Use of state sequence analysis for care pathway analysis: The example of multiple sclerosis

The concept of care pathways is increasingly being used to enhance the quality of care and to optimize the use of resources for health care. We here propose an innovative method in epidemiology that is derived from social sciences: state sequence analysis (SSA). This method takes into account the chronology of care consumption and allows for identification of specific patterns. A process for using SSA in the health area is proposed and discussed. The main steps are: data coding, measurement of dissimilarities between sequences (focusing on optimal matching methods and the choice of related costs), and application of a clustering method to obtain a typology of sequence patterns. As an example of its use in the health area, SSA was employed to analyse care pathways of a random sample of patients with multiple sclerosis. This sample has been selected from the main French healthcare database covering the period 2007 to 2013 ( n = 1 000). A five-cluster typology was obtained which allowed distinction of care consumption groups. Overall, about half of the patients had low care consumption, about one quarter had medium to high consumption, and another quarter had high consumption. We conclude that state sequence analysis is an innovative and flexible methodology that is worth considering in health care research.

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Patient Flow or the Patient’s Journey? Exploring Health Care Providers’ Experiences and Understandings of Implementing a Care Pathway to Improve the Quality of Transitional Care for Older People

Qualitative Health Research ◽

10.1177/10497323211003861 ◽

2021 ◽

pp. 104973232110038

Author(s):

Cecilie Fromholt Olsen ◽

Astrid Bergland ◽

Jonas Debesay ◽

Asta Bye ◽

Anne Gudrun Langaas

Keyword(s):

Health Care ◽

Older People ◽

Health Care Providers ◽

Transitional Care ◽

Care Pathway ◽

Patient Flow ◽

Care Pathways ◽

Care Providers ◽

Patient Centered ◽

Care For Older People

Internationally, the implementation of care pathways is a common strategy for making transitional care for older people more effective and patient-centered. Previous research highlights inherent tensions in care pathways, particularly in relation to their patient-centered aspects, which may cause dilemmas for health care providers. Health care providers’ understandings and experiences of this, however, remain unclear. Our aim was to explore health care providers’ experiences and understandings of implementing a care pathway to improve transitional care for older people. We conducted semistructured interviews with 20 health care providers and three key persons, along with participant observations of 22 meetings, in a Norwegian quality improvement collaborative. Through a thematic analysis, we identified an understanding of the care pathway as both patient flow and the patient’s journey and a dilemma between the two, and we discuss how the negotiation of conflicting institutional logics is a central part of care pathway implementation.

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Multichannel sequence analysis: An innovative method to study patterns of care pathways. Application to multiple sclerosis based on French Health Insurance data

Revue d Épidémiologie et de Santé Publique ◽

10.1016/j.respe.2018.05.534 ◽

2018 ◽

Vol 66 ◽

pp. S430-S431 ◽

Cited By ~ 1

Author(s):

J. Roux ◽

O. Grimaud ◽

E. Leray

Keyword(s):

Multiple Sclerosis ◽

Health Insurance ◽

Sequence Analysis ◽

Patterns Of Care ◽

Care Pathways ◽

Health Insurance Data ◽

Innovative Method ◽

Insurance Data

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Do we need electronic support for pathways: the Spanish experience

International Journal of Care Pathways ◽

10.1258/jicp.2009.009010 ◽

2009 ◽

Vol 13 (2) ◽

pp. 67-74 ◽

Cited By ~ 2

Author(s):

Ricard Rosique

Keyword(s):

Health Care ◽

Care Pathway ◽

Successful Implementation ◽

Care Pathways ◽

Hospital Managers ◽

Strategic Resources ◽

Care Processes ◽

Strategy Planning ◽

Electronic Support ◽

Hospital General

Care pathways are excellent tools for quality management in health care concerning the standardization of care processes, as they promote organized and efficient patient care established on evidence-based practice. The implementation of a care pathway project at any health-care setting means a change of the organizational culture. E-pathways (electronic pathways) are strategic resources in order to get the successful implementation of a care pathway project. The concept of e-pathway is recent enough and there are some different experiences worldwide. In 2000, the first electronic pathways were implemented at Hospital de Mataró, in Barcelona, Spain. The benefits of using e-pathways (Eira Healthcare Server) are very clear at Hospital de Mataró: immediate records with no transcriptions, information in the palm of your hand, no prints, and rigour and reliability. Another recent and interesting experience is the development and introduction of e-pathways at Hospital General de l'Hospitalet, in Barcelona, Spain, using an SAP integrated health-care solution. The strategy planning of hospital managers should take into account the need and priority of any pathway project linked to e-pathways. Some experiences in Spain have proven that we do really need electronic support for pathways. Electronic pathways are a basic support and should not be postponed when implementing care pathways.

