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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Medical Informatics and Decision Making 1/2012

Decision-making in healthcare: a practical application of partial least square path modelling to coverage of newborn screening programmes

BMC Medical Informatics and Decision Making > Ausgabe 1/2012
Katharina E Fischer
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6947-12-83) contains supplementary material, which is available to authorized users.

Competing interests

This research was carried out on behalf of the Helmholtz Zentrum München, German Research Center for Environmental Health (HMGU). The HMGU is an independent organization funded by the German and Bavarian governments. During the course of this study, the author was an employee of the HMGU and neither did nor does have a conflict of interest with regard to this study.



Decision-making in healthcare is complex. Research on coverage decision-making has focused on comparative studies for several countries, statistical analyses for single decision-makers, the decision outcome and appraisal criteria. Accounting for decision processes extends the complexity, as they are multidimensional and process elements need to be regarded as latent constructs (composites) that are not observed directly. The objective of this study was to present a practical application of partial least square path modelling (PLS-PM) to evaluate how it offers a method for empirical analysis of decision-making in healthcare.


Empirical approaches that applied PLS-PM to decision-making in healthcare were identified through a systematic literature search. PLS-PM was used as an estimation technique for a structural equation model that specified hypotheses between the components of decision processes and the reasonableness of decision-making in terms of medical, economic and other ethical criteria. The model was estimated for a sample of 55 coverage decisions on the extension of newborn screening programmes in Europe. Results were evaluated by standard reliability and validity measures for PLS-PM.


After modification by dropping two indicators that showed poor measures in the measurement models’ quality assessment and were not meaningful for newborn screening, the structural equation model estimation produced plausible results. The presence of three influences was supported: the links between both stakeholder participation or transparency and the reasonableness of decision-making; and the effect of transparency on the degree of scientific rigour of assessment. Reliable and valid measurement models were obtained to describe the composites of ‘transparency’, ‘participation’, ‘scientific rigour’ and ‘reasonableness’.


The structural equation model was among the first applications of PLS-PM to coverage decision-making. It allowed testing of hypotheses in situations where there are links between several non-observable constructs. PLS-PM was compatible in accounting for the complexity of coverage decisions to obtain a more realistic perspective for empirical analysis. The model specification can be used for hypothesis testing by using larger sample sizes and for data in the full domain of health technologies.
Additional file 1 : Systematic search. (DOC 54 KB)
Additional file 2 : Survey questionnaire. (PDF 209 KB)
Additional file 3 : Evaluation measures. (DOC 171 KB)
Authors’ original file for figure 1
Authors’ original file for figure 2
Authors’ original file for figure 3
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