Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
HEOR Group, Value and Access Division, Novartis Pharma K.K, Tokyo, Japan.
J Med Econ. 2024 Jan-Dec;27(1):1134-1145. doi: 10.1080/13696998.2024.2395164. Epub 2024 Sep 6.
The Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway (NASP), a guideline-based regional clinical pathway, was developed to manage low-density lipoprotein cholesterol levels for patients with acute myocardial infarction (AMI) in the Nagasaki prefecture in Japan. This study aimed to summarize the perceived best practices and barriers for the dissemination and operation of the NASP.
This exploratory sequential mixed methods study was developed around the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Focus group interviews were conducted with 24 physicians with experience treating AMI in alignment with the NASP at foundation hospitals. The identified themes and insights were integrated into the development of the questionnaire. The web-based, self-administered questionnaire with a cross-sectional study design was given to 62 physicians in the Nagasaki prefecture. Mixed-method data integration of the results from both study phases was conducted through meta-inferences made from the qualitative and quantitative data.
The best practices included the development of multi-disciplinary operation teams at medical facilities in preparation for the implementation of the NASP, the simplification of the document preparation process, and the establishment of an additional medical fees policy for the utilization of the NASP instead of patient referral documents. Practices tailored to the type of medical institute such as instructing patients on the NASP regimen during index hospitalization for acute-care hospitals, and the development of NASP instructions and manuals for primary care hospitals/outpatient clinics were also recommended. In addition, barriers to the implementation of the NASP such as missed eligible AMI patients for the NASP and the inconsistent implementation to eligible AMI patients were identified.
This study identified the perceived best practices and barriers for the NASP. This knowledge should be considered when expanding the NASP to other institutions across Japan.
长崎急性心肌梗死二级预防临床路径（NASP）是一种基于指南的区域临床路径，旨在管理日本长崎县急性心肌梗死（AMI）患者的低密度脂蛋白胆固醇水平。本研究旨在总结 NASP 传播和实施的最佳做法和障碍。
本探索性序贯混合方法研究围绕 RE-AIM（范围、有效性、采用、实施、维持）框架展开。在基础医院，与 NASP 一致，对 24 名有 AMI 治疗经验的医生进行了焦点小组访谈。确定的主题和见解被纳入问卷的制定。在长崎县，向 62 名医生发放了基于网络的横断面研究设计的自我管理问卷。通过对定性和定量数据进行元推断，对两个研究阶段的结果进行了混合方法数据整合。
最佳实践包括在医疗机构中组建多学科运营团队，为实施 NASP 做好准备，简化文件编制流程，并为利用 NASP 而不是患者转诊文件制定额外的医疗费用政策。还建议根据医疗机构的类型制定实践措施，例如在急性护理医院为住院患者介绍 NASP 方案，以及为初级保健医院/门诊制定 NASP 说明和手册。此外，还确定了 NASP 实施的障碍，例如错过 NASP 合格的 AMI 患者和对合格的 AMI 患者实施不一致。
本研究确定了 NASP 的最佳做法和障碍。在向日本其他机构推广 NASP 时，应考虑这些知识。
