The use of computer-interpretable clinical guidelines to manage care complexities of patients with multimorbid conditions: A review.
The use of computer-interpretable clinical guidelines to manage care complexities of patients with multimorbid conditions: A review.
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DOI：
10.1177/2055207618804927
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发表时间：
2018-01
期刊：
影响因子：
3.9
通讯作者：
Arvanitis TN
中科院分区：
文献类型：
--
作者：
Bilici E;Despotou G;Arvanitis TN
临床实践指南（CPG）记录了关于治疗和管理条件的循证信息和建议。CPG通常专注于单一疾病的管理;然而，在许多情况下，患者将处于多种健康状况（多发病）的中心。需要并行遵循多个CPG，每个CPG管理一个单独的条件，这通常会导致可能相互作用的指令，例如药物冲突。此外，基于患者特定信息提供定制护理的动力导致需要能够以综合方式提供指南，识别和管理它们的交互。近年来，CPG已被格式化为计算机可解释指南（CIG）。这使得开发CIG驱动的临床决策支持系统（CDSS）成为可能，该系统允许开发有助于系统和可靠地管理多个指南的IT应用程序。本研究的重点是了解使用CIG为基础的CDSS，以管理护理复杂性的患者与多发性硬化症。回顾了2011年至2017年的文献，其中包括：（a）多病患者护理中的挑战和障碍，（B）CIG在CDSS增强护理提供中的作用，以及（c）减轻多病患者护理复杂性的方法。生成综合护理计划，检测和解决治疗和药物之间的不良相互作用，处理护理步骤中的时间约束，支持患者-护理人员共享决策以及保持护理的连续性是使用基于CIG的CDSS实现的一些方法。
Clinical practice guidelines (CPGs) document evidence-based information and recommendations on treatment and management of conditions. CPGs usually focus on management of a single condition; however, in many cases a patient will be at the centre of multiple health conditions (multimorbidity). Multiple CPGs need to be followed in parallel, each managing a separate condition, which often results in instructions that may interact with each other, such as conflicts in medication. Furthermore, the impetus to deliver customised care based on patient-specific information, results in the need to be able to offer guidelines in an integrated manner, identifying and managing their interactions. In recent years, CPGs have been formatted as computer-interpretable guidelines (CIGs). This enables developing CIG-driven clinical decision support systems (CDSSs), which allow the development of IT applications that contribute to the systematic and reliable management of multiple guidelines. This study focuses on understanding the use of CIG-based CDSSs, in order to manage care complexities of patients with multimorbidity. The literature between 2011 and 2017 is reviewed, which covers: (a) the challenges and barriers in the care of multimorbid patients, (b) the role of CIGs in CDSS augmented delivery of care, and (c) the approaches to alleviating care complexities of multimorbid patients. Generating integrated care plans, detecting and resolving adverse interactions between treatments and medications, dealing with temporal constraints in care steps, supporting patient-caregiver shared decision making and maintaining the continuity of care are some of the approaches that are enabled using a CIG-based CDSS.
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