A health equity monitoring framework based on process mining

TL;DR

This paper introduces a new framework using process mining to measure health equity in healthcare delivery, focusing on treatment processes and timing disparities.

Contribution

The novel contribution is a process mining framework that comprehensively assesses health equity across entire care processes, not just isolated treatment steps.

Findings

No significant differences were found in treatment between male and female sepsis patients in the ICU.

Non-English-speaking patients experienced notable delays in treatment initiation despite similar illness severity.

The framework offers a comprehensive approach to identifying healthcare disparities beyond single treatment steps.

Abstract

In the United States, there is a proposal to link hospital Medicare payments with health equity measures, signaling a need to precisely measure equity in healthcare delivery. Despite significant research demonstrating disparities in health care outcomes and access, there is a noticeable gap in tools available to assess health equity across various health conditions and treatments. The available tools often focus on a single area of patient care, such as medication delivery, but fail to examine the entire health care process. The objective of this study is to propose a process mining framework to provide a comprehensive view of health equity. Using event logs which track all actions during patient care, this method allows us to look at disparities in single and multiple treatment steps, but also in the broader strategy of treatment delivery. We have applied this framework to the management of patients with sepsis in the Intensive Care Unit (ICU), focusing on sex and English language proficiency. We found no significant differences between treatments of male and female patients. However, for patients who don’t speak English, there was a notable delay in starting their treatment, even though their illness was just as severe and subsequent treatments were similar. This framework subsumes existing individual approaches to measure health inequities and offers a comprehensive approach to pinpoint and delve into healthcare disparities, providing a valuable tool for research and policy-making aiming at more equitable healthcare.

The US is pushing major legislative efforts to make health equity a primary factor in the reimbursement of health institutions. This raises the question of how to measure health equity. Specifically, how to measure health equity within these care-delivering healthcare institutions that are not affected by existing institutional inequities outside the care-delivering institution. We introduce a process mining framework that assesses equity in the care-delivering processes. This means we investigate how different treatments are conducted, how they are timed, and how the general care strategy is allocated. This framework equips regulatory bodies with a toolkit to assess the equity of delivered care within an institution.

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