Evaluating Diagnostic Accuracy and Treatment Outcomes of Emerging Clinical Protocols in Managing Complex Internal Medicine Disorders

Abstract

Background: Complex internal medicine admissions are prone to diagnostic discordance and variable treatment outcomes, particularly in high-volume tertiary settings, motivating the adoption of structured, technology-assisted clinical protocols to standardize diagnostic and therapeutic pathways. Objective: To evaluate whether emerging protocol-based care is associated with improved diagnostic concordance and better inpatient and short-term post-discharge outcomes compared with conventional care among adults with complex internal medicine disorders. Methods: A retrospective observational cohort study was conducted across tertiary care teaching hospitals in Lahore, Pakistan, over a 12-month period. Adult inpatients (n=300) managed under internal medicine services were classified by documented care pathway into emerging protocol-based care (n=152) or conventional care (n=148). Primary diagnostic performance was assessed as diagnostic concordance between the initial working diagnosis within 24 hours and the final adjudicated discharge diagnosis. Outcomes included clinical improvement at discharge (CGI-I ≤3), length of stay, in-hospital complications, and 30-day readmission. Multivariable logistic regression adjusted for age, sex, comorbidity burden, disease category, and baseline severity. Results: Diagnostic concordance was higher with emerging protocols (90.8% vs 81.1%; risk difference 9.7%, 95% CI 2.8–16.6; p=0.006). Clinical improvement was more frequent (84.2% vs 69.6%; OR 2.34, 95% CI 1.36–4.03; p=0.002), length of stay was shorter (5.8±1.9 vs 8.4±2.3 days; mean difference −2.6, 95% CI −3.1 to −2.1; p<0.001), and 30-day readmissions were lower (7.9% vs 14.9%; OR 0.49, 95% CI 0.23–0.99; p=0.046). Protocol-based care independently predicted favorable outcomes (adjusted OR 2.47, 95% CI 1.44–4.22; p=0.001). Conclusion: Emerging protocol-based care was associated with improved diagnostic concordance and clinically meaningful gains in efficiency and short-term outcomes in complex internal medicine admissions.