Analyzing Patterns of Service Utilization Using Graph Topology to Understand the Dynamic of the Engagement of Patients with Complex Problems with Health Services

Background: Providing care to persons with complex problems is inherently difficult due to several factors, including the impacts of proximal determinants of health, treatment response, the natural emergence of comorbidities, and service system capacity to provide timely required services. Providing visibility into the dynamics of patients’ engagement can help to optimize care for patients with complex problems. Method: In a previous work, graph machine learning and NLP methods were used to model the products of service system dynamics as atemporal entities, using a data model that collapsed patient encounter events across time. In this paper, the order of events is put back into the data model to provide topological depictions of the dynamics that are embodied in patients’ movement across a complex healthcare system. Result: The results show that directed graphs are well suited to the task of depicting the way that the diverse components of the system are functionally coupled—or remain disconnected—by patient journeys. Conclusion: By setting the resolution on the graph topology visualization, important characteristics can be highlighted, including highly prevalent repeating sequences of service events readily interpretable by clinical subject matter experts. Moreover, this methodology provides a first step in addressing the challenge of locating potential operational problems for patients with complex issues engaging with a complex healthcare service system.