Clinical and operational insights from data-driven care pathway mapping: a systematic review

Abstract

Background Accumulated electronic data from a wide variety of clinical settings has been processed using a range of informatics methods to determine the sequence of care activities experienced by patients. The “as is” or “de facto” care pathways derived can be analysed together with other data to yield clinical and operational information. It seems likely that the needs of both health systems and patients will lead to increasing application of such analyses. A comprehensive review of the literature is presented, with a focus on the study context, types of analysis undertaken, and the utility of the information gained. Methods A systematic review was conducted of literature abstracting sequential patient care activities (“de facto” care pathways) from care records. Broad coverage was achieved by initial screening of a Scopus search term, followed by screening of citations (forward snowball) and references (backwards snowball). Previous reviews of related topics were also considered. Studies were initially classified according to the perspective captured in the derived pathways. Concept matrices were then derived, classifying studies according to additional data used and subsequent analysis undertaken, with regard for the clinical domain examined and the knowledge gleaned. Results 254 publications were identified. The majority (n = 217) of these studies derived care pathways from data of an administrative/clinical type. 80% (n = 173) applied further analytical techniques, while 60% (n = 131) combined care pathways with enhancing data to gain insight into care processes. Discussion Classification of the objectives, analyses and complementary data used in data-driven care pathway mapping illustrates areas of greater and lesser focus in the literature. The increasing tendency for these methods to find practical application in service redesign is explored across the variety of contexts and research questions identified. A limitation of our approach is that the topic is broad, limiting discussion of methodological issues. Conclusion This review indicates that methods utilising data-driven determination of de facto patient care pathways can provide empirical information relevant to healthcare planning, management, and practice. It is clear that despite the number of publications found the topic reviewed is still in its infancy.

Modelagem, Mineração e Análise de Jornadas / Trajetórias de Pacientes

“…Por conta da complexidade e da quantidade das variáveis existentes na condução da saúde de um paciente, o tipo de informação utilizada direciona o tipo de análise e que aqui será denominada como Perspectiva [Manktelow et al 2022]. As perspectivas possíveis incluem o diagnóstico, especialidades, departamentos, atividades assistenciais, entre outras; é possível também fazer a combinação entre essas perspectivas gerando uma terceira análise [de Oliveira et al 2020b, Conca et al 2018, Arnolds and Gartner 2018, Rebuge and Ferreira 2012, Najjar et al 2018, Zhang et al 2015a.…”

Using Directed Acyclic Graphs (Dags) to Represent the Data Generating Mechanisms of Disease and Healthcare Pathways: A Guide for Educators, Students, Practitioners and Researchers

“…Healthcare students, practitioners and researchers unacquainted with DAGs are likely to find them comfortingly familiar and remarkably accessible, since they closely resemble the path diagrams and flowcharts that have become popular for summarising a huge variety of sequential and contingent processes, including disease and healthcare pathways (see, for example: https://www.wikipathways.org/, Martens et al 2021; and https://cks.nice.org.uk/, Manktelow et al 2022;and Young et al, 2018; see also Figure 1.1). Indeed, although DAGs are directed rather than directive -and do not include (or require) the symbols that formal flowcharts use as guides for navigating between 'start' and 'end' points (Ensmenger, 2016) -their use of uni-directional arrows to represent causal paths between successive variables mirrors the directional 'connectors' that flowcharts use to move from 'start' to 'finish' via a sequence of 'inputs', 'processes' and 'outputs' contingent on 'decisions' made at key points along the way.…”

Identification of an Oncological Clinical Pathway through Questionnaires to health professionals

“…Concerning our study, Portugal has one study in this systematic review, therefore our interest of increasing this number. (10) (11) Studies of clinical pathways for Oncology and other diseases have been developed in countries like USA, China, France, Norway, Scotland, England, New Zealand, The Netherlands, Hungary, Italy, South Korea, Canada, and Denmark, to name a few. (12)…”