Applying sequence clustering techniques to explore practice-based ambulatory care pathways in insurance claims data.
Eur J Public Health
; 28(2): 214-219, 2018 04 01.
Article
en En
| MEDLINE
| ID: mdl-29040495
ABSTRACT
Background:
Care pathways are a widely used mean to ensure well-coordinated and high quality care by defining the optimal timing and interval of health services for a specific indication. However, evidence on common sequences of services actually followed by patients has rarely been quantified. This study aims to explore whether sequence clustering techniques can be used to empirically identify typical treatment sequences in ambulatory care for heart failure (HF) patients and compare their effectiveness.Methods:
Routine data of HF patients were provided by a large statutory sickness fund in Germany from 2009 until 2011. Events were categorized by either (i) the specialty of the physician, (ii) the type of service/procedure provided and (iii) the medication prescribed. Similarities between sequences were measured using the 'longest common subsequence' (LCS). The k-medoids clustering algorithm was applied to identify distinct subgroups of sequences. We used logistic regression to identify the most effective sequences for avoiding hospitalizations.Results:
Treatment data of 982 incident HF patients were analyzed to identify typical treatment sequences. The cluster analysis revealed three distinct clusters of specialty sequences, four clusters of procedure sequences and four clusters of prescription sequences. Clusters differed in terms of timing and interval of physician visits, procedures and drug prescriptions as well as comorbidities and HF hospitalization rates. We found no significant association between cluster membership and HF hospitalization.Conclusions:
Sequence clustering techniques can be used as an explorative tool to systematically extract, describe compare and analyze treatment sequences and associated characteristics.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Calidad de la Atención de Salud
/
Atención Ambulatoria
/
Reclamos Administrativos en el Cuidado de la Salud
/
Insuficiencia Cardíaca
Tipo de estudio:
Guideline
/
Prognostic_studies
Límite:
Humans
País/Región como asunto:
Europa
Idioma:
En
Revista:
Eur J Public Health
Asunto de la revista:
EPIDEMIOLOGIA
/
SAUDE PUBLICA
Año:
2018
Tipo del documento:
Article
País de afiliación:
Alemania