How can we use the data of the software ViaTrajectoire to study care pathways? The example of the post-acute stroke pathway in the French department Pyrénées-Orientales in 2013
Dr Claire DUFLOSa, Mrs Annick LE PAPEa, Dr Grégoire MERCIERb, Prof Jacques PÉLISSIERc
a Unité d’Aide à la Décision, Pôle Etudes et Perspectives en Santé, Agence Régionale de Santé Languedoc-Roussillon, b Unité de Recherche Médico-Economique, Département d’Information Médicale, CHU Montpellier, c Coordination Régionale SSR et HAD. Fédération HU de Médecine Physique et de Réadaptation Montpellier-Nîmes, CHU Nîmes
Introduction. The choice of the Rehabilitation care Unit that fits the medical, functional and social status of the patient is one of the main barriers to effective implementation of post-acute stroke care pathways in France. Acute care units use the online software ViaTrajectoire to send standardized admission applications to rehabilitation care units. This software offers information about rehabilitation care units and a decision aid system. We propose a methodology to describe post-acute hospital stroke care pathways using individual data from ViaTrajectoire.
Methods. We included all admission applications for acute stroke patients. We built patient clusters by a hierarchical ascending classification on principal components. We described the features of the care pathways within these groups.
Results. In a four groups clustering, three groups were clinically pertinent : aged patients, with multiple deficiencies ; younger patients, with marked deficiencies, but able to support an intensive rehabilitation program ; patients with mild deficiencies, but who could not be discharged. Admission rates in rehabilitation care units were respectively of 83%, 88% and 79%.
Discussion. Individual data from ViaTrajectoire permitted us to draw a clinical and organizational vision of post-acute stroke care pathways. We discuss these pathways according to official guidelines. This software should be improved in the aim to better understand the needs of the health care system.
Keywords : Care pathways, stroke, coordination, rehabilitation care, administrative data