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2019 | OriginalPaper | Chapter

Analysis and Optimization of a Sepsis Clinical Pathway Using Process Mining

Authors : Ricardo Alfredo Quintano Neira, Bart Franciscus Antonius Hompes, J. Gert-Jan de Vries, Bruno F. Mazza, Samantha L. Simões de Almeida, Erin Stretton, Joos C. A. M. Buijs, Silvio Hamacher

Published in: Business Process Management Workshops

Publisher: Springer International Publishing

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Abstract

In this work, we propose and apply a methodology for the management and optimization of clinical pathways using process mining. We adapt the Clinical Pathway Analysis Method (CPAM) by taking into consideration healthcare providers’ needs. We successfully applied the methodology in the sepsis treatment of a major Brazilian hospital. Using data extracted from the hospital information system, a total of 5,184 deviations in the execution of the sepsis clinical pathway were discovered and categorized in 43 different types. We identified the process as it was actually executed, two bottlenecks, and significant differences in performance in cases that deviated from the prescribed clinical pathway. Furthermore, factors such as patient age, gender, and type of infection were shown to affect performance. The analysis results were validated by an expert panel of clinical professionals and verified to provide valuable, actionable insights. Based on these insights, we were able to suggest optimization points in the sepsis clinical pathway.

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Two-tailed Mann-Whitney U test: \(U=261,472.5\); \(n1=366\); \(n2=1,199\); \(p<0.001\).

van der Aalst, W.M.P.: Process Mining - Data Science in Action, 2nd edn. Springer, Heidelberg (2016). https://doi.org/10.1007/978-3-662-49851-4CrossRef

Acampora, G., Vitiello, A., Di Stefano, B., van der Aalst, W.M.P., Günther, C.W., Verbeek, E.: IEEE 1849TM: The XES Standard. IEEE Comput. Intell. Mag., 4–8 (2017)

Augusto, V., Xie, X., Prodel, M., Jouaneton, B., Lamarsalle, L.: Evaluation of discovered clinical pathways using process mining and joint agent-based discrete-event simulation. In: Winter Simulation Conference, WSC 2016, Washington, DC, USA, pp. 2135–2146. IEEE (2016)

Baker, K., et al.: Process mining routinely collected electronic health records to define real-life clinical pathways during chemotherapy. I. J. Med. Inform. 103, 32–41 (2017)CrossRef

Caron, F., Vanthienen, J., Vanhaecht, K., Van Limbergen, E., Deweerdt, J., Baesens, B.: A process mining-based investigation of adverse events in care processes. Health Inf. Manag. J. 43(1), 16–25 (2014)

Carrillo-Esper, R., Carrillo-Cordova, J.R., Carrillo-Cordova, L.D.: Epidemiological study of sepsis in Mexican intensive care units. Cir. Cir. 77(4), 301–308 (2009)

Chalupka, A.N., Talmor, D.: The economics of sepsis. Criti. Care Clin. 28(1), 57–76 (2012)CrossRef

Chawla, A., Westrich, K., Matter, S., Kaltenboeck, A., Dubois, R.: Care pathways in US healthcare settings: current successes and limitations, and future challenges. Am. J. Manag. Care 22(1), 53–62 (2016)

CIHI: Canadian Institute for Health Information: In focus: A national look at sepsis (2009). https://secure.cihi.ca/estore/productFamily.htm?&pf=PFC1564

10.

Dixit, P.M., Garcia Caballero, H.S., Corvò, A., Hompes, B.F.A., Buijs, J.C.A.M., van der Aalst, W.M.P.: Enabling interactive process analysis with process mining and visual analytics. In: BIOSTEC: HEALTHINF, Porto, Portugal, vol. 5, pp. 573–584. SciTePress, February 2017

11.

Fernandez-Llatas, C., et al.: Analyzing medical emergency processes with process mining: the stroke case. In: Daniel, F., Sheng, Q.Z., Motahari, H. (eds.) BPM 2018. LNBIP, vol. 342, pp. 214–225. Springer, Cham (2019). https://doi.org/10.1007/978-3-030-11641-5_17CrossRef

12.

Finfer, S., Bellomo, R., Lipman, J., French, C., Dobb, G., Myburgh, J.: Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units. Intensive Care Med. 30(4), 589–596 (2004)CrossRef

13.

Fujino, Y., et al.: Impact of regional clinical pathways on the length of stay in hospital among stroke patients in Japan. Med. Care 52(7), 634–640 (2014)CrossRef

14.

Hompes, B.F.A., van der Aalst, W.M.P.: Lifecycle-based process performance analysis. In: Panetto, H., Debruyne, C., Proper, H., Ardagna, C., Roman, D., Meersman, R. (eds.) OTM 2018 Conferences. LNCS, vol. 11229, pp. 336–353. Springer, Cham (2018). https://doi.org/10.1007/978-3-030-02610-3_19CrossRef

15.

Hompes, B.F.A., Buijs, J.C.A.M., van der Aalst, W.M.P.: A generic framework for context-aware process performance analysis. In: Debruyne, C., et al. (eds.) OTM 2016 Conferences. LNCS, vol. 10033, pp. 300–317. Springer, Cham (2016). https://doi.org/10.1007/978-3-319-48472-3_17CrossRef

16.

