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基于流程挖掘的健康公平性监测框架。

A health equity monitoring framework based on process mining.

作者信息

Adams Jan Niklas, Ziegler Jennifer, McDermott Matthew, Douglas Molly J, Eber René, Gichoya Judy Wawira, Goode Deirdre, Sankaranarayanan Swami, Chen Ziyue, van der Aalst Wil M P, Celi Leo Anthony

机构信息

Chair of Process and Data Science, RWTH Aachen University, Aachen, Germany.

Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America.

出版信息

PLOS Digit Health. 2024 Aug 28;3(8):e0000575. doi: 10.1371/journal.pdig.0000575. eCollection 2024 Aug.

Abstract

In the United States, there is a proposal to link hospital Medicare payments with health equity measures, signaling a need to precisely measure equity in healthcare delivery. Despite significant research demonstrating disparities in health care outcomes and access, there is a noticeable gap in tools available to assess health equity across various health conditions and treatments. The available tools often focus on a single area of patient care, such as medication delivery, but fail to examine the entire health care process. The objective of this study is to propose a process mining framework to provide a comprehensive view of health equity. Using event logs which track all actions during patient care, this method allows us to look at disparities in single and multiple treatment steps, but also in the broader strategy of treatment delivery. We have applied this framework to the management of patients with sepsis in the Intensive Care Unit (ICU), focusing on sex and English language proficiency. We found no significant differences between treatments of male and female patients. However, for patients who don't speak English, there was a notable delay in starting their treatment, even though their illness was just as severe and subsequent treatments were similar. This framework subsumes existing individual approaches to measure health inequities and offers a comprehensive approach to pinpoint and delve into healthcare disparities, providing a valuable tool for research and policy-making aiming at more equitable healthcare.

摘要

在美国,有一项将医院医疗保险支付与健康公平措施挂钩的提议,这表明需要精确衡量医疗服务中的公平性。尽管有大量研究表明医疗保健结果和可及性存在差异,但在评估各种健康状况和治疗方法中的健康公平性时,可用工具存在明显差距。现有的工具通常只关注患者护理的单一领域,如药物递送,但未能审视整个医疗过程。本研究的目的是提出一个过程挖掘框架,以全面了解健康公平性。通过使用跟踪患者护理期间所有行动的事件日志,这种方法使我们不仅能够查看单个和多个治疗步骤中的差异,还能查看更广泛的治疗策略差异。我们已将此框架应用于重症监护病房(ICU)中脓毒症患者的管理,重点关注性别和英语语言能力。我们发现男性和女性患者的治疗之间没有显著差异。然而,对于不会说英语的患者,即使他们的病情同样严重且后续治疗相似,其治疗开始时间也有明显延迟。该框架包含了现有的衡量健康不平等的个体方法,并提供了一种全面的方法来查明和深入研究医疗保健差异,为旨在实现更公平医疗保健的研究和政策制定提供了一个有价值的工具。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2624/11355534/8233c3058c74/pdig.0000575.g001.jpg

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