Clinical pathways analysis of patients in medical institutions based on hard and fuzzy clustering methods

Modeling the processes in a healthcare system plays a large role in understanding its activities and serves as the basis for increasing the efficiency of medical institutions. The tasks of analyzing and modeling large amounts of urban healthcare data using machine learning methods are of particular importance and relevance for the development of industry solutions in the framework of digitalization of the economy, where data is the key factor in production. The problem of automatic analysis and determination of clinical pathways groups of patients based on clustering methods is considered in this research. Existing projects in this area reflect a great interest on the part of the scientific community in such studies; however, there is a need to develop a number of methodological approaches for their further practical application in urban outpatient institutions, taking into account the specifics of the organization being analyzed. The aim of the study is to improve the quality of management and segmentation of patient input flow in urban medical institutions based on cluster analysis methods for the further development of recommendation services. One approach to achieving this goal is the development and implementation of clinical pathways, or patient trajectories. In general, the clinical pathway of a patient might be interpreted as the trajectory when receiving medical services in respective institutions. The approach of developing groups of patient routes by the hierarchical agglomerative algorithm with the Ward method and Additive Regularization of Topic Models (ARTM) is presented in this article. A computational experiment based on public data on the routes of patients with a diagnosis of sepsis is described. One feature of the proposed approach is not just the automation of the determination of similar groups of patient trajectories, but also the consideration of clinical pathways patterns to form recommendations for organizing the resource allocation of a medical institution. The proposed approach to segmenting the input heterogeneous flow of patients in urban medical institutions on the basis of clustering consists of the following steps: 1) preparing the data of the medical institution in the format of an event log; 2) encoding patient routes; 3) determination of the upper limit of the clinical pathway length; 4) hierarchical agglomerative clustering; 5) additive regularization of topic models (ARTM); 6) identifying popular patient route patterns. The resulting clusters of routes serve as the foundation for the further development of a simulation model of a medical institution and provide recommendations to patients. In addition, these groups may underlie the development of the robotic process automation system (RPA), which simulates human actions and allows you to automate the interpretation of data to manage the resources of the institution.