Abstract
BackgroundPublic health in several countries is characterized by a shortage of professionals and a lack of economic resources. Monitoring and redesigning processes can foster the success of health care institutions, enabling them to provide a quality service while simultaneously reducing costs. Process mining, a discipline that extracts knowledge from information system data to analyze operational processes, affords an opportunity to understand health care processes.ObjectiveHealth care processes are highly flexible and multidisciplinary, and health care professionals are able to coordinate in a variety of different ways to treat a diagnosis. The aim of this work was to understand whether the ways in which professionals coordinate their work affect the clinical outcome of patients.MethodsThis paper proposes a method based on the use of process mining to identify patterns of collaboration between physician, nurse, and dietitian in the treatment of patients with type 2 diabetes mellitus and to compare these patterns with the clinical evolution of the patients within the context of primary care. Clustering is used as part of the preprocessing of data to manage the variability, and then process mining is used to identify patterns that may arise.ResultsThe method is applied in three primary health care centers in Santiago, Chile. A total of seven collaboration patterns were identified, which differed primarily in terms of the number of disciplines present, the participation intensity of each discipline, and the referrals between disciplines. The pattern in which the three disciplines participated in the most equitable and comprehensive manner had a lower proportion of highly decompensated patients compared with those patterns in which the three disciplines participated in an unbalanced manner.ConclusionsBy discovering which collaboration patterns lead to improved outcomes, health care centers can promote the most successful patterns among their professionals so as to improve the treatment of patients. Process mining techniques are useful for discovering those collaborations patterns in flexible and unstructured health care processes.
Highlights
En individuos ≥ 45 años sin otros factores de riesgo, solicitar glicemia en ayunas c/3 años
Estrategias para prevenir la diabetes y modificar factores de riesgo CV
Realizar pesquisa de diabetes tipo 2 en individuos mayores de 45 años asintomáticos y en menores de 45 con sobrepeso u obesidad y otros factores de riesgo
Summary
Realizar una evaluación del riesgo cardiovascular en todo paciente diabético al momento del diagnóstico y anualmente para definir las metas e intervenciones terapéuticas. A todo paciente diabético con PA >140/90 mm Hg se le debe indicar cambios en su estilo de vida y tratamiento farmacológico, desde el momento del diagnóstico. En todo paciente diabético con riesgo cardiovascular alto o muy alto con un colesterol LDL mayor de 100 mg/dL debe recibir estatinas junto con consejería intensiva para lograr cambios en su estilo de vida. Iniciar tratamiento farmacológico con metformina (a no ser que esté contraindicada), junto con cambios en el estilo de vida en todo paciente diabético, al momento del diagnóstico. Ante la presencia de una hiperglicemia muy elevada (HbA1c ≥9%) en pacientes sintomáticos, iniciar tratamiento con insulina junto con las intervenciones para lograr cambios en el estilo de vida. La cirugía bariátrica es una alternativa terapéutica para pacientes obesos con diabetes tipo 2 y un IMC ≥ 35 kg/m2, siempre y cuando cumplan con los criterios propios de dicha indicación: edad 15 – 60 años, diabetes de menos de 10 años de evolución, mala respuesta al tratamiento médico de la obesidad y de la diabetes, paciente informado, psicológicamente estable y comprometido con el tratamiento
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