Graduation Year


Document Type




Degree Granting Department

Industrial and Management Systems Engineering

Major Professor

José L. Zayas-Castro, Ph.D.

Co-Major Professor

Peter J. Fabri, M.D., Ph.D.

Committee Member

Ali Yalcin, Ph.D.


health care, care cycle, patient flow, clinical pathways, medical databases


The US spends more money on health care than other industrialized nations. Nevertheless, the US lags behind them in life expectancies, access to care, and other health indicators. This can be attributed to the numerous issues that afflict the US health care sector - the lack of a universal health coverage, increasing medical errors, over and under-treatment of patients, lack of standardization, and so on.

It is believed that the structure of health care delivery as it exists in the US is broken, which consequently reduces the quality of provided care and increases costs. There is a growing consensus among the different players in the sector that a complete overhaul of the health care system is required. This study presents an approach to identify patient treatment over a cycle of care.

Every medical condition has a care cycle over which treatment is provided. The complete cycle of care of most medical conditions comprise of both inpatient and ambulatory care and start from the onset of the disease to its resolution. There are established guidelines that state what care should be provided during various points of this cycle. It is important to identify and analyze the flow of patients through this cycle of care. Once the flow is identified, various analyses can then be conducted to identify bottlenecks, delays, redundancies and other issues that reduce efficiency and increase costs.

Unfortunately, due to the fact that medical data is collected for either medical or billing purposes and not for an operational analysis, it is very difficult to analyze the flow of patients over this cycle of care. This study developed a framework to extract relevant patient medical information from existing administrative databases of health care organizations. This was used to create patient flow paths across a segment of the care cycle to enable the analysis of the care treatment. A case study was conducted at a federal health care provider to identify and map the flow over the care cycle of patients with lung cancer.