Clinical pathways outline standardized processes in the delivery of care for a specific disease. Patient journeys through the healthcare system, however, can deviate substantially from these pathways. Given the positive benefits of clinical pathways, it is important to measure the concordance of patient pathways so that variations in health system performance or bottlenecks in the delivery of care can be detected, monitored, and acted upon. This paper proposes the first data-driven inverse optimization approach to measuring pathway concordance in any problem context. Our specific application considers clinical pathway concordance for stage III colon cancer. We develop a novel concordance metric and demonstrate using real patient data from Ontario, Canada that it has a statistically significant association with survival. Our methodological approach considers a patient’s journey as a walk in a directed graph, where the costs on the arcs are derived by solving an inverse shortest path problem. The inverse optimization model uses two sources of information to find the arc costs: reference pathways developed by a provincial cancer agency (primary) and data from real-world patient-related activity from patients with both positive and negative clinical outcomes (secondary). Thus, our inverse optimization framework extends existing models by including data points of both varying “primacy” and “alignment.” Data primacy is addressed through a two-stage approach to imputing the cost vector, whereas data alignment is addressed by a hybrid objective function that aims to minimize and maximize suboptimality error for different subsets of input data. This paper was accepted by Chung Piaw Teo, Special Issue on Data-Driven Prescriptive Analytics.

In this paper, we present and analyze a mathematical programming approach to expansion draft optimization in the context of the 2017 NHL expansion draft involving the Vegas Golden Knights, noting that this approach can be generalized to future NHL expansions and to those in other sports leagues. In particular, we present a novel mathematical optimization approach, consisting of two models, to optimize expansion draft protection and selection decisions made by the various teams. We use this approach to investigate a number of expansion draft scenarios, including the impact of “collaboration” between existing teams, the trade-off between team performance and salary cap flexibility, as well as opportunities for Vegas to take advantage of side agreements in a “leverage” experiment. Finally, we compare the output of our approach to what actually happened in the expansion draft, noting both similarities and discrepancies between our solutions and the actual outcomes. Overall, we believe our framework serves as a promising foundation for future expansion draft research and decision-making in hockey and in other sports.

Clinical pathways outline standardized processes in the delivery of care for a specific disease. Patient journeys through the healthcare system, though, can deviate substantially from recommended or reference pathways.Given the positive benefits of clinical pathways, it is important to measure the concordance of patient pathways so that variations in health system performance or bottlenecks in the delivery of care can be detected, monitored, and acted upon. This paper proposes the first data-driven inverse optimization approach to measuring pathway concordance in any problem context. Our specific application considers clinical pathway concordance for stage III colon cancer. We apply our novel concordance metric to a real dataset of colon cancer patients from Ontario, Canada and show that it has a statistically significant association with survival. Our methodological approach considers a patient's journey as a walk in a directed graph, where the costs on the arcs are derived by solving an inverse shortest path problem. The inverse optimization model uses two sources of information to find the arc costs: reference pathways developed by a provincial cancer agency (primary) and data from real-world patient-related activity from patients with both positive and negative clinical outcomes (secondary). Thus, our inverse optimization framework extends existing models by including data points of both varying "primacy" and "goodness". Data primacy is addressed through a two-stage approach to imputing the cost vector, while data goodness is addressed by a hybrid objective function that aims to both minimize and maximize suboptimality error for different subsets of input data.

Clinical pathways are standardized processes that outline the steps required for managing a specific disease. However, patient pathways often deviate from clinical pathways. Measuring the concordance of patient pathways to clinical pathways is important for health system monitoring and informing quality improvement initiatives. In this paper, we develop an inverse optimization-based approach to measuring pathway concordance in breast cancer, a complex disease. We capture this complexity in a hierarchical network that models the patient's journey through the health system. A novel inverse shortest path model is formulated and solved on this hierarchical network to estimate arc costs, which are used to form a concordance metric to measure the distance between patient pathways and shortest paths (i.e., clinical pathways). Using real breast cancer patient data from Ontario, Canada, we demonstrate that our concordance metric has a statistically significant association with survival for all breast cancer patient subgroups. We also use it to quantify the extent of patient pathway discordances across all subgroups, finding that patients undertaking additional clinical activities constitute the primary driver of discordance in the population.

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