Inverse optimization on hierarchical networks: an application to breast cancer clinical pathways

• Published in: Health care management science Vol. 25; no. 4; pp. 590 - 622
• Main Authors: Chan, Timothy C. Y., Forster, Katharina, Habbous, Steven, Holloway, Claire, Ieraci, Luciano, Shalaby, Yusuf, Yousefi, Nasrin
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2022; Springer Nature B.V
• Subjects: Breast cancer; Business and Management; Econometrics; Health Administration; Health care management; Health Informatics; Management; Operations research; Operations Research/Decision Theory; Optimization; Patient care planning; Ontario Canada; Canada; Survival analysis; Operations research; Breast cancer; Inverse optimization; Hierarchical network; Clinical pathway concordance
• ISSN: 1386-9620; 1572-9389
• DOI: 10.1007/s10729-022-09599-z

Clinical pathways are standardized processes that outline the steps required for managing a specific disease. However, patient pathways often deviate from clinical pathways. Measuring the concordance of patient pathways to clinical pathways is important for health system monitoring and informing quality improvement initiatives. In this paper, we develop an inverse optimization-based approach to measuring pathway concordance in breast cancer, a complex disease. We capture this complexity in a hierarchical network that models the patient’s journey through the health system. A novel inverse shortest path model is formulated and solved on this hierarchical network to estimate arc costs, which are used to form a concordance metric to measure the distance between patient pathways and shortest paths (i.e., clinical pathways). Using real breast cancer patient data from Ontario, Canada, we demonstrate that our concordance metric has a statistically significant association with survival for all breast cancer patient subgroups. We also use it to quantify the extent of patient pathway discordances across all subgroups, finding that patients undertaking additional clinical activities constitute the primary driver of discordance in the population.