Data-driven clinical and cost pathways for chronic care delivery.
Am J Manag Care
; 22(12): 816-820, 2016 Dec.
Article
em En
| MEDLINE
| ID: mdl-27982668
ABSTRACT
OBJECTIVES:
This study illustrates a systematic methodology to embed medical costs into the exact flow of clinical events associated with chronic care delivery. We summarized and visualized the results using clinical and cost data, with the goal of empowering patients and care providers with actionable information as they navigate through a multitude of clinical events and medical expenses. STUDYDESIGN:
We analyzed the electronic health records (EHRs) and medication cost data of 288 patients from 2009 to 2011, whose initial diagnoses included chronic kidney disease stage 3, hypertension, and diabetes.METHODS:
We developed chronological pathways of care and costs for each patient from EHR and medication cost data. Using a data-driven method called clinical pathway (CP) learning, which leverages statistical machine-learning algorithms, we categorized patients into clinically similar subgroups based on progressing clinical complexity and associated care needs. The CP-based subgroups were compared against cost-based subgroups stratified by quartiles of total medication costs, and visualized via pathways that are color-coded by costs.RESULTS:
Our methods identified 3 CP-based, and 4 cost-based, patient subgroups. Two sets of subgroups from each approach indicated some clinical similarity in terms of average statistics, such as number of diagnoses and medication needs. However, the CP-based subgroups displayed significant variation in costs; conversely, large differences in clinical needs were observed among cost-based subgroups.CONCLUSIONS:
This study demonstrates that CPs extracted from EHRs can be enhanced with appropriate cost information to potentially provide detailed visibility into the variability and inconsistencies in current best practices for chronic care delivery.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Doença Crônica
/
Gastos em Saúde
/
Procedimentos Clínicos
/
Atenção à Saúde
/
Registros Eletrônicos de Saúde
Tipo de estudo:
Guideline
/
Health_economic_evaluation
/
Prognostic_studies
Aspecto:
Determinantes_sociais_saude
Limite:
Female
/
Humans
/
Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Am J Manag Care
Assunto da revista:
SERVICOS DE SAUDE
Ano de publicação:
2016
Tipo de documento:
Article