Analysis of the Relationship Between the Implementation of the Clinical Pathway for NSTEMI Disease and Service Variance

  • Palupi Setyo Hapsari Universitas Mulawarman
  • Ratno Adrianto Universitas Mulawarman
  • Irfansyah Baharuddin Pakki Universitas Mulawarman
Keywords: clinical pathway, NSTEMI, quality of care, service variance

Abstract

This research was conducted to address the increasing number of NSTEMI (Non-ST Elevation Myocardial Infarction) cases, which represent a significant portion of heart attack patients (85%) according to the 2023 Ischemic Myocardial Infarction National Audit. The challenge for healthcare providers is to ensure optimal care for these patients. Clinical Pathways are structured guidelines designed to improve service quality, but despite a relatively high compliance rate (82%) for filling out Clinical Pathways at Taman Husada Bontang Hospital, there has been no clear analysis of how Clinical Pathway implementation benefits patient outcomes. Therefore, the study aims to evaluate the relationship between the implementation of Clinical Pathway and the quality of care provided to NSTEMI patients. The study aims to analyze the relationship between the implementation of the Clinical Pathway for NSTEMI patients and the quality of service at Taman Husada Bontang Hospital. Quantitative research method with a cross-sectional case study approach. The sample technique used is non-probability sampling; the number of samples is 50 Clinical Pathway forms from NSTEMI patients treated at the hospital during the 2022-2023 period. The Chi Square test on the service variance variable has a significant relationship with the implementation of Clinical Pathway, with a p value of 0.000 < 0.05, incomplete documentation resulting in a lack of information about the service variance provided with an OR value of 1.5. The conclusion is that the implementation of Clinical Pathway is significantly related to the quality of services, especially the variance of actions given to patients.  To improve service quality, improvements are needed in documentation and regular evaluation of the implementation of the Clinical Pathway.

References

Anderson, J. L., & Morrow, D. A. (2017). Acute Myocardial Infarction. The New England Journal of Medicine, 376(21), 2053–2064. https://doi.org/10.1056/NEJMra1606915

Cram, P., Hatfield, L. A., Bakx, P., Banerjee, A., Fu, C., Gordon, M., Heine, R., Huang, N., Ko, D., Lix, L. M., Novack, V., Pasea, L., Qiu, F., Stukel, T. A., De Groot, C. U., Yan, L., & Landon, B. (2022). Variation in revascularisation use and outcomes of patients in hospitals with acute myocardial infarction across six high-income countries: Cross-sectional cohort study. The BMJ, 1–11. https://doi.org/10.1136/bmj-2021-069164

Firmanda, D. (2010). Implementation of Quality Management System in Hospitals: Introduction. 1–74.

Ministry of Health. (2023). Kep of the Director General of Health No. 02.02/D/9737/2023 concerning the Implementation of Clinical Pathways for Hospitals.

Ministry of Health of the Republic of Indonesia. (2018). Riskesdas 2018.

NHS, 2023. (2023). Management of Heart Attack : analyses from the Myocardial 2023 Summary Report.

Nurdin, F. W., Purwadhi, P., & Agung, I. W. (2023). Evaluation of Clinical Pathway Implementation in Pneumonia Cases in the Internal Medicine Inpatient Unit at Risa Sentra Medika Hospital, Mataram, with the Integrated Care Pathway Appraisal Tool (ICLINICAL PATHWAYAT) Method. Journal of Health Policy and Management, 8(1), 30–38. https://doi.org/10.26911/thejhpm.2023.08.01.0

Plugaru, A., Ivanov, M., Ivanov, V., Popovici, I., Ciobanu, L., Dicusar, O., & Popovici, M. (2021). Preliminary data from the retrospective and prospective observational studies on nSTEMI patient management in Moldova. https://api.semanticscholar.org/CorpusID:250079403

Robert, B., & Brown, E. B. (2004). E Book Health Economics (Issue 1).

Rotter, T. (2013). Clinical Pathways in Hospitals: Evaluating effects and costs. http://repub.eur.nl/pub/39428

Simanungsong. (2017). The effect of the implementation of acute appendicitis and inguinal hernia clinical pathway on the quality, cost, and variance of services at IRNA Surgery AWS Samarinda. POSTGRADUATE PROGRAM OF HASANUDDIN UNIVERSITY OF MAKASSAR, MI, 1–180

Subekti, Y., & Nurwahyuni, A. (2019). Effect of Clinical Pathway on Length of Stay and Hospital Cost: A Systematic Review. 556–564. https://doi.org/10.26911/the6thiClinical Pathwayh-fp. 04.43

Subkhan, S., Suci, T., & Lestari Ramadhan, S. (2022). Analysis of Clinical Pathway Implementation of Urinary Tract Stones at Royal Prima General Hospital Medan. International Journal of Health and Pharmaceutical (IJHP), 3(3), 341–352. https://doi.org/10.51601/ijhp.v3i3.172.

Published
2025-10-01
How to Cite
Hapsari, P. S., Adrianto, R., & Pakki, I. B. (2025). Analysis of the Relationship Between the Implementation of the Clinical Pathway for NSTEMI Disease and Service Variance. Indonesian Journal of Global Health Research, 7(5), 419-426. https://doi.org/10.37287/ijghr.v7i5.6773

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