Relationship between patient costs and patient pathways

PURPOSE: The purpose of this paper is to identify actual (as-is) patient pathway variation among breast cancer patients and to investigate the relationship between pathways and the cost incurred by patients. DESIGN/METHODOLOGY/APPROACH: Both quantitative and qualitative methods were employed to analyze data from four Swedish hospital groups. Quantitative methods include event-log data mining and statistical analyses on the related patient cost from the Swedish breast cancer quality registry and case-costing system. Qualitative methods included collaboration with and interviewing domain experts. FINDINGS: Unique pathways, followed by only one patient, were generally costlier than the most and less frequent pathways. Earlier study findings are confirmed for mastectomy patients, with more frequent pathways having a lower cost, whereas contradicting and inconclusive results emerged for the partial mastectomy patient groups. Highest variation in pathways was identified for patients receiving chemotherapy. PRACTICAL IMPLICATIONS: The common belief - if one follows a standardized patient pathway, then the cost will be lower - should be re-examined based on the actual pathways that occur in reality. ORIGINALITY/VALUE: The relationships between patient pathways and patient cost allow more complex insights, beyond the general causal relationship between successfully implementing a "to-be" care pathway and lower cost. This highlights data-driven research's importance, where actual pathways (as-is) provide more useful information than to-be care pathways.