Evaluation of the Care Pathway in a Cohort of Breast Cancer Patients from Northern Italy : a New Methodological Approach

Background: The evaluation of the care pathway in oncologic patients is complex, as the components of the decision process are dependent and influenced by each other. The statistical methods proposed in the literature oversimplify this entangled problem. Objective: The aim of the present study was to propose a new method to evaluate the adherence to guidelines of procedures performed from the diagnostic to the follow-up phase of breast cancer care pathway. Methods: On women with incident breast cancer occurring in 2007-09, we calculated 24 health indicators as the proportion of women not performing a particular diagnostic/therapeutic procedure. Indicators were calculated for the 23 hospitals with all data available. We developed a theoretical model organizing the indicators into 4 different domains of the care pathway (Diagnosis; Surgical treatment; Medical treatment; Follow-up), plus one domain for patients’ characteristics and one for complications. After excluding highly correlated procedures, the model included 19 indicators. We used the Partial Least Squares Path Model (PLS-PM) approach to summarize the indicators into these domains and investigate the relationship among them. Results: We found a negative correlation between the two domains including the indicators measuring lack of adherence to diagnostic and surgical guidelines, and a positive correlation between the domain measuring lack of adherence to surgical guidelines and the one including patients’ characteristics. Conclusion: This is a unique example of PLS-PM application to the evaluation of the care pathway of an oncologic disease, overcoming the limits of the previously applied methods.