Machine learning approaches for the discovery of clinical pathways from patient data: A systematic review

Background:

Clinical pathways are sequences of events followed during the clinical care of a group of patients who meet pre-defined criteria. They have many applications ranging from healthcare evaluation and optimization to clinical decision support. These pathways can be discovered from existing healthcare data, in particular with machine learning which is a family of methods used to learn patterns from data. This review provides a comprehensive overview of the literature concerning the use of machine learning methods for clinical pathway discovery from patient data.

Methods:

Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method , we conducted a systematic review of the existing literature. We searched 6 databases, i.e., ACM Digital Library, ScienceDirect, Web of Science, PubMed, IEEE Xplore, and Scopus spanning from January 2004 to December 2023 using search terms pertinent to clinical pathways and their development. Subsequently, the retrieved papers were analyzed to assess their relevance to the scope of this study.

Results:

In total, 131 papers that met the specified inclusion criteria were identified. These papers expressed diverse motivations behind data-driven clinical pathway discovery ranging from knowledge discovery to conformance checking with established clinical guidelines (derived from existing literature and clinical experts). Notably, the predominant methods employed (67.2%, $n$=88) involved unsupervised machine learning techniques, such as clustering and process mining.

Conclusions:

Relevant clinical pathways can be discovered from patient data using machine learning methods, with the desirable potential to aid clinical decision-making in healthcare. However, to reach this objective, the methods used to discover pathways should be reproducible, and rigorous performance evaluation by clinical experts needs to be conducted for validation.