Bernardo Valdivieso

Using Process Mining for Automatic Support of Clinical Pathways Design

The creation of tools supporting the automatization of the standardization and continuous control of healthcare processes can become a significant helping tool for clinical experts and healthcare systems willing to reduce variability in clinical practice. The reduction in the complexity of design and deployment of standard Clinical Pathways can enhance the possibilities for effective usage of computer assisted guidance systems for professionals and assure the quality of the provided care. Several technologies have been used in the past for trying to support these activities but they have not been able to generate the disruptive change required to foster the general adoption of standardization in this domain due to the high volume of work, resources, and knowledge required to adequately create practical protocols that can be used in practice. This chapter proposes the use of the PALIA algorithm, based in Activity-Based process mining techniques, as a new technology to infer the actual processes from the real execution logs to be used in the design and quality control of healthcare processes.

e_Disease Management. A system for the management of the chronic conditions

Disease Management (DM) is a system of coordinated healthcare intervention and communications for populations with conditions in which patient self-care efforts are significant. e-DM makes reference to processes of DM based on clinical guidelines sustained in the scientific medical evidence and supported by the intervention of Information and Telecommunication Technology (ICT) in all levels where these plans are developed. This paper discusses the design and implementation of a e-DM system which meets the requirements for the integrated chronic disease management following the recommendations of the Disease Management Association and the American Heart Association.

Heart Cycle: Facilitating the deployment of advanced care processes

Current trends in health management improvement demand the standardization of care protocols to achieve better quality and efficiency. The use of Clinical Pathways is an emerging solution for that problem. However, current Clinical Pathways are big manuals written in natural language and highly affected by human subjectivity. These problems make their deployment and dissemination extremely difficult in real practice environments. Furthermore, the intrinsic difficulties for the design of formal Clinical Pathways requires new specific design tools to help making them relly useful and cost-effective. Process Mining techniques can help to automatically infer processes definition from execution samples and, thus, support the automatization of the standardization and continuous control of healthcare processes. This way, they can become a relevant helping tool for clinical experts and healthcare systems for reducing variability in clinical practice and better understand the performance of the system.

Telemedicina en el manejo de pacientes con enfermedad inflamatoria intestinal

Inflammatory bowel disease (IBD) is a chronic and relapsing disorder with significant medical, social and financial impacts. IBD patients require continuous follow-up, and healthcare resource use in this context increases over time. In the last decade, telemedicine has influenced the treatment of chronic diseases like IBD via the application of information and communication technologies to provide healthcare services remotely. Telemedicine and its various applications (telemanagement, teleconsulting and tele-education) enable closer follow-up and provide education resources that promote patient empowerment, encouraging treatment optimisation over the entire course of the disease. We describe the impact of using telemedicine on IBD health outcomes and discuss the limitations of implementing these systems in the real-life management of IBD patients.

The effect of telehealth, telephone support or usual care on quality of life, mortality and healthcare utilization in elderly high-risk patients with multiple chronic conditions. A prospective study

BACKGROUND AND OBJECTIVE To assess the effect of home based telehealth or structured telephone support interventions with respect to usual care on quality of life, mortality and healthcare utilization in elderly high-risk multiple chronic condition patients. PATIENTS AND METHODS 472 elderly high-risk patients with plurimorbidity in the region of Valencia (Spain) were recruited between June 2012 and May 2013, and followed for 12 months from recruitment. Patients were allocated to either: (a) a structured telephone intervention, a nurse-led case management program with telephone follow up every 15 days; (b) telehealth, which adds technology for remote self-management and the exchange of clinical data; or (c) usual care. Main outcome measures was quality of life measured by the EuroQol (EQ-5D) instrument, cognitive impairment, functional status, mortality and healthcare resource use. Inadequate randomization process led us to used propensity scores for adjusted analyses to control for imbalances between groups at baseline. RESULTS EQ-5D score was significantly higher in the telehealth group compared to usual care (diff: 0.19, 0.08-0.30), but was not different to telephone support (diff: 0.04, -0.05 to 0.14). In adjusted analyses, inclusion in the telehealth group was associated with an additional 0.18 points in the EQ-5D score compared to usual care at 12 months (p<0.001), and with a gain of 0.13 points for the telephone support group (p<0.001). No differences in mortality or utilization were found, except for a borderline significant increase in General Practitioner visits. CONCLUSIONS Telehealth was associated with better quality of life. Important limitations of the study and similarity of effects to telephone intervention call for careful endorsement of telemedicine. Clinicaltrials.gov (identifier: NCT02447562).

Development and evaluation of an Innovative Chronic Disease Management Program in Valencia-La Fe Health Department

Valencia La Fe-Health Department, aligned with the Regional Ministry of Health, is pushing an Innovative Chronic Diseases Management Program, by introducing a new, proactive, care model based on current policies, best practices and evidence available aiming to a greater control of the patients while they are at homes. The program has been developed working on the seven courses of action, covering all the components required according to experts. This includes a) identification and stratification of the population, b) care processes design in coordination with all health care resources involved according to case management methodology, c) guidelines and protocols documentation and design of educational programs, d) Service portfolio development and care planning and coordination across care level e) promotion of new technologies, f) continuous assessment and improvement of quality of care g) alignment of resources and incentives in the Health Department. The predictive model developed identifies 3.28% of the total population, related to 72% annual consumption of unplanned weighted resources in our reference population. Chronic management program was evaluated through both a quasi-experimental study including 1900 patients enrolled in the case management program and a randomized clinical trial (RCT) including 495 patients on 3 branches (standard practice, phone supported intervention and technology based intervention). RCT preliminary results regarding health-related quality of life and other outcomes variables will be available during the first quarter of 2014.

Accessing to electronic medical history using a mobility intra hospital system

The aim of this paper is to describe the solution that has been developed in Valencia Region (Spain) to provide health professionals (physicians and nurses) access to all the functionalities of a Hospital Information System (HIS) already available at fixed clients workstations. These functionalities are adapted to the care process carried out at patient bedside. In this way, professionals will have access to treatment and administration, recording of vital signs, nursing assessment, scales, care plan, extractions, medical records, progress notes so that they have all necessary information at the bedside, and record swiftly changes that occur in-situ. In addition, clinical safety is reinforced, including RFID patient identification mechanisms and barcode readers for blood samples or unidosis medication.