…
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