Identifying and Investigating Ambulatory Care Sequences Before Invasive Coronary Angiography

Abstract

Background: The concept of care pathways is widely used to provide efficient, timely, and evidence-based medical care. Recently, the investigation of actual empirical patient pathways has gained attention. We demonstrate the usability of State Sequence Analysis (SSA), a data mining approach based on sequence clustering techniques, on comprehensive insurance claims data from Germany to identify empirical ambulatory care sequences. We investigate patients with coronary artery disease before invasive coronary angiography (CA) and compare identified patterns with guideline recommendations. This patient group is of particular interest due to high and regionally varying CA rates.Methods: Events relevant for the care of coronary artery disease patients, namely physician consultations and medication prescriptions, are identified based on medical guidelines and combined to define states.State sequences are determined for 1.5 years before CA. Sequence similarity is defined for clustering, using optimal matching with theoryinformed substitution costs. We visualize clusters, present descriptive statistics, and apply logistic regression to investigate the association of cluster membership with subsequent undesired care events.Results: Five clusters are identified, the included patients differing with respect to morbidity, urbanity of residential area, and health care utilization. Clusters exhibit significant differences in the timing, structure, and extent of care before CA. When compared with guideline recommendations, 3 clusters show signs of care deficits.Conclusions: Our analyses demonstrate the potential of SSA for exploratory health care research. We show how SSA can be used on insurance claims data to identify, visualize, and investigate care patterns and their deviations from guideline recommendations.

Analysis of the Effect of the Communication Ability of Nurses in Outpatient Infusion Room on the Treatment Experience of Patients and Their Families

“…It is evident that nurses' communication skills can improve the positive coping emotions of patients' families. The main reason analyzed by the researchers was that effective communication between nurses and patients deepened the knowledge of the families about patients' condition and nurses' work, so that they had a clearer perception of the whole process of their loved ones' illness and infusion and had a clear direction and confidence in the psychological coping process [ 20 ].…”

“…Computational and Mathematical Methods in Medicine deepened the knowledge of the families about condition and nurses' work, so that they had a clearer perception of the whole process of their loved ones' illness and infusion and had a clear direction and confidence in the psychological coping process [20]. Also, in the correlation analysis for nurses' nursing and patients' CD-RISC and HHI scores, it was learned that there was a positive correlation between the total CD-RISC score and resilience dimension scores of families, and the total HHI score and scores of each dimension and nurses' communication scores of each dimension, which was consistent with the above discussion.…”