A retrospective cohort study mapping real‑world psychosis care pathways and guideline adherence using integrated electronic health records
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Accepted version
Author(s)
Type
Journal Article
Abstract
Objectives: To develop a systematic, data-driven approach to map patient journeys and apply this to care pathways, assessing alignment with published guidance and highlighting potential areas to improve service delivery, using the case study of first diagnosis of psychosis.
Design: Using document review, an idealised patient journey was developed. Event data were extracted from electronic health records using a systematic process to map real-world patient journeys across care settings.
Setting: North West London’s de-identified integrated care records system (Discover). Participants: 3,219 (mean age 37 years; 55% men) adult patients (18 to 64) registered in North West London in December 2024, with a first episode of psychosis recorded between 2016 and 2019.
Main outcomes: Mapping full patient journeys, including care transitions and service contacts (i.e. psychiatric admissions, EIP involvement, and GP management). Comparison of real‑world pathways against NICE guidelines.
Results: Case identification yielded demographic trends comparable with national and local level data. Two-thirds of cases had their diagnosis first recorded in primary care, with many already attending secondary care services (i.e. records may not reflect where diagnosis was clinically established). Only 18% had a clearly identifiable record of an early intervention in psychosis (EIP) service, and the recorded duration of EIP involvement varied widely. Psychiatric admission, readmission, and use of crisis and emergency services were frequent. A large proportion of patient records showed no recorded healthcare contact within either 30 days or 6 months following the index admission. The patient journey models highlighted the complexity and heterogeneity of psychosis care and were difficult to manage and visualise using available
models (process maps and matrices).
Conclusions: Real-world patient journeys in psychosis, as represented in electronic medical records, appear to diverge widely from NICE-recommended care, particularly around diagnosis, EIP service provision, and post-discharge follow-up. Interpretability is likely limited by
incomplete and inconsistent recording, with ambiguities posing a challenge to utilisation and interpretation of this data to reliably inform clinical decision-making, service evaluation, and policy. This work points to the need for more advanced analytical tools (i.e. artificial intelligence
and optimisation) to better interpret and use patient journey data.
Design: Using document review, an idealised patient journey was developed. Event data were extracted from electronic health records using a systematic process to map real-world patient journeys across care settings.
Setting: North West London’s de-identified integrated care records system (Discover). Participants: 3,219 (mean age 37 years; 55% men) adult patients (18 to 64) registered in North West London in December 2024, with a first episode of psychosis recorded between 2016 and 2019.
Main outcomes: Mapping full patient journeys, including care transitions and service contacts (i.e. psychiatric admissions, EIP involvement, and GP management). Comparison of real‑world pathways against NICE guidelines.
Results: Case identification yielded demographic trends comparable with national and local level data. Two-thirds of cases had their diagnosis first recorded in primary care, with many already attending secondary care services (i.e. records may not reflect where diagnosis was clinically established). Only 18% had a clearly identifiable record of an early intervention in psychosis (EIP) service, and the recorded duration of EIP involvement varied widely. Psychiatric admission, readmission, and use of crisis and emergency services were frequent. A large proportion of patient records showed no recorded healthcare contact within either 30 days or 6 months following the index admission. The patient journey models highlighted the complexity and heterogeneity of psychosis care and were difficult to manage and visualise using available
models (process maps and matrices).
Conclusions: Real-world patient journeys in psychosis, as represented in electronic medical records, appear to diverge widely from NICE-recommended care, particularly around diagnosis, EIP service provision, and post-discharge follow-up. Interpretability is likely limited by
incomplete and inconsistent recording, with ambiguities posing a challenge to utilisation and interpretation of this data to reliably inform clinical decision-making, service evaluation, and policy. This work points to the need for more advanced analytical tools (i.e. artificial intelligence
and optimisation) to better interpret and use patient journey data.
Date Acceptance
2026-04-27
Citation
BMJ Connections Mental Health
Journal / Book Title
BMJ Connections Mental Health
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
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Publication Status
Accepted