Algorithm and care pathway: Clinical guidelines and healthcare processes

Abstract Background Telehealth (TH) was introduced as a promising tool to support integrated care for the management of chronic obstructive pulmonary disease (COPD). It aims at improving self-management and providing remote support for continuous disease management. However, it is often not clear how TH-supported services fit into existing pathways for COPD management. The objective of this study is to uncover where TH can successfully contribute to providing care for COPD patients exemplified in a Greek care pathway. The secondary objective is to identify what conditions need to be considered for successful implementation of TH services. Methods Building on a single case study, we used a two-phase approach to identify areas in a Greek COPD care pathway where care services that are recommended in clinical guidelines are currently not implemented (challenges) and areas that are not explicitly recommended in the guidelines but that would benefit from TH services (opportunities). In phase I, we used the care delivery value chain framework to identify the divergence between the clinical guidelines and the actual practice captured by a survey with COPD healthcare professionals. In phase II, we conducted in-depth interviews with the same healthcare professionals based on the discovered divergences. The responses were analyzed with respect to identified opportunities for TH and care pathway challenges. Results Our results reveal insights in two areas. First, several areas with challenges were identified: patient education, self-management, medication adherence, physical activity, and comorbidity management. TH opportunities were perceived as offering better bi-directional communication and a tool for reassuring patients. Second, considering the identified challenges and opportunities together with other case context details a set of conditions was extracted that should be fulfilled to implement TH successfully. Conclusions The results of this case study provide detailed insights into a care pathway for COPD in Greece. Addressing the identified challenges and opportunities in this pathway is crucial for adopting and implementing service innovations. Therefore, this study contributes to a better understanding of requirements for the successful implementation of integrated TH services in the field of COPD management. Consequently, it may encourage healthcare professionals to implement TH-supported services as part of routine COPD management.

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The Flat-Footed Child—To Treat or Not to Treat

Journal of the American Podiatric Medical Association ◽

10.7547/0980386 ◽

2008 ◽

Vol 98 (5) ◽

pp. 386-393 ◽

Cited By ~ 42

Author(s):

Angela Margaret Evans

Keyword(s):

Clinical Guidelines ◽

Clinical Decision Making ◽

Care Pathway ◽

Meta Analysis ◽

Clinical Care ◽

Clinical Decision ◽

Evidence Based ◽

Foot Orthoses ◽

Traffic Light ◽

Clinical Care Pathway

Background: This article addresses the treatment of pediatric flatfoot with foot orthoses and explores the existing knowledge from an evidence-based perspective. Methods: Studies investigating the use of foot orthoses for pediatric flatfoot were reviewed and ranked on the evidence hierarchy model according to research designs. Clinical guidelines and efficacy rating methods were also reviewed. Results: Three randomized controlled trials exist, and a systematic review and possible meta-analysis of these studies is in progress. The results of these studies, although not definitive for the use of orthoses for pediatric flatfoot, provide useful direction. Clinical guidelines for the management of flatfoot are a useful supplement for clinical decision making and have been enhanced. Conclusion: This article presents a pragmatic and evidence-based clinical care pathway for clinicians to use for pediatric flatfoot. It uses a simple “traffic light” framework to identify three subtypes of pediatric flatfoot. The clinician is advised to 1) treat symptomatic pediatric flatfoot, 2) monitor (or with discretion simply treat) asymptomatic nondevelopmental pediatric flatfoot, and 3) identify and advise asymptomatic developmental pediatric flatfoot. (Children with juvenile arthritis should receive customized foot orthoses.) This approach will dispel much of the contention surrounding the use of foot orthoses in children. (J Am Podiatr Med Assoc 98(5): 386–393, 2008)

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Knowledge-Based Support to the Treatment of Exceptions in Computer Interpretable Clinical Guidelines

Natural Language Processing ◽

10.4018/978-1-7998-0951-7.ch032 ◽

2020 ◽

pp. 658-687

Author(s):

Alessio Bottrighi ◽

Giorgio Leonardi ◽

Luca Piovesan ◽

Paolo Terenziani

Keyword(s):

