Healthcare utilization after a first hospitalization for COPD: a new approach of State Sequence Analysis based on the '6W' multidimensional model of care trajectories

Abstract

Background: Published methods to describe and visualize Care Trajectories (CTs) as patterns of healthcare use are very sparse, often incomplete, and not intuitive for non-experts. Our objectives are to propose a typology of CTs one year after a first hospitalization for Chronic Obstructive Pulmonary Disease (COPD), and describe CT types and compare patients' characteristics for each CT type. Methods: This is an observational cohort study extracted from Quebec's medico-administrative data of patients aged 40 to 84 years hospitalized for COPD in 2013 (index date). The cohort included patients hospitalized for the first time over a 3-year period before the index date and who survived over the follow-up period. The CTs consisted of sequences of healthcare use (e.g. ED-hospital-home-GP-respiratory therapists, etc.) over a one-year period. The main variable was a CT typology, which was generated by a 'tailored' multidimensional State Sequence Analysis, based on the "6W" model of Care Trajectories. Three dimensions were considered: the care setting ("where"), the reason for consultation ("why"), and the speciality of care providers ("which"). Patients were grouped into specific CT types, which were compared in terms of care use attributes and patients' characteristics using the usual descriptive statistics.

Exploring social inequalities in healthcare trajectories following diagnosis of diabetes: a state sequence analysis of linked survey and administrative data

“…Using group-based trajectory modeling over an 11-year period, they found seven trajectories (persistent irregular use, generalized to irregular, irregular to generalized, persistent generalized, generalized to specialized, specialized to generalized, and persistent specialized); membership to which differed by age, SES, and residential location [ 23 ]. Another approach applied a tailored state sequence analysis to study where a service was undertaken, by which specialist, and for which diagnosis among a cohort of patients with chronic obstructive pulmonary disease followed for 1 year [ 24 ]. Five trajectory types, corresponding to low healthcare utilization, moderate healthcare utilization, and three high utilization groups with predominantly respiratory diagnoses, cardiovascular diagnoses, and other diagnoses, respectively [ 24 ].…”

“…Another approach applied a tailored state sequence analysis to study where a service was undertaken, by which specialist, and for which diagnosis among a cohort of patients with chronic obstructive pulmonary disease followed for 1 year [ 24 ]. Five trajectory types, corresponding to low healthcare utilization, moderate healthcare utilization, and three high utilization groups with predominantly respiratory diagnoses, cardiovascular diagnoses, and other diagnoses, respectively [ 24 ]. Our analysis took a slightly different approach in assigning care states a lasting duration.…”

<p>Trajectory Modelling Techniques Useful to Epidemiological Research: A Comparative Narrative Review of Approaches</p>

“…18,123 Based on a previous "multidimensional model of care trajectories", 112 a comprehensive approach of sequence analysis, considering simultaneously illness condition, care providers and care settings, has recently been proposed. 124 As in other classification methods presented in this review, subgroup membership can be used as a dependent or independent variable to explore predictors of health trajectories and their contribution to future outcomes.…”

“…Vanasse et al (2020) 124 used sequence analysis to identify similar care trajectories among patients after a first hospitalization for chronic obstructive pulmonary disease (COPD). The care trajectories consisted of sequences of healthcare utilization over a one-year period, with "weeks" as the time unit.…”

Care consumption of people with multiple sclerosis: A multichannel sequence analysis in a population-based setting in British Columbia, Canada

“…[24][25][26] Such methods have mainly been used in social sciences, [24][25][26] but are gaining interest in the field of public health. 4,[27][28][29][30] With the MCSA, each individual is associated with multiple distinct but synchronized sequences (aligned to the time-windows), called 'channels'. Each channel taps a distinct aspect of the whole trajectory.…”