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Event Surrogate from Clinical Pathway Completion to Daily Meal for Availability Extension Using Standard Electronic Medical Records: a Retrospective Cohort Study

  • Systems-Level Quality Improvement
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Abstract

This study aimed to improve generalizability of our previous study that analyzed clinical pathway (CP) completion. Although our previous study demonstrated that CP completion can reduce the length of hospital stay, it is possible for few medical organizations to extract the implementation of treatment registered on CP from typical electronic medical records. Therefore, we have defined a prospective event for event substitution, called meal completion (MC), in which patients can take their meal daily. Data were collected from April 2013 to March 2018 from the electronic medical records of the University of Miyazaki Hospital. We used propensity score matching to extract records from 8033 patients. Patients were further divided into the MC and non-MC groups; 2577 patients in each group were available for data analysis. The numbers of patients with CP completion were 646 (28.1%) in the MC group and 411 (18.2%) in the non-MC group. The P value of the chi-square test was <0.001. According to this result, there was the causation from MC to increase in CP completion. Additionally, it was possible to consider the inclusion relationship in all treatments (universal set), treatments registered on CP (subset of all treatments), and meals (subset of treatments registered on CP). In conclusion, MC can substitute for CP completion because the demonstration is appropriate for the Prentice criterion, which is often used for the evaluation of a surrogate endpoint.

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Acknowledgments

The authors would like to thank Enago (www.enago.jp) for the English language review.

Funding

There were no external funding sources for this study.

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Authors and Affiliations

  1. Department of Hospital Institutional Research, University of Miyazaki Hospital, 5200 Kibara Kiyotake-cho, Miyazaki, 8891692, Japan

    Hiroki Furuhata, Kenji Araki & Taisuke Ogawa

  2. Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, 5200 Kibara Kiyotake-cho, Miyazaki, 8891692, Japan

    Hiroki Furuhata

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  1. Hiroki Furuhata
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Contributions

Hiroki Furuhata: Conceptualization; data curation; formal analysis; Investigation; methodology; software; visualization; and writing – original draft.

Kenji Araki: Funding acquisition; project administration; resources; supervision; validation; and writing – review and editing.

Taisuke Ogawa: Data curation; validation; and writing – review and editing.

Corresponding author

Correspondence to Hiroki Furuhata.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

All procedures performed in studies involving human participants were in line with the ethical standards of the Committee of Medical Ethics, University of Miyazaki (ethics approval number, O-0383) and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained by an opt-out method. Concretely, the authors noted details of this study on their website and asked participants to offer the authors not to use their information until the specified date. After this date, the authors could use information without patients’ consent.

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Furuhata, H., Araki, K. & Ogawa, T. Event Surrogate from Clinical Pathway Completion to Daily Meal for Availability Extension Using Standard Electronic Medical Records: a Retrospective Cohort Study. J Med Syst 45, 33 (2021). https://doi.org/10.1007/s10916-021-01714-x

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