Article

Personalised Care Plan Management Utilizing Guideline-Driven Clinical Decision Support Systems

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Abstract

Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans.

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... The concept of PPC was first introduced in the cardiac surgery context in 2008 [13], and since then it has been implemented to other medical settings. In recent evaluations, PPC provision in various medical fields has been rated as beneficial for the patients in terms of shorter convalescence periods and a reduced risk of disease chronification [13,14]. ...
... In September 2018, we implemented PPC for inpatient endometriosis treatment at our gynaecological department Agaplesion Diakonie Hospital, Kassel, Germany, a stage II endometriosis treatment and research centre (certified by the Endometriosis Research Foundation (Stiftung Endometrioseforschung)), and an academic teaching hospital. Based on previously evaluated PPC concepts implemented in various medical settings, we developed the following treatment algorithm adapted to our needs [13,14]. Patients who were referred or presented themselves at our hospital for a suspected symptomatic endometriosis were assigned to a person (reference physician) of our service (board-certified gynaecologist specialised in the treatment of endometriosis, as defined by the Endometriosis Research Foundation (Stiftung Endometrioseforschung)) [15]. ...
Article
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Purpose The aim of this retrospective cohort study was to validate patient’s satisfaction and surgical complication rate in patients treated at a certified endometriosis centre with personal patient care (PPC). Methods The implementation of PPC at a gynaecologic treatment centre was retrospectively evaluated by analysing perioperative complications using the Clavien Dindo (CD) classification and patient satisfaction utilizing the Picker Patient Experience Questionnaire (PPE-15) for a total of 219 symptomatic endometriosis patients treated surgically at a certified endometriosis centre (Agaplesion Diakonie Hospital, Kassel, Germany) between November 2018 and April 2019. Data from our sample on complication rates and satisfaction were compared with those from reference samples published by Radosa et al. and Jenkinson et al. Results An overall complication rate of 10.96% (24 out of 219 patients) was observed. Four endometriosis patients (1.83%) had major complications with complications grade III according to the CD classification system. 155 patients out of 219 chose to answer the PPE-15 (return rate 70.78%). 92 patients (59.35%) reported about problems during their treatment in our hospital in their PPE-15. “Doctors sometimes talked as if I was not here” was the best rated item (1.2%) in our cohort. “Staff gave conflicting information” was the most mentioned item (33.55%) by patients during their hospital stay in relation to patient dissatisfaction. Conclusion Incorporation of PPC in the surgical inpatient treatment of endometriosis patients resulted in a low postoperative complication rate and a high patient satisfaction in our study cohort. Furthermore, nursing staff of endometriosis patients also needs particular attention.
... However, none of these addresses the needs of patients to manage their multiple chronic conditions. There have been numerous works in the literature that studied not only involving patients suffering from multiple chronic conditions, but also involving older multimorbid patients in managing their own care [2,12,14,15]. However, the designs of these solutions do not consider specific needs of patients with dementia, hence remain too complex. ...
Conference Paper
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Management of multiple chronic conditions introduces demanding challenges for patients. This situation becomes more complex when multimorbidity is associated with dementia. In this paper, we present the design of a mobile Patient Empowerment Platform that enables older multimorbid patients with mild dementia or mild cognitive impairment (MCI) to easily follow their complex care plans and increase their adherence. We focus on the presentation of the human-centered design process that we have followed with the involvement of patients, informal caregivers, and healthcare professionals via the clinical pilot sites of the CAREPATH project. We elaborate the design challenges we have faced and present the iterative mock-ups that have been created in cooperation with end users to address these challenges and the final PEP design.
... It remains unclear if the clinicians are undertaking care planning for the patients who benefit most from it. We believe that help from clinical decision support systems would bring care planning to the front line in general practice and lessen the number of patients with T2D without a care plan [24,25]. ...
Article
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Objective: To study the association of personalised care plans with monitoring and controlling clinical outcomes, prescription of cardiovascular and antihyperglycaemic medication and utilisation of primary care services in patients with type 2 diabetes (T2D). Patients: Primary care T2D outpatients from the Rovaniemi Health Centre. Setting: The municipal health centre, Rovaniemi, Finland. Design: A cross-sectional, observational, retrospective register-based study. The patients were divided into three groups: 'no care plan entries' (usual care); '1-2 care plan entries'; and '3 or more care plan entries'. Main outcome measures: Monitoring of clinical and biochemical measures, achievement of treatment targets, prescription of cardiovascular and antihyperglycemic medication, and use of primary care services. Results: A total of 5104 patients with T2D (mean age 65.5 years (SD 12.4)), of which 67% had at least one care plan entry. Compared to usual care, the establishment of a care plan (either care plan group) was associated with better monitoring of glycosylated haemoglobin A1c, low-density-lipoprotein cholesterol, systolic blood pressure (sBP), and renal function, and there was more frequent prescription of all cardiovascular and antihyperglycemic medication. Patients in either care plan group were more likely to achieve sBP target (p < 0.05). Patients without a care plan had more unplanned primary care physician contacts compared to patients in care plan groups (p < 0.001). Conclusion: Establishment of a care plan is associated with more intensive and focussed care of patients with T2D. The appropriate use of primary care resources is essential and personalised care plans may contribute to the treatment of patients with T2D.Key PointsCare planning aims to empower patients with type 2 diabetes. This study demonstrates that personalised care planning is associated withmore frequent monitoring for clinical outcomes,more frequent prescription of cardiovascular and antihyperglycemic medication andmore frequent utilisation of planned diabetes consultations when compared to usual care.
