JMIR Publications

ABSTRACT

Background:

Tracing frequent users of care services is highly relevant to policymakers and clinicians, as it may enable them to avoid wasting scarce resources. Data collection on frequent users from all possible care providers may be cumbersome due to patient privacy, competition, incompatible information systems and efforts involved.

Objective:

This study explores the use of a single key source, Emergency Medical Services (EMS) records, for tracing and revealing patterns of care consumption of frequent users.

Methods:

A retrospective study was performed analyzing EMS calls from the province of Drenthe in the Netherlands, between 2012–2017. Process mining is applied to identify the structure of patient routings, i.e., their consecutive visits to hospitals, nursing homes and EMS. Routings are used to identify and quantify frequent users, recognizing frail elderly as a focal group. The structure of these routes is analyzed at patient and group levels, aiming to gain insight into regional coordination issues and workload distributions among care providers.

Results:

Frail elderly aged ≥ 70 represent over 50% of frequent users, making ≥ 4 calls per year. Over the period of observation their annual number and the number of calls increase from 395 to 628 and 2,607 to 3,615, respectively. Structural analysis based on process mining reveals that two categories of frail elderly emerge: low complexity patients who are in need of dialysis, radiation therapy or hyperbaric medicine, involving few providers; and high complexity patients for whom routings appear chaotic.

Conclusions:

The efficient approach exploits the role of EMS as the unique regional ‘ferryman’, while combined use of EMS data and process mining allows for the effective and efficient tracing of frequent users of care services. The approach supports regional policymakers and clinicians by quantifying and detailing frequent user consumption patterns in support of subsequent policy adaptations.