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

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 decis...

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Main Author:	Hussien Ahmed Al-Ashwal, Rania
Format:	Thesis
Language:	English
Published:	2017
Subjects:	QH Natural history
Online Access:	http://eprints.utm.my/id/eprint/79488/1/RaniaHussienPFBME2017.pdf
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spelling	my-utm-ep.794882018-10-31T12:41:42Z Clinical pathway evaluation model for ST elevation myocardial infarction optimal patient care 2017 Hussien Ahmed Al-Ashwal, Rania QH Natural history 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. 2017 Thesis http://eprints.utm.my/id/eprint/79488/ http://eprints.utm.my/id/eprint/79488/1/RaniaHussienPFBME2017.pdf application/pdf en public phd doctoral Universiti Teknologi Malaysia, Faculty of Biosciences and Medical Engineering Faculty of Biosciences and Medical Engineering
institution	Universiti Teknologi Malaysia
collection	UTM Institutional Repository
language	English
topic	QH Natural history
spellingShingle	QH Natural history Hussien Ahmed Al-Ashwal, Rania Clinical pathway evaluation model for ST elevation myocardial infarction optimal patient care
description	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.
format	Thesis
qualification_name	Doctor of Philosophy (PhD.)
qualification_level	Doctorate
author	Hussien Ahmed Al-Ashwal, Rania
author_facet	Hussien Ahmed Al-Ashwal, Rania
author_sort	Hussien Ahmed Al-Ashwal, Rania
title	Clinical pathway evaluation model for ST elevation myocardial infarction optimal patient care
title_short	Clinical pathway evaluation model for ST elevation myocardial infarction optimal patient care
title_full	Clinical pathway evaluation model for ST elevation myocardial infarction optimal patient care
title_fullStr	Clinical pathway evaluation model for ST elevation myocardial infarction optimal patient care
title_full_unstemmed	Clinical pathway evaluation model for ST elevation myocardial infarction optimal patient care
title_sort	clinical pathway evaluation model for st elevation myocardial infarction optimal patient care
granting_institution	Universiti Teknologi Malaysia, Faculty of Biosciences and Medical Engineering
granting_department	Faculty of Biosciences and Medical Engineering
publishDate	2017
url	http://eprints.utm.my/id/eprint/79488/1/RaniaHussienPFBME2017.pdf
_version_	1747818238532648960

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

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