Hompes, B.F.A., Maaradji, A., La Rosa, M., Dumas, M., Buijs, J.C.A.M., van der Aalst, W.M.P.: Discovering causal factors explaining business process performance variation. In: Dubois, E., Pohl, K. (eds.) CAiSE 2017. LNCS, vol. 10253, pp. 177–192. Springer, Cham (2017). https://doi.org/10.1007/978-3-319-59536-8_12CrossRef

17.

Hompes, B., Dixit, P., Buijs, J.: Using process analytics to improve healthcare processes. Data Science for Healthcare: Methodologies and Applications, pp. 305–325. Springer, Cham (2019). https://doi.org/10.1007/978-3-030-05249-2_12CrossRef

18.

Hospital Samaritano, Com 125 anos de atividades, o Hospital Samaritano Higienópolis, destaca-se pela excelência e humanização no atendimento à saúde (2019). http://samaritano.com.br/institucional/institucional/

19.

Khalifa, M., Alswailem, O.: Clinical pathways: identifying development, implementation and evaluation challenges. In: ICIMTH, pp. 131–134. IOS Press (2015)

20.

Kumar, A., et al.: Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit. Care Med. 34(6), 1589–1596 (2006)CrossRef

21.

Liao, X., Du, B., Lu, M., Wu, M., Kang, Y.: Current epidemiology of sepsis in mainland China. Ann. Transl. Med. 4(17), 324 (2016) CrossRef

22.

Machado, F.R., et al.: The epidemiology of sepsis in Brazilian intensive care units (the Sepsis PREvalence Assessment Database, SPREAD): an observational study. Lancet Infect. Dis. 17(11), 1180–1189 (2017)CrossRef

23.

Mans, R.S., van der Aalst, W.M.P., Vanwersch, R.J.B.: Process Mining in Healthcare - Evaluating and Exploiting Operational Healthcare Processes. SBPM. Springer, Cham (2015). https://doi.org/10.1007/978-3-319-16071-9CrossRef

24.

Palleschi, M.T., Sirianni, S., O’Connor, N., Dunn, D., Hasenau, S.M.: An interprofessional process to improve early identification and treatment for sepsis. J. Healthc. Qual. 36(4), 23–31 (2014)CrossRef

25.

Panella, M., Marchisio, S., Di Stanislao, F.: Reducing clinical variations with clinical pathways: do pathways work? Int. J. Qual. Health Care 15(6), 509–521 (2003)CrossRef

26.

Quintano Neira, R.A.: A multi-criteria process mining optimization tool and its application in a sepsis clinical pathway. Ph.D. thesis, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro (2018)

27.

Quintano Neira, R.A., Hamacher, S., Japiassú, A.M.: Epidemiology of sepsis in Brazil: incidence, lethality, costs, and other indicators for Brazilian Unified Health System hospitalizations from 2006 to 2015. PLoS ONE 13(4), e0195873 (2018)CrossRef

28.

Quintano Neira, R.A., de Vries, G., Caffarel, J., Stretton, E.: Extraction of data from a hospital information system to perform process mining. Stud. Health Technol. Inform. 245, 554–558 (2017)

29.

Revista exame: Os hospitais brasileiros de excelência em 2014. https://exame.abril.com.br/seu-dinheiro/os-hospitais-brasileiros-de-excelencia-em-2014

30.

Rodríguez, F., et al.: The epidemiology of sepsis in Colombia: a prospective multicenter cohort study in ten university hospitals. Crit. Care Med. 39(7), 1675–1682 (2011)CrossRef

31.

Rojas, E., Munoz-Gama, J., Sepúlveda, M., Capurro, D.: Process mining in healthcare: a literature review. J. Biomed. Inform. 61, 224–236 (2016)CrossRef

32.

Singer, M., et al.: The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315(8), 801–810 (2016)CrossRef

33.

Society of Critical Care Medicine: Surviving sepsis campaign. http://www.survivingsepsis.org

34.

The EPISEPSIS Study Group: EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med. 30(4), 580–588 (2004)

35.

Tukey, J.: Exploratory Data Analysis. Addison-Wesley, Reading (1977)MATH

36.

XES Working Group: IEEE Standard for eXtensible Event Stream (XES) for achieving interoperability in event logs and event streams. IEEE Std 1849-2016, pp. 1–50 (2016)

37.

Yang, W., Su, Q.: Process mining for clinical pathway: literature review and future directions. In: 2014 11th International Conference on Service Systems and Service Management (ICSSSM), pp. 1–5 (2014)

38.

Yoo, S., et al.: Assessment of hospital processes using a process mining technique: outpatient process analysis at a tertiary hospital. I. J. Med. Inform. 88, 34–43 (2016)CrossRef

39.

Zhang, Y., Padman, R., Patel, N.: Paving the COWpath: learning and visualizing clinical pathways from electronic health record data. J. Biomed. Inform. 58, 186–197 (2015)CrossRef

Title: Analysis and Optimization of a Sepsis Clinical Pathway Using Process Mining
Authors: Ricardo Alfredo Quintano Neira
Bart Franciscus Antonius Hompes
J. Gert-Jan de Vries
Bruno F. Mazza
Samantha L. Simões de Almeida
Erin Stretton
Joos C. A. M. Buijs
Silvio Hamacher
Publisher: Springer International Publishing
Book: Business Process Management Workshops
Print ISBN: 978-3-030-37452-5

Electronic ISBN: 978-3-030-37453-2

Copyright Year: 2019
DOI: https://doi.org/10.1007/978-3-030-37453-2_37

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