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Public health and multiple sclerosis in Italy

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1105 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

D Bezzini ◽

M A Battaglia ◽

M Ponzio ◽

T Manacorda ◽

P Zaratin ◽

...

Keyword(s):

Multiple Sclerosis ◽

Health System ◽

National Health ◽

Care Pathway ◽

Clinical Care ◽

National Health System ◽

Interdisciplinary Management ◽

Care Pathways ◽

Health And Social Care ◽

Diagnosis Therapy

Abstract Background Multiple Sclerosis (MS) is a complex and progressive disease of the central nervous system. In Italy, prevalence of MS ranges from 198 (continental Regions) to 370 (Sardinia) per 100,000. Despite a National Health System, differences among Regions cause inequalities in access to and quality of care, also involving chronic diseases and disabilities, including MS. Methods Interviews and focus groups involving persons with MS, caregivers, institutions, patients association and other stakeholders were conducted in 2019, to evaluate MS policy landscape, existing services, guidelines and care pathways regarding diagnosis, therapy, follow up, strenghts and weaknesses. Results 600 MS specialized neurologists and 350 MS nurses operate in 240 MS Centers located in hospital neurology departments providing clinical care, disease modifying drugs (DMDs), interdisciplinary care. 13 Regions on 20 approved a PDTA (Diagnosis, Therapy, Care Pathway), other are due by 2020. A reference national PDTA has been already discussed by Regional Health Authorities Conference and Ministry of Health. Regional multistakeholder observatories will be organized. A national MS registry started in 2017, at present involving over 140 Centers and including data of 50% (60.000 patients) of estimated prevalence. Discussion MS specialized centers are recognized as the key component of MS care in Italy and the main refererral for 80% of patients, also taking in account that over 60% of patients receive a DMD. Access to rehabilitation is lacking and hospital, community and primary care linkage is needed, also considering transition from early stages to severe disability. Access to psycological support is variable and cost containment strategies restrict drug access and symptomatic care in some areas along with lacking of interdisciplinary management. It is mandatory to integrate health and social care pathways accordingly with the National Plan for Chronicity in which MS has to be included. Key messages MS specialized centers are the backbone care network in Italy. Integrated care pathways (PDTA) stated as National Health System rules define the right for the patients to receive the proper care.

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Mental health care pathways

European Psychiatry ◽

10.1016/s0924-9338(11)72253-2 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 546-546

Author(s):

D. Kingdon ◽

A. Gregoire

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Care Pathway ◽

Clinical Information ◽

Relevant Information ◽

Care Pathways ◽

Term Care ◽

Information Leaflets ◽

The Uk

IntroductionThe term, care pathway, has been used to describe multidisciplinary/ multi-agency outline of anticipated care, placed in an appropriate timeframe, to help a patient with a specific condition or set of symptoms move progressively through a clinical experience to positive outcomes. In practice, a multitude of disparate projects have produced outputs ranging from pages of interconnected boxes and arrows with rather basic entries to thick and indigestible wads of paper. Certainly the idea of a ‘mental health care pathway’ accessible and used by the general public, service users, carers, primary and secondary care has seemed overwhelmingly complex and unworkable.Aims & objectivesTo make relevant service and clinical information available when and where in a person's progress or a clinician treatment path it was needed.MethodWebsite hyperlinks allow linkage within websites and to other websites with relevant information (e.g. ICD10, NICE guidelines, and Patient information leaflets). A development prototype funded by the UK NHS has been established to form the basis for a website to be launched in mid-2011 (www.mentalhealth.southcentral.nhs.uk).ResultsThe prototype contains links to evidence-based information on maintaining mental health and on ‘coping with problems’. Service Pathways describe detail of processes occurring in mental health care. Diagnostic care pathways start as broad categories [Kingdon et al, 2010] with links to diagnosis, medication (e.g. connects to the National Formulary) and psychological management sites.ConclusionsWeb technology allows information about mental health care pathways to be accessed more systematically and readily and has application internationally.

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