... The majority of the published literature on care coordination tools was excluded because the tools have not yet been implemented in clinical settings. [98][99][100][101][102] Algorithms and Advanced Analytics Twenty articles met criteria for inclusion and were focused on predicting risk at the individual or population level and tailoring care to mitigate risks and avoid overtreatment (Table 3). One RCT was included; Prabhakaran et al. found that a mobile health (mHealth) application that helped PLWMCC weigh preventive and chronic disease monitoring options was not more successful at controlling diabetes and blood pressure than the addition of a nurse-driven reminder system. ...
Article
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Objective: To review evidence regarding the use of Health Information Technology (health IT) interventions aimed at improving care for people living with multiple chronic conditions (PLWMCC) in order to identify critical knowledge gaps. Data sources: We searched MEDLINE, CINAHL, PsycINFO, EMBASE, Compendex, and IEEE Xplore databases for studies published in English between 2010-2020. Study design: We identified studies of health IT interventions for PLWMCC across three domains: self-management support, care coordination, and algorithms to support clinical decision-making. Data collection/extraction methods: Structured search queries were created and validated. Abstracts were reviewed iteratively to refine inclusion and exclusion criteria. The search was supplemented by manually searching the bibliographic sections of the included studies. The search included a forward citation search of studies nested within a clinical trial to identify the clinical trial protocol and published clinical trial results. Data was extracted independently by two reviewers. Principal findings: The search yielded 1907 articles; 44 were included. Nine randomized controlled trials (RCTs) and 35 other studies including quasi-experimental, usability, feasibility, qualitative studies, or development/validation studies of analytic models. Five RCTs had positive results and the remaining four RCTs showed that the interventions had no effect. The studies address individual patient engagement and assess patient-centered outcomes such as quality of life. Few RCTs assess outcomes such as disability and none assess mortality. Conclusions: Despite a growing body of literature on health IT interventions or multicomponent interventions including a health IT component for chronic disease management, current evidence for applying health IT solutions to improve care for PLWMCC is limited. The body of literature included in this review provides critical information on the state of the science as well as the many gaps that need to be filled for digital health to fulfill its promise in supporting care delivery that meets the needs of PLWMCC. This article is protected by copyright. All rights reserved.
... C3-Cloud 1 is a European Commission supported Horizon 2020 research and innovation project, which aims at improving the provision of integrated care to patients with multimorbitity via enhanced ICT solutions. The research aims at resolving guideline conflicts (by reconciliation of varying recommendations from individual disease guidelines), supporting clinical decision making through clinical decision support services, and facilitating communication among multidisciplinary care team members through an interoperable platform, which integrates patients' health records from existing Electronic Health Record (EHR) systems [5]. The project mainly focuses on elderly patients (65+) with diabetes, heart failure, renal failure and depression in different comorbidity combinations. ...
Article
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The number of patients with multimorbidity has been steadily increasing in the modern aging societies. The European C3-Cloud project provides a multidisciplinary and patient-centered "Collaborative Care and Cure-system" for the management of elderly with multimorbidity, enabling continuous coordination of care activities between multidisciplinary care teams (MDTs), patients and informal caregivers (ICG). In this study various components of the infrastructure were tested to fulfill the functional requirements and the entire system was subjected to an early application testing involving different groups of end-users. MDTs from participating European regions were involved in requirement elicitation and test formulation, resulting in 57 questions, distributed via an internet platform to 48 test participants (22 MDTs, 26 patients) from three pilot sites. The results indicate a high level of satisfaction with all components. Early testing also provided feedback for technical improvement of the entire system, and the paper points out useful evaluation methods.
... C3-Cloud is an e-health ICT system, offering integrated, patient-centered care, considering all aspects of multi-morbidity, creating a collaborative environment for all involved stakeholders [1]. The navel of the system consists of the patient care plan, a digital shared picture of the patients' needs and care regime. ...
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C3-Cloud is a project aiming to provide an ICT infrastructure, which will allow patient centric and integrated care, based on best practice guideline, for patients with multi-morbidity. Clinical Decision Support, by checking the patient's record for known adverse interactions when the medication changes. The drug interaction advisory service provides recommendations in the three languages used in the project's pilot sites, for over 1000 substances, based on the UK's NICE BNF body of knowledge.
... For example, Dayan et al. [15] introduced the traumatic brain injury (TBI) prediction rules in a CDSS to foresee risks of TBI. Laleci et al. [28] utilized a guideline-based CDSS to help manage the personal care plans of elders. Rodriguez et al. [42] introduced a "send & hold" system, utilizing clinical decision support rules to reduce the avoidable vitamin testing. ...
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