Automated Conflict Resolution in Clinical Pathways

据估计，到2018年，英国患有三种或三种以上长期疾病（也称为多重疾病）的人数将从190万增加到290万。由于吸烟、饮食、衰老和缺乏运动等共同的危险因素，各种慢性疾病同时发生。四种最常见的慢性疾病是癌症、慢性阻塞性肺疾病（COPD）、冠心病和糖尿病。最近的一项研究发现，超过97%的中度至重度COPD患者至少伴有一种慢性疾病。在临床设置过程是复杂的，并受到一些社会，技术和组织因素的影响。这种复杂性可能导致医生在实践、适当的护理记录和医疗成本管理方面的差异。为了减少不一致性，基于现有最佳证据的临床指南已经出现，目的是支持临床工作人员并提高医疗保健质量。目前的指导方针几乎完全侧重于单一条件。因此，对患者应用多种指导方针可能会导致相互冲突的护理建议。在软件系统设计和开发中，我们创建能够支持环境/用户与系统之间多种交互的计算机系统。这些交互通常反映不同的、可能是相互冲突的观点，例如由不同的用户或涉众提出的观点。尽管软件系统规范和病人护理指南看起来不同，但本质上它们有一些共同之处。在这两种情况下，我们都有（部分）有序的行动序列（又名活动或任务）的程序和执行，在计算机科学中称为“执行的痕迹”，在临床实践中称为“路径”。在基于计算机的系统中，操作由用户或计算机（更具体地说，是系统中的单个组件或对象）执行。就护理指南而言，行动由医生、患者和护理人员执行。在这两种情况下，当个别执行和路径不相容时，可能会产生冲突。在本提案中，我们研究了检测多病临床路径冲突的自动化方法，并提出了解决这些冲突的解决方案。

By 2018, it is estimated that the number of people in the UK with three or more long-term conditions, also known as multimorbidity , will have grown from 1.9 million to 2.9 million. Various chronic diseases develop simultaneously in response to common risk factors such as smoking, diet, ageing and inactivity. The four most common chronic diseases are cancer, chronic obstructive pulmonary disease (COPD), coronary heart disease and diabetes. A recent study found that over 97% of patients with moderate to severe COPD had at least one concomitant chronic disease. In clinical settings processes are complex and are influenced by a number of social, technical and organisational factors. This complexity can result in variation in how physicians practice, appropriate care is documented, and healthcare costs managed. To reduce inconsistencies, clinical guidelines have emerged based on the best existing evidence, with the aim to support clinical staff and improve the quality of healthcare. Current guidelines almost entirely focus on single conditions. As a result, applying multiple guidelines to a patient may potentially result in conflicting recommendations for care. In software system design and development, we create computer systems capable to support diverse interactions between the environment/users and the system. These interactions often reflect different and possibly conflicting viewpoints, such as those presented by different users or stakeholders. Although software system specification and patient care guidelines seem different, inherently they have something in common. In both cases we have procedures and executions of (partially) ordered sequence of actions (aka activities or tasks) called "traces of execution" in computer science or "pathways" in clinical practice. In the case of computer-based systems, actions are carried out by users or computers (more specifically individual components or objects in the system). In the case of care guidelines, actions are carried out by physicians, patients and carers. In both cases, conflict may arise when individual executions and pathways are incompatible. In this proposal, we investigate automated methods of detection of conflicts in clinical pathways for multimorbidities and propose solutions that resolve them .