BMC Med Inform Decis Mak - Temporal representation of care trajectories of cancer patients using data from a regional information system: an application in breast cancer.


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CKGROUND: Ensuring that all cancer patients have access to the appropriate treatment within an appropriate time is a strategic priority in many countries. There is in particular a need to describe and analyse cancer care trajectories and to produce waiting time indicators. We developed an algorithm for extracting temporally represented care trajectories from coded information collected routinely by the general cancer Registry in Poitou-Charentes region, France. The present work aimed to assess the performance of this algorithm on real-life patient data in the setting of non-metastatic breast cancer, using measures of similarity.METHODS: Care trajectories were modeled as ordered dated events aggregated into states, the granularity of which was defined from standard care guidelines. The algorithm generates each state from the aggregation over a period of tracer events characterised on the basis of diagnoses and medical procedures. The sequences are presented in simple form showing presence and order of the states, and in an extended form that integrates the duration of the states. The similarity of the sequences, which are represented in the form of chains of characters, was calculated using a generalised Levenshtein distance.RESULTS: The evaluation was performed on a sample of 159 female patients whose itineraries were also calculated manually from medical records using the same aggregation rules and dating system as the algorithm. Ninety-eight per cent of the trajectories were correctly reconstructed with respect to the ordering of states. When the duration of states was taken into account, 94% of the trajectories matched reality within three days. Dissimilarities between sequences were mainly due to the absence of certain pathology reports and to coding anomalies in hospitalisation data.CONCLUSIONS: These results show the ability of an integrated regional information system to formalise care trajectories and automatically produce indicators for time-lapse to care instatement, of interest in the planning of care in cancer. The next step will consist in evaluating this approach and extending it to more complex trajectories (metastasis, relapse) and to other cancer localisations.

Resumo Limpo

ckground ensur cancer patient access appropri treatment within appropri time strateg prioriti mani countri particular need describ analys cancer care trajectori produc wait time indic develop algorithm extract tempor repres care trajectori code inform collect routin general cancer registri poitoucharent region franc present work aim assess perform algorithm reallif patient data set nonmetastat breast cancer use measur similaritymethod care trajectori model order date event aggreg state granular defin standard care guidelin algorithm generat state aggreg period tracer event characteris basi diagnos medic procedur sequenc present simpl form show presenc order state extend form integr durat state similar sequenc repres form chain charact calcul use generalis levenshtein distanceresult evalu perform sampl femal patient whose itinerari also calcul manual medic record use aggreg rule date system algorithm ninetyeight per cent trajectori correct reconstruct respect order state durat state taken account trajectori match realiti within three day dissimilar sequenc main due absenc certain patholog report code anomali hospitalis dataconclus result show abil integr region inform system formalis care trajectori automat produc indic timelaps care instat interest plan care cancer next step will consist evalu approach extend complex trajectori metastasi relaps cancer localis

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