Background: Optimizing care for patients with complex problems entails the integration of clinically appropriate problem-specific clinical protocols, and the optimization of service-system-encompassing clinical pathways. However, alignment of service system operations with Clinical Practice Guidelines (CPGs) is far more challenging than the time-bounded alignment of procedures with protocols. This is due to the challenge of identifying longitudinal patterns of service utilization in the cross-continuum data to assess adherence to the CPGs. Method: This paper proposes a new methodology for identifying patients’ patterns of service utilization (PSUs) within sparse high-dimensional cross-continuum health datasets using graph community detection. Result: The result has shown that by using iterative graph community detections, and graph metrics combined with input from clinical and operational subject matter experts, it is possible to extract meaningful functionally integrated PSUs. Conclusions: This introduces the possibility of influencing the reorganization of some services to provide better care for patients with complex problems. Additionally, this introduces a novel analytical framework relying on patients’ service pathways as a foundation to generate the basic entities required to evaluate conformance of interventions to cohort-specific clinical practice guidelines, which will be further explored in our future research.

Healthcare organizations have a contractual obligation to the public to address population-level inequities to health services access and shed light on them. Various studies have focused on achieving equitable access to healthcare services for vulnerable patients. However, these studies do not provide a nuanced perspective based on the local reality across the full continuum of care. In previous work, graph topology was used to provide visual depictions of the dynamics of patients’ movement across a complex healthcare system. Using patients’ encounters data represented as a graph, this study expands on previous work and proposes a methodology to identify and quantify cohort-specific disparities in accessing healthcare services across the continuum of care. The result has demonstrated that a more nuanced approach to assessing access-to-care disparity is doable using patients’ patterns of service utilization from a longitudinal cross-continuum healthcare dataset. The proposed method can be used as part of a toolkit to support healthcare organizations that wish to structure their services to provide better care to their vulnerable populations based on the local realities. This provides a first step in addressing inequities for vulnerable patients in accessing healthcare services. However, additional steps need to be considered to fully address these inequities.

Similar to many Machine Learning models, both accuracy and speed of the Cluster weighted models (CWMs) can be hampered by high-dimensional data, leading to previous works on a parsimonious technique to reduce the effect of ”Curse of dimensionality” on mixture models. In this work, we review the background study of the cluster weighted models (CWMs). We further show that parsimonious technique is not sufficient for mixture models to thrive in the presence of huge high-dimensional data. We discuss a heuristic for detecting the hidden components by choosing the initial values of location parameters using the default values in the ”FlexCWM” R package. We introduce a dimensionality reduction technique called T-distributed stochastic neighbor embedding (TSNE) to enhance the parsimonious CWMs in high-dimensional space. Originally, CWMs are suited for regression but for classification purposes, all multi-class variables are transformed logarithmically with some noise. The parameters of the model are obtained via expectation maximization algorithm. The effectiveness of the discussed technique is demonstrated using real data sets from different fields.

Individuals from a variety of backgrounds are affected by the opioid crisis. To provide optimal care for individuals at risk of opioid overdose and prevent subsequent overdoses, a more targeted response that goes beyond the traditional taxonomical diagnosis approach to care management needs to be adopted. In previous works, Graph Machine Learning and Natural Language Processing methods were used to model the products for planning and evaluating the treatment of patients with complex issues. This study proposes a methodology of partitioning patients in the opioid overdose cohort into various communities based on their patterns of service utilization (PSUs) across the continuum of care using graph community detection and applying survival analysis to predict time-to-second overdose for each of the communities. The results demonstrated that the overdose cohort is not homogeneous with respect to the determinants of risk. Moreover, the risk for subsequent overdose was quantified: there is a 51% higher chance of experiencing a second overdose for a high-risk community compared to a low-risk community. The proposed method can inform a more efficient treatment heterogeneity approach for a cohort made of diverse individuals, such as the opioid overdose cohort. It can also guide targeted support for patients at risk of subsequent overdoses.