P0853DECISION SUPPORT SYSTEM (DSS) FOR DIAGNOSTICS AND TREATMENT OF PATIENTS WITH CKD COMPLICATIONS

Background and Aims Some of the most common complications of CKD are anemia and bone and mineral disorders (BMD). Adequacy of treatment of patients with these complications directly affects their life quality and duration. The goal of our work is to create medical decision support system (MDSS) that will be able to generate recommendations on diagnostics and treatment of CKD patients with anemia and BMD complications, based on clinical guidelines and control the fulfillment of corresponding prescriptions. Method We have developed an automated medical decision support system that generates recommendations on patient’s treatment and further studies that are mandatory according to regulations, based on patient’s electronic medical record. The functionality of MDSS is based on knowledge base (KB), which consists of clinical guidelines formalized as mathematical logic operators. The system is also able to control how medical staff fulfills generated diagnostic and treatment prescriptions: deadlines, duration and order of actions, mandatory studies from regulations, drug therapy, etc. The assessment of the system was conducted on more than 2000 CKD patients on chronic dialysis from 30 “Nefrosovet” hemodialysis clinics. Results MDSS was developed using process-based management principles and was successfully employed on representative sample of patients with CKD on chronic dialysis from “Nefrosovet” hemodialysis clinics. The system generated recommendations for this group of patients for the duration of 6 months. Recommendations were related to diagnostics and treatment of patients, specific diagnoses, scheduled and additional studies, drug prescriptions (where dose was set by a physician), etc. As a result of using a system, we were able to reduce average treatment cost of patient by 14% for anemia related treatment and by 36% for BMD related treatment. At the same time the treatment quality has improved from an average of 46% to 60% of patients in target ranges of key laboratory parameters after 6 months of system usage. Treatment cost has reduced due to the timely start and gradual cancelation (by indications) of drug therapy, which also allowed us to avoid overadministration of unnecessary drugs. Conclusion Deployment of developed MDSS for process-based management of patients with CKD on chronic dialysis with anemia and BMD complications has shown high cost efficiency. Furthermore, automated diagnostics, therapy and prescription fullfilment control is performed without loss of quality, sometimes even with the improvement of quality of treatment process.