title: Automatic variance analysis of multistage care pathways.
abstract: A care pathway (CP) is a standardized process that consists of multiple care stages, clinical activities and their relations, aimed at ensuring and enhancing the quality of care. However, actual care may deviate from the planned CP, and analysis of these deviations can help clinicians refine the CP and reduce medical errors. In this paper, we propose a CP variance analysis method to automatically identify the deviations between actual patient traces in electronic medical records (EMR) and a multistage CP. As the care stage information is usually unavailable in EMR, we first align every trace with the CP using a hidden Markov model. From the aligned traces, we report three types of deviations for every care stage: additional activities, absent activities and violated constraints, which are identified by using the techniques of temporal logic and binomial tests. The method has been applied to a CP for the management of congestive heart failure and real world EMR, providing meaningful evidence for the further improvement of care quality.
authors.affiliation: IBM Research, Beijing, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Li
authors.affiliation: IBM Research, Beijing, China.
authors.forename: Haifeng
authors.initials: H
authors.lastname: Liu
authors.affiliation: IBM Research, Beijing, China.
authors.forename: Shilei
authors.initials: S
authors.lastname: Zhang
authors.affiliation: IBM Research, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Mei
authors.affiliation: IBM Research, Beijing, China.
authors.forename: Guotong
authors.initials: G
authors.lastname: Xie
authors.affiliation: IBM Research, Beijing, China.
authors.forename: Yiqin
authors.initials: Y
authors.lastname: Yu
authors.affiliation: IBM Research, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: IBM T. J. Watson Research Center, Hawthorne, NY, USA.
authors.forename: Geetika T
authors.initials: GT
authors.lastname: Lakshmanan
mesh_terms: D000704:Analysis of Variance; D001185:Artificial Intelligence; D019091:Critical Pathways / Q000145:classification* / Q000592:standards*; D003627:Data Interpretation, Statistical; D057286:Electronic Health Records / Q000145:classification* / Q000592:standards*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D008390:Markov Chains; D009323:Natural Language Processing; D010363:Pattern Recognition, Automated / Q000379:methods; D011785:Quality Assurance, Health Care / Q000379:methods*