Process Mining on National Health Care Data for the Discovery of Patient Journeys of Older Adults

Abstract

ObjectiveUnderstanding the longitudinal patterns of health care utilization among older adults is crucial for designing effective patient journeys and enhancing care coordination across settings. This study aims to uncover the most common patient journeys of older adults. DesignThis explorative study used process mining techniques to analyze national health care data from 2017 to 2019, focusing on patient care journeys of older adults (aged ≥65 years) in the Netherlands. Setting and ParticipantsData were sourced from Statistics Netherlands, encompassing all residents aged ≥65 years as of January 1, 2017. Health care usage declarations from various care settings during 2017-2019 were included. Patient journeys were exclusively selected if their initiation points were certain. MethodsData underwent rigorous preprocessing, merging, and filtering to create a single event log file suitable for process mining. Patients were categorized by age and medication use, and differences in patient journeys were analyzed. Process mining techniques generated visualizations illustrating the connections between care forms and the impact of changes in one form on others. ResultsThe study included 3,177,203 individuals aged 65 years and older, with 44% experiencing 1 or more patient journeys totaling 2,469,663 journeys in 2017-2019. Most care journeys for older adults were simple and short. The top 10 most frequent journeys had 4 or fewer care forms, with 95% of journeys for the 65+ population and 90% for the 85+ population having 4 or fewer care transitions. Long-term care forms, such as home care, personal care, and long-term care, accounted for the majority of time spent in the system. Conclusions and ImplicationsThis pioneering study used process mining to show that most older adults tend to have a straightforward health care need, often involving the emergency department and hospitalizations. However, a smaller group among the population requires more complex and prolonged care, especially in the 85+ population. Reducing the number of transitions for this population, although impacting fewer people, might result in a larger effect on the overall system.