Data Structures ◽

Clinical Guidelines ◽

Medical Knowledge ◽

Healthcare Services ◽

Severe Trauma ◽

Treatment Modalities ◽

Software Systems ◽

Knowledge Based ◽

Different Types ◽

Healthcare Processes

Clinical guidelines are one of the major tools that have been introduced to increase the rationalization of healthcare processes, granting both the quality and the standardization of healthcare services, and the minimization of costs. Computer interpretable clinical guidelines (CIGs) are widely adopted in order to assist practitioners in decision making, providing them evidence-based recommendations based on the best available medical knowledge. However, a main problem in CIG adoption is the fact that, in the medical context, some degree of uncertainty is often present. Thus, during guidelines executions on specific patients, unpredictable facts and conditions (henceforth called exceptions) may occur. A proper and immediate treatment of such exceptions is mandatory, but most of the current software systems coping with CIGs do not support it. In this paper, the authors describe how the GLARE system has been extended to deal with this purpose. They identify different types of exceptions, considering their “pre-locability” and “pre-plannability”. On the basis of such parameters, the authors propose different treatment modalities, consisting of both data structures to model the different types of exceptions, and the algorithms to treat them. The resulting methodology is an innovative one, integrating different Artificial Intelligence techniques (ranging from planning to ontology-based reasoning). Finally, they also discuss how they implemented their system-independent methodology on top of GLARE, and describe its application in the ROPHS project, considering the management of the severe trauma guideline.

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Knowledge-Based Support to the Treatment of Exceptions in Computer Interpretable Clinical Guidelines

International Journal of Knowledge-Based Organizations ◽

10.4018/ijkbo.2016070101 ◽

2016 ◽

Vol 6 (3) ◽

pp. 1-27

Author(s):

Alessio Bottrighi ◽

Giorgio Leonardi ◽

Luca Piovesan ◽

Paolo Terenziani

Keyword(s):

Clinical Guidelines ◽

Medical Knowledge ◽

Healthcare Services ◽

Severe Trauma ◽

Treatment Modalities ◽

Software Systems ◽

Evidence Based ◽

Knowledge Based ◽

Different Types ◽

Healthcare Processes

Clinical guidelines are one of the major tools that have been introduced to increase the rationalization of healthcare processes, granting both the quality and the standardization of healthcare services, and the minimization of costs. Computer interpretable clinical guidelines (CIGs) are widely adopted in order to assist practitioners in decision making, providing them evidence-based recommendations based on the best available medical knowledge. However, a main problem in CIG adoption is the fact that, in the medical context, some degree of uncertainty is often present. Thus, during guidelines executions on specific patients, unpredictable facts and conditions (henceforth called exceptions) may occur. A proper and immediate treatment of such exceptions is mandatory, but most of the current software systems coping with CIGs do not support it. In this paper, the authors describe how the GLARE system has been extended to deal with this purpose. They identify different types of exceptions, considering their “pre-locability” and “pre-plannability”. On the basis of such parameters, the authors propose different treatment modalities, consisting of both data structures to model the different types of exceptions, and the algorithms to treat them. The resulting methodology is an innovative one, integrating different Artificial Intelligence techniques (ranging from planning to ontology-based reasoning). Finally, they also discuss how they implemented their system-independent methodology on top of GLARE, and describe its application in the ROPHS project, considering the management of the severe trauma guideline.

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Review of clinical guidelines for children and adolescents with attention deficit hyperactivity disorder and their application to an Irish context

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2014.63 ◽

2014 ◽

Vol 32 (3) ◽

pp. 283-293 ◽

Cited By ~ 3

Author(s):

G. Kavanagh ◽

S. O’Hanrahan ◽

G. Hughes ◽

F. McNicholas

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Children And Adolescents ◽

Healthcare System ◽

Attention Deficit ◽

Clinical Guidelines ◽

Care Pathway ◽

Neurodevelopmental Disorder ◽

Clinical History ◽

Hyperactivity Disorder ◽

Irish Context

Background:Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with international prevalence rates estimated to be 5%. It is currently the most common disorder treated in Child and Adolescent Mental Health Services in Ireland. There have been a number of guidelines worldwide produced to aid clinicians in the diagnosis and treatment of ADHD; however, there are no guidelines available specifically for the Irish population and healthcare system.Objectives:The aim of this paper is to review the available clinical guidelines for the diagnosis and management of ADHD in children adolescents across North America, Canada, Europe and the United Kingdom and to apply these to an Irish context.Methods:A number of international guidelines were reviewed. A proposed pathway for the assessment and treatment of children and adolescents with ADHD has been devised with the recommendation that a formalised consensus guideline should be implemented.Conclusion:This review paper has highlighted that there is consensus between the guidelines for the diagnosis of ADHD with a thorough clinical history remaining the gold standard. They further agree on the importance of identifying co-morbid disorders. When it comes to the treatment, the guidelines are less unified. This current paper has devised a proposed care pathway for ADHD in Ireland to ensure high quality cost effective care within its healthcare system.

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