Validation of an interactive process mining methodology for clinical epidemiology through a cohort study on chronic...

Process mining holds promise for analysing longitudinal data in clinical epidemiology, yet its application remains limited. The objective of this study was to propose and evaluate a methodology for applying process mining techniques in observational clinical epidemiology. We propose a methodology that integrates a cohort study design with data-driven process mining, with an eight-step approach, including data collection, data extraction and curation, event-log generation, process discovery, process abstraction, hypothesis generation, statistical testing, and prediction. These steps facilitate the discovery of disease progression patterns. We implemented our proposed methodology in a cohort study comparing new users of proton pump inhibitors (PPI) and H2 blockers (H2B). PPI usage was associated with a higher risk of disease progression compared to H2B usage, including a greater than 30% decline in estimated Glomerular Filtration Rate (eGFR) (Hazard Ratio [HR] 1.6, 95% Confidence Interval [CI] 1.4-1.8), as well as increased all-cause mortality (HR 3.0, 95% CI 2.1-4.4). Furthermore, we investigated the associations between each transition and covariates such as age, gender, and comorbidities, offering deeper insights into disease progression dynamics. Additionally, a risk prediction tool was developed to estimate the transition probability for an individual at a future time. The proposed methodology bridges the gap between process mining and epidemiological studies, providing a useful approach to investigating disease progression and risk factors. The synergy between these fields enhances the depth of study findings and fosters the discovery of new insights and ideas.