Medical Informatics Research and Development Centre, University of Pannonia, Veszprém, Egyetem u. 10 8200, Hungary.
Department of Medical Rehabilitation and Physical Medicine, University of Szeged, Szeged, Korányi fasor 8-10 6720, Hungary.
J Healthc Eng. 2017;2017:6937194. doi: 10.1155/2017/6937194. Epub 2017 Nov 14.
Our goal was to apply statistical and network science techniques to depict how the clinical pathways of patients can be used to characterize the practices of care providers.
We included the data of 506,087 patients who underwent procedures related to ischemic heart disease. Patients were assigned to one of the 136 primary health-care centers using a voting scheme based on their residence. The clinical pathways were classified, and the spectrum of the pathway types was computed for each center, then a network was built with the centers as nodes and spectrum correlations as edge weights. Then Louvain clustering was used to group centers with similar pathway spectra.
We identified 3 clusters with rather distinct characteristics that occupy quite compact spatial areas, though no geographical information was used in clustering. Network analysis and hierarchical clustering show the dominance of medical university clinics in each cluster.
Though clinical guidelines provide a uniform regulation for medical decisions, doctors have great freedom in daily clinical practice. This freedom leads to regional preferences of certain clinical pathways, the intercenter professional links, and geographical locality and coupled with quantifiable consequences in terms of care costs and periprocedural risk of patients.
我们的目标是应用统计和网络科学技术来描述患者的临床路径如何用于描述医疗服务提供者的实践。
我们纳入了 506087 名接受与缺血性心脏病相关治疗的患者的数据。患者根据居住地使用投票方案被分配到 136 个初级保健中心之一。对临床路径进行分类，并计算每个中心的路径类型谱，然后以中心为节点，路径谱相关性为边权重构建网络。然后使用 Louvain 聚类将具有相似路径谱的中心进行分组。
我们发现了 3 个具有明显特征的聚类，它们占据了相当紧凑的空间区域，尽管聚类中没有使用地理信息。网络分析和层次聚类显示了医学大学诊所在每个聚类中的主导地位。
尽管临床指南为医疗决策提供了统一的规定，但医生在日常临床实践中有很大的自由。这种自由导致了某些临床路径的区域性偏好、中心间的专业联系以及地理位置，并与患者的治疗费用和围手术期风险等可量化后果相关。
