Clustering 5-Year Multidimensional Health Care Trajectory Patterns in Alzheimer's Disease and Related Syndromes

Area of Science:

• Gerontology
• Public Health
• Health Services Research

Background:

• Personalized care plans are recommended for Alzheimer's disease and related syndromes (ADRS) patients.
• Equal access to ADRS care and services is crucial for optimal health benefits.
• Healthcare utilization trajectories (HUT) can vary based on individual and contextual factors.

Purpose of the Study:

• To describe HUT patterns in ADRS patients using multidimensional clustering.
• To determine the proportion of patients with favorable HUTs.
• To identify factors associated with favorable HUTs.

Main Methods:

• A cohort of 103,317 ADRS patients was followed for 5 years using French health system data.
• Partitioning around medoids and Levenshtein distances were used to identify 15 patient clusters across three age groups.
• Multivariable logistic regression identified determinants of favorable HUTs.

Main Results:

• Approximately 25% of patients exhibited favorable HUTs, characterized by slow, progressive, at-home-centered care.
• Favorable HUTs were associated with individual factors (age, female gender, fewer comorbidities, lower deprivation) and contextual factors (access to nurses, nursing homes).
• Significant, though small, inter-territorial variance in HUT was observed across all age groups.

Conclusions:

• Favorable healthcare utilization trajectories remain uncommon, indicating a need for improved care strategies.
• Understanding barriers to favorable HUTs requires further qualitative research.
• Efforts to optimize ADRS patient care pathways are essential.