JMIR Publications

ABSTRACT

Background:

The National Health Service (NHS) Talking Therapies programme treats people with common mental health problems in England according to “stepped care”, where lower intensity interventions are offered in the first instance, where clinically appropriate. Limited resources and pressure to achieve service standards mean that programme providers are exploring all opportunities to evaluate and improve the flow of patients through their service. Existing research has found variation in clinical performance and stepped care implementation across sites, and has identified associations between service delivery and patient outcomes. Process mining offers a data-driven approach to analysing and evaluating healthcare processes and systems, enabling presumed models of service delivery to be compared with the actual implementation in practice. The value and utility of applying process mining to NHS Talking Therapies data for the analysis of care pathways has not been studied.

Objective:

Better understanding of systems of service delivery will support improvements and planned programme expansion. Our research therefore intends to demonstrate the value and utility of applying process mining to NHS Talking Therapies care pathways using electronic health records.

Methods:

Routine collection of a wide variety of data about activity and patient outcomes underpins the Talking Therapies programme. In our study, anonymised individual patient referral records from two sites over two years were analysed using process mining to visualise the care pathway process by mapping the care pathway and identifying common pathway routes.

Results:

Process mining enabled the identification and visualisation of patient flows directly from routinely collected data. These visualisations illustrated waiting periods and identified potential bottlenecks, such as the wait for higher intensity Cognitive Behavioural Therapy (CBT) treatment at Site 1. We also observed that patients discharged from treatment waiting lists appeared to experience longer wait durations than those that started treatment. Process mining allowed us to analyse treatment pathways, showing that referrals commonly experienced treatment routes that involved either low or high intensity interventions alone. Of the most common routes, more than five times as many referrals experienced direct access to high intensity treatment rather than stepped care. Overall, 3.6-4.2% (n=45,401, n = 12,590) of all referrals experienced stepped care.

Conclusions:

Our findings demonstrate how process mining can be applied to Talking Therapies care pathways to evaluate pathway performance, explore relationships between performance issues and highlight systemic issues such as ‘step-up' being relatively uncommon within a stepped care system. Integration of process mining capability into routine monitoring will enable NHS Talking Therapies service stakeholders to explore such issues from a process perspective. These insights will provide value to services by identifying areas for service improvement, providing evidence for capacity planning decisions and by facilitating better quality analysis into how health systems can affect patient outcomes.