# Assessing the Impact of Patient Characteristics on Genetic Clinical Pathways: A Regression Approach
## 4 Discussion and Conclusions  
The research examined an almost unexplored problem to our knowledge, the analysis of clinical pathways for pregnancies that are at risk. In this field, the activity is carried out in a rather fragmented way from the organizational point of view, holding more a clinical structure point of view and with the laboratory providing the service rather than the patient. Indeed, to our knowledge and looking into the international literature, in the genetic services, there are no studies that explore the patient individual characteristics that might affect the diagnostic pathway and the overall pathway length. The limitations of the current situation depend mainly on the insufficient availability of data: the initial phase of the research devoted a lot of time to this aspect, to demonstrate the need to collect individual data per patient. This is the premise for starting to think \begin{table}
\begin{tabular}{l c c c} \hline \hline
**Clinical Pathway** & **Full Sample** & **Not-EMA Sample** & **Foreign Women Sample** \\ \hline \multirow{3}{*}{Weeks of pregnancy} & 0.0789 & 0.138 & 0.116 \\  & (0.608) & (0.736) & (0.421) \\ \multirow{3}{*}{Foreign} & 1.013 & 1.547 & - \\  & (0.886) & (0.778) & - \\  & \(-1.175\)*** & \(-2.783\)*** & \(-1.439\) \\ \multirow{3}{*}{Live births} & (\(-3.385\)) & (\(-3.314\)) & (\(-1.529\)) \\  & 0.0936 & 0.0697 & - \\ \multirow{3}{*}{Miscarriages} & (0.226) & (0.0564) & \multirow{3}{*}{-} \\  & (0.703) & (0.846) & (\(-0.571\)) \\ \multirow{3}{*}{Voluntary pregnancy} & 0.702 & 0.0644 & 7.091 \\  & (0.946) & (0.0202) & (1.135) \\ \multirow{3}{*}{Hospital specialist} & 1.270 & 3.271** & \(-0.945\) \\  & (1.605) & (2.042) & (\(-0.208\)) \\ \multirow{3}{*}{Private specialist} & 3.267** & 6.046** & \(-2.667\) \\  & (2.304) & (2.537) & (\(-0.974\)) \\ \multirow{3}{*}{Consultant specialist} & 2.203** & 4.285** & 6.244 \\  & (2.104) & (2.005) & (1.424) \\ \multirow{3}{*}{NHS specialist} & 1.202 & 3.774 & 1.813 \\  & (0.973) & (1.061) & (0.462) \\ \multirow{3}{*}{DB1} & 20.63*** & 19.04*** & \(-3.199\) \\  & (11.99) & (8.357) & (\(-1.400\)) \\ \multirow{3}{*}{DB2} & 11.25*** & 9.807*** & 21.98** \\  & (3.855) & (2.626) & (2.373) \\ \multirow{3}{*}{DB3} & 16.41** & 15.06*** & 7.120 \\  & (4.425) & (3.613) & (0.582) \\ \multirow{3}{*}{DB4} & 15.95** & 14.36** & 19.55* \\  & (2.615) & (2.190) & (1.651) \\ \multirow{3}{*}{DB5} & 6.135** & 4.507 & 15.91 * \\  & (2.524) & (1.316) & (1.853) \\ \multirow{3}{*}{DB6} & 1.383 & \(-1.319\) & 6.205 \\  & (0.962) & (\(-0.583\)) & (0.552) \\ \multirow{3}{*}{DB7} & 0.765 & 0.423 & \(-0.533\) \\  & (0.342) & (0.142) & (\(-0.0548\)) \\ \multirow{3}{*}{Materal age} & \(-0.961\) & - & \(-0.869\) \\  & (\(-0.596\)) & - & (\(-0.0758\)) \\ \multirow{3}{*}{Constant} & 27.64*** & 26.18*** & 29.33*** \\  & (7.938) & (6.859) & (2.884) \\ \multirow{3}{*}{Number of observations} & 2119 & 853 & 321 \\ \multirow{3}{*}{R Squared} & 0.442 & 0.461 & 0.474 \\ \hline \hline \end{tabular} Note: *** \(p<0.001\); ** \(p<0.01\); * \(p<0.05\).  
\end{table} 
Table 23: Clinical pathway length for the full sample and for not-EMA and foreign women samples. in terms of pathways and, above all, for making these pathways operational in clinical practice as well. Since a potential weakness and limitation of this study is the availability of data only for one year in the past, it is to be hoped that the database that has been experimentally collected can continue to be implemented and extended to other genetics centers and laboratories, preferably leading to a single regional survey system. The analysis of clinical pathways requires, in fact, the comparison of different situations to be able to highlight which is the best reference practice that combines the best care with the best use of resources, with a view to their appropriateness, which is the fundamental property of the essential levels of care provided by our health care system.