Developing new methods for patient care pathway assessment for breast cancer patients in Hungary

Abstract

Abstract Issue The idea of progressive healthcare models is to treat patients preferably in one location as close to their homes as possible. This contradicts the demands of efficiency: to centralise the availability of expensive procedures and highly specialised staff. Healthcare systems need to navigate between these challenges, especially in public health issues such as cancer care. Description of the problem Achieving the best possible health outcomes requires evidence-based policies that find balance between the demands of accessibility and efficiency. Therefore, we aimed to set up a methodology to review the healthcare model and assess patient movements across the system. We analysed the roaming paths of breast cancer patients diagnosed in Hungary in 2017. Inter-hospital roaming was represented as a graph: hospitals were the nodes, patient movements from one hospital to another were directed edges. This allowed us to apply network analysis: modularisation, weighted degrees calculation, etc. We then introduced the measure of terminality. A hospital is terminal in a given pathway if it is the last new one, i.e. all hospitals visited later had already been visited before. Terminality is defined as the proportion of terminal events among all pathways that cross a given hospital. The rationale of this is that the last hospital in cancer pathways is usually not the highest level one: after advanced treatments, patients are often referred back to local hospitals. Results Testing the method on Hungarian breast cancer patients we observed that results fit our prior expectations. The official ranking of hospitals on the progressivity scale (reflecting the availability of advanced treatments) shows sufficient agreement with terminality. Minor differences may point to situations where the healthcare system does not work fully according to regulations. Lessons Our methodology is recommended for system level patient pathway analysis in order to develop evidence-based healthcare policies. Key messages • Graph representation of inter-hospital patient roaming supports evidence-based policy developments for more efficient patient pathways in cancer care, regardless of the healthcare system design. • The applied new network analysis methodology can help assessing the real life processes of cancer care in a healthcare system through identifying the specifics of inter-hospital patient movements.