Defining care trajectories: The example of endometrial cancer

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BackgroundThe era of patient-centered care might lead to the conclusion that there are as many configurations of healthcare utilization within episodes of care as there are patients. However, variability among episodes of care is limited by factors such as local resources or patient characteristics. As a result, the differences among episodes of care are reduced, and a limited number of care trajectories are expected. ObjectiveThe aim of this study was to investigate the ability to identify clinically significant care trajectories using data on healthcare services used by patients with endometrial cancer. MethodsA retrospective review of sixteen healthcare services used by 394 patients newly diagnosed with endometrial cancer was undertaken. Latent class analysis was used to investigate care trajectories. ResultsThe analyses segregated patients into six care trajectories: 1) surgery without hospitalizations and emergency room [ER] visits; 2) surgery with hospitalizations and ER visits; 3) surgery, radiation therapy, and chemotherapy, without hospitalizations and ER visits; 4) surgery, radiation therapy, and chemotherapy, with hospitalizations and ER visits; 5) surgery and radiation therapy; 6) surgery and chemotherapy, with hospitalizations and ER visits. Classification of patients in trajectories with versus without hospitalizations and ER visits could only partially be explained by age, cancer stage, and grade. Concluding statementUtilization of healthcare services can be grouped into a number of defined trajectories in endometrial cancer. Identifying care trajectories and parameters associated with care trajectories could have important clinical and administrative implications.