Date of Award
Doctor of Philosophy
Charles Noon, Randy Bradley, Bogdan Bichescu
The main focus of this study is to create a standardized approach to evaluating the impact of the patient care pathways across all major disease categories and key outcome measures in a hospital setting when randomized clinical trials are not feasible. Toward this goal I identify statistical methods, control factors, and adjustments that can correct for potential confounding in observational studies. I investigate the efficiency of existing bias correction methods under varying conditions of imbalanced samples through a Monte Carlo simulation. The simulation results are then utilized in a case study for one of the largest primary diagnosis areas, chronic obstructive pulmonary disease (COPD) at the University of Tennessee Medical Center.
The analysis of the COPD pathway effects on the readmission rates showed a significant positive impact, with reduction in the probability of readmissions between 12% and 16%. The reduction in the length of stay was reported across all the models with historical controls, but the effect was not statistically significant.
Romanova, Anna V., "Evaluating the Effects of Standardized Patient Care Pathways on Clinical Outcomes. " PhD diss., University of Tennessee, 2015.