PRO77 Sequence Analysis of Cystic Fibrosis Care Management Pathway: A Population-Study Based on the French National Claims Databases

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Routine management of cystic fibrosis (CF) has recently turned a corner with an increase in ambulatory care, which would improve lifestyle and reduce in-hospital infections. Our objective was to cluster management patterns considering both chronology and places of care (ambulatory or in-hospital) through sequential analysis. CF patients were selected in 2016 within the French National Claims Databases (SNIIRAM), from which individual 2-year pathways for medical visits with specialists involved in CF management was built. Optimal matching was used to transform this pathway into 3-month sequences, prior to apply unsupervised methods classifying management patterns. Among the 10,568 CF patients identified, 7,360 were considered for the sequential analysis (no healthcare consumption: n=503; no medical visit of interest: n=2, 705). Patterns were highly differentiated for the place of care. The partition around Meloids (PAM) was the most successful method to classify trajectories. A 3-cluster typology was retained: 35% patients belonged to the “ambulatory” cluster, 32% to the “mixed” one – with both in and out-patient visits at each sequence -, and 33% to the “low management” one. From a multinomial regression analysis: (i) age is a determinant of management patterns (p<0.001) - with majority of preschool children [0-6[, school children [6-12[ and adolescents [12-18[ belonging to the “mixed cluster” (42%, 41% and 46%, respectively), while most of adults belonged to the “ambulatory” one (43%) -, (ii) incident patients were more likely to belong to the “mixed” cluster (p=0.023). A third of CF patients with medical follow-up is almost entirely managed in ambulatory, mainly adults; a third is managed by both in and outpatient care. The question patient with low or no management will be further assessed. On-going analyses will allow the identification of the determinants (e.g. comorbidities, treatments, medical devices) associated with the distribution of CF patients within the management patterns.