Clinical pathway evaluation model for ST elevation myocardial infarction optimal patient care

Abstract

Recently, clinical pathway (CP) has been used to reduce the variation and optimise the ST-elevation myocardial infarction (STEMI) process of care. The evaluation domains of STEMI CP quality remain inconsistent information. The aim of this research is to develop an evaluation model to guide the decision making on the optimal STEMI clinical pathways content and design. A qualitative and quantitative (mixed method) was used to generate and analyse the data of this research. First, the initial research STEMI clinical pathway concept has been developed from theory and practice. Second, the concept was tested in subsequent questionnaires distributions (pilot and actual study). Third, a clinical pathway quality evaluation model for STEMI (STEMICPQ) has been proposed and then assessed by structural equation modelling (SEM) path analysis using smart PLS version 3.0 software. Fourth, the sensitivity and specificity of the proposed model were tested in comparison to three quality criteria performance in 138 retrospective trial records. The results of the two stages questionnaire demonstrated an agreement on the items grouping and classification by the experts on most of the items of the questionnaire. A total of 186 responses from the second questionnaire have been returned involving 84 specialists and 76 nurses. The items content validity index (ICVI) is greater than 80%, and the construct reliability (Cronbach Alpha) is 0.85. This research proposes a model consisted of three STEMI CP quality domains (Design and Content, Process and Activity, and Outcome and Variance) with total 30 items and 60 sub-items and proven its ability to evaluate the quality of STEMICP. The STEMICPQ model validation results have established strong composite reliability, predictive relevance and power of explanation. The hypothesis testing revealed that the outcome and variance is a strong predictor of the STEMI clinical pathway quality with path coefficient (β) = 0.65, t statistics (t) = 17.4 and item loadings significant (p) = 0.000. From a retrospective CP trial study, the overall predictive power of the STEMICPQ shows high sensitivity of 0.915, specificity of 0.942 and area under the curve accuracy (AUC) of 0.93 in comparison to the length of stay criterion (LOS) of STEMI patients. As a conclusion, this model revealed suitable to be implemented in the health care institution to improve the quality of healthcare for STEMI patients. Also, it provides the experts with a valid, feasible and practical decision-making tool to be used in the hospitals during the design stage of STEMI CP. This work does not cover the organisational or human factors.