Benefits and Limitations of Business Process Model Notation in Modeling Patient Healthcare Trajectory: A Scoping Review Protocol

Introduction: The adoption of business process model notation (BPMN) in modeling healthcare trajectory can enhance the efficiency and efficacy of healthcare organizations and ultimately improve patient outcomes while restraining costs. However, existing systematic reviews have been inconclusive regarding the effectiveness of BPMN in modeling healthcare trajectory. The aims of this scoping review are to map and aggregate existing evidence on the main benefits and limitations associated with BPMN in healthcare trajectory and highlight areas of improvement on using BPMN and its extensions in healthcare practices, which have not been systematically scoped. Methods and Analysis : The proposed scoping review will be performed in accordance with the methodological framework suggested by Arksey and O’Malley and further refined by Levac et al. A wide range of electronic databases and grey literature sources will be systematically searched using predefined keywords, from 2004 onwards. The review will include any study design with a focus on the application of the BPMN approach applied for optimizing healthcare trajectories (e.g., diagnostic, and therapeutic process, decision making, cost, and resources), published in either English or French. Two reviewers will independently screen titles, abstracts, and full-text articles and select studies meeting the inclusion criteria. A customized data extraction form will be used to extract data from the included studies. The results will be presented in tabular format developed iteratively by the research team. Ethics and dissemination : Research ethics approval is not required as exclusively secondary data will be used. Review findings will be used to advance understanding about BPMN, its extensions and its application in healthcare trajectory optimization. The review will develop recommendations about how to tailor BPMN strategies at optimizing care pathways and decision-making processes. Our findings will be disseminated in peer-reviewed journals and presentations and through discussions with relevant organizations and stakeholders.

Benefits and Limitations of Business Process Model Notation in Modeling Patient Healthcare Trajectory: A Scoping Review Protocol

Introduction: The adoption of business process model notation (BPMN) in modeling healthcare trajectory can enhance the efficiency and efficacy of healthcare organizations and ultimately improve patient outcomes while restraining costs. However, existing systematic reviews have been inconclusive regarding the effectiveness of BPMN in modeling healthcare trajectory. The aims of this scoping review are to map and aggregate existing evidence on the main benefits and limitations associated with BPMN in healthcare trajectory and highlight areas of improvement on using BPMN and its extensions in healthcare practices, which have not been systematically scoped. Methods and Analysis: The proposed scoping review will be performed in accordance with the methodological framework suggested by Arksey and O’Malley and further refined by Levac et al. A wide range of electronic databases and grey literature sources will be systematically searched using predefined keywords, from 2004 onwards. The review will include any study design with a focus on the application of the BPMN approach applied for optimizing healthcare trajectories (e.g., diagnostic, and therapeutic process, decision making, cost, and resources), published in either English or French. Two reviewers will independently screen titles, abstracts, and full-text articles and select studies meeting the inclusion criteria. A customized data extraction form will be used to extract data from the included studies. The results will be presented in tabular format developed iteratively by the research team.Ethics and dissemination: Research ethics approval is not required as exclusively secondary data will be used. Review findings will be used to advance understanding about BPMN, its extensions and its application in healthcare trajectory optimization. The review will develop recommendations about how to tailor BPMN strategies at optimizing care pathways and decision-making processes. Our findings will be disseminated in peer-reviewed journals and presentations and through discussions with relevant organizations and stakeholders.

Qualitative Document Analysis of Patient’s Healthcare Trajectory With and Without Palliative Care

Palliative care is important to the care of seriously ill patients to support the patient and family. Palliative care is often timely in the inpatient setting, but delayed in outpatient care, leading to missed opportunities. Identifying when to engage patients with palliative care in outpatient settings has been challenging. As part of a larger quality improvement project to increase access to palliative care, a qualitative sub-study was completed to identify missed palliative care engagement opportunities in patient’s healthcare trajectories. A document analysis of patients notes from a convenience sample of 20 recently deceased patients who received care within the Veteran Affairs healthcare system (VAHCS) was completed. Patients were sorted into four categories that emerged from initial analysis: cancer/palliative, non-cancer/palliative, cancer/non-palliative, and non-cancer/non-palliative. Two qualitative analysts reviewed the notes, paying particular attention to notes preceding or following seminal healthcare events. Patients in the cancer/non-palliative category were more likely to decline preventive care, engage less with the VAHCS health care or only interacted with the VAHCS for specific needs (e.g., determine VA health benefits). Similarly, non-cancer/non-palliative care patients were more likely to use a mix of VAHCS and outside healthcare, with inpatient care occurring outside of the VAHCS. For non-palliative care patients, seminal healthcare events were less likely to occur in the VAHCS. Thus, identifying opportunities to engage patients with palliative outside of seminal healthcare events may be important to increasing patient access within the VAHCS.

Hospital healthcare flows: A longitudinal clustering approach of acute coronary syndrome in women over 45 years

Acute coronary syndrome (ACS) in women is a growing public health issue and a death leading cause. We explored whether the hospital healthcare trajectory was characterizable using a longitudinal clustering approach in women with ACS. From the 2009–2014 French nationwide hospital database, we extracted spatio-temporal patterns in ACS patient trajectories, by replacing the spatiality by their hospitalization cause. We used these patterns to characterize hospital healthcare flows in a visualization tool. We clustered these trajectories with kmlShape to identify time gap and tariff profiles. ACS hospital healthcare flows have three key categories: Angina pectoris, Myocardial Infarction or Ischemia. Elderly flows were more complex. Time gap profiles showed that readmissions were closer together as time goes by. Tariff profiles were different according to age and initial event. Our approach might be applied to monitoring other chronic diseases. Further work is needed to integrate these results into a medical decision-making tool.

Healthcare trajectory of children with rare bone disease attending pediatric emergency departments

Background Children with rare bone diseases (RBDs), whether medically complex or not, raise multiple issues in emergency situations. The healthcare burden of children with RBD in emergency structures remains unknown. The objective of this study was to describe the place of the pediatric emergency department (PED) in the healthcare of children with RBD. Methods We performed a retrospective single-center cohort study at a French university hospital. We included all children under the age of 18 years with RBD who visited the PED in 2017. By cross-checking data from the hospital clinical data warehouse, we were able to trace the healthcare trajectories of the patients. The main outcome of interest was the incidence (IR) of a second healthcare visit (HCV) within 30 days of the index visit to the PED. The secondary outcomes were the IR of planned and unplanned second HCVs and the proportion of patients classified as having chronic medically complex (CMC) disease at the PED visit. Results The 141 visits to the PED were followed by 84 s HCVs, giving an IR of 0.60 [95% CI: 0.48–0.74]. These second HCVs were planned in 60 cases (IR = 0.43 [95% CI: 0.33–0.55]) and unplanned in 24 (IR = 0.17 [95% CI: 0.11–0.25]). Patients with CMC diseases accounted for 59 index visits (42%) and 43 s HCVs (51%). Multivariate analysis including CMC status as an independent variable, with adjustment for age, yielded an incidence rate ratio (IRR) of second HCVs of 1.51 [95% CI: 0.98–2.32]. The IRR of planned second HCVs was 1.20 [95% CI: 0.76–1.90] and that of unplanned second HCVs was 2.81 [95% CI: 1.20–6.58]. Conclusion An index PED visit is often associated with further HCVs in patients with RBD. The IRR of unplanned second HCVs was high, highlighting the major burden of HCVs for patients with chronic and severe disease.