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.

Background: As patients interact with a healthcare service system, patterns of service utilization (PSUs) emerge. These PSUs are embedded in the sparse high-dimensional space of longitudinal cross-continuum health service encounter data. Once extracted, PSUs can provide quality assurance/quality improvement (QA/QI) efforts with the information required to optimize service system structures and functions. This may improve outcomes for complex patients with chronic diseases. Method: Working with longitudinal cross-continuum encounter data from a regional health service system, various pattern detection analyses were conducted, employing (1) graph community detection algorithms, (2) natural language processing (NLP) clustering, and (3) a hybrid NLP–graph method. Result: These approaches produced similar PSUs, as determined from a clinical perspective by clinical subject matter experts and service system operations experts. Conclusions: The similarity in the results provides validation for the methodologies. Moreover, the results stress the need to engage with clinical or service system operations experts, both in providing the taxonomies and ontologies of the service system, the cohort definitions, and determining the level of granularity that produces the most clinically meaningful results. Finally, the uniqueness of each approach provides an opportunity to take advantage of the various analytical capabilities that each approach brings, which will be further explored in our future research.

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.