title: Classification of hospital pathways in the management of cancer: application to lung cancer in the region of burgundy.
abstract: BACKGROUND
  The evaluation of national cancer plans is an important aspect of their implementation. For this evaluation, the principal actors in the field (doctors, nurses, etc.) as well as decision-makers must have access to information that is reliable, synthetic and easy to interpret, and which reflects the implementation process in the field. We propose here a methodology to make this type of information available in the context of reducing inequalities with regard to access to healthcare for patients with lung cancer in the region of Burgundy.
  
  
  METHODS
  We used the national medico-administrative DRG-type database, which gathers together all hospital stays. By using this database, it was possible to identify and reconstruct the care management history of these patients. That is, by linking together all attended hospitals, sorted chronologically. Eligible patients were at least 18 years old, whatever the gender and had undergone surgery for their lung cancer. They had to be residents of Burgundy at the time of the first operation between 2006 and 2008. Patient's pathway was defined as the sequence of all attended hospitals (hospital stays) during the year of follow up linked together using an anonymised patient identifier. We then constructed a pathway typology of pathway using an unsupervised clustering method, and conducted a spatial analysis of this typology.
  
  
  RESULTS
  Between 2006 and 2008, we selected 495 patients in the 4 administrative departments of the Burgundy region. They accounted for a total of 3821 stays during the year of follow-up. There were 393 men (79%) and the mean age was 64 (95% confidence interval: 63-65) years. We reconstructed 94 pathways (about five per patient). Here, neighbourhood's cares accounted for 41% of them, while 44% included a surgical intervention outside the region of Burgundy. We constructed a pathway typology with five classes. Spatial analysis showed that the vast majority of initial surgeries took place in the major regional centres.
  
  
  CONCLUSIONS
  The construction of a pathway typology leads to better understanding of the reasoning that lies behind the movements of patients. It opens the way for analysis of the collaboration between the different healthcares establishments attended, which should bring to light associations that need to be developed.
authors.affiliation: Service de Biostatistique et d'Information Médicale, Centre Hospitalier Universitaire, 21000 Dijon, Boulevard Jeanne d'Arc BP 77908, 21079 Dijon Cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Nuemi
authors.forename: F
authors.initials: F
authors.lastname: Afonso
authors.forename: A
authors.initials: A
authors.lastname: Roussot
authors.forename: L
authors.initials: L
authors.lastname: Billard
authors.forename: J
authors.initials: J
authors.lastname: Cottenet
authors.forename: E
authors.initials: E
authors.lastname: Combier
authors.forename: E
authors.initials: E
authors.lastname: Diday
authors.forename: C
authors.initials: C
authors.lastname: Quantin
mesh_terms: D000368:Aged; D019091:Critical Pathways; D005260:Female; D005602:France / Q000453:epidemiology; D006751:Hospital Information Systems; D006760:Hospitalization; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Clustering; Epidemiology; Hospital information systems; Lung neoplasm; Management care pathways; Medical record linkage