Patient healthcare trajectory. An essential monitoring tool: a systematic review

Abstract

Background: Patient healthcare trajectory is a recent emergent topic in the literature, encompassing broad concepts. However, the rationale for studying patients' trajectories, and how this trajectory concept is defined remains a public health challenge. Our research was focused on patients' trajectories based on disease management and care, while also considering medico-economic aspects of the associated management. We illustrated this concept with an example: a myocardial infarction (MI) occurring in a patient's hospital trajectory of care. The patient follow-up was traced via the prospective payment system. We applied a semi-automatic text mining process to conduct a comprehensive review of patient healthcare trajectory studies. This review investigated how the concept of trajectory is defined, studied and what it achieves.Methods: We performed a PubMed search to identify reports that had been published in peer-reviewed journals between January 1, 2000 and October 31, 2015. Fourteen search questions were formulated to guide our review. A semi-automatic text mining process based on a semantic approach was performed to conduct a comprehensive review of patient healthcare trajectory studies. Text mining techniques were used to explore the corpus in a semantic perspective in order to answer non-a priori questions. Complementary review methods on a selected subset were used to answer a priori questions.Results: Among the 33,514 publications initially selected for analysis, only 70 relevant articles were semi-automatically extracted and thoroughly analysed. Oncology is particularly prevalent due to its already well-established processes of care. For the trajectory thema, 80% of articles were distributed in 11 clusters. These clusters contain distinct semantic information, for example health outcomes (29%), care process (26%) and administrative and financial aspects (16%). Conclusion:This literature review highlights the recent interest in the trajectory concept. The approach is also gradually being used to monitor trajectories of care for chronic diseases such as diabetes, organ failure or coronary artery and MI trajectory of care, to improve care and reduce costs. Patient trajectory is undoubtedly an essential approach to be further explored in order to improve healthcare monitoring.

Anticipatory Care in Potentially Preventable Hospitalizations: Making Data Sense of Complex Health Journeys

“…Anticipatory care for people with complex trajectories, we argue, and this paper provides supporting evidence, should monitor perceived health current and anticipated future states that emerge from the dynamic network interactions between the microlevel of individual biology to the macrolevel factors of their environments. Clinical team functioning will be dependent upon the usefulness of their models or representations in the present environment and the future environment (35, 36). An anticipatory care provider/team has to talk about the current and the anticipated state to deal with the what is likely to become evident at a future point in time.…”

“…Clinical team functioning will be dependent upon the usefulness of their models or representations in the present environment and the future environment (35). Anticipatory care is often supported by trajectory data analytics with expanding opportunities for predictive analytics and learning how to apply anticipatory principles to improve outcomes (36).…”

Evidence-based Clinical Decision Support Systems for the prediction and detection of three disease states in critical care: A systematic literature review

“…Applications also include therapy guidance, as well as updating clinicians on new or changed recommendations 96 . CDS can also provide guidance by predicting clinical trajectories for different patient profiles over time 97 .…”

Patient or family perceived deterioration in functional status and outcome after intensive care admission: a retrospective cohort analysis of routinely collected data

“… 12 Although weighted towards acute physiological derangement, scoring systems may also incorporate non-physiological parameters, which include age, comorbidity, frailty and emergency indication for ICU admission. However, the concept of decline in functional status and worsening trajectory is not included, despite it being described in the medical literature for over a decade in patients that are towards end of life, 13 in certain chronic disease states 14 and those who are frail. 15 …”