A Mixed-Initiative Approach to the Conciliation of Clinical Guidelines for Comorbid Patients

The treatment of patients affected by multiple pathologies (comorbid patients) is one of the main challenges for the modern healthcare. Clinical practice guidelines provide evidence-based information about interventions considering only single pathologies. To support physicians in the treatment of comorbid patients, suitable methodologies must be devised. In our previous work, we have (i) devised an ontology of interactions, (ii) proposed a mixed-initiative approach (based on the ontology) to support physicians in the detection of interactions between guidelines, and (iii) extended our approach to consider the temporal dimension. In this paper, we move a step forward, by (iv) identifying a set of practical “management options” used by physicians in their daily practice to manage interactions between guidelines and (v) providing the methodologies to support physicians in the application of such management options in reconciling the guidelines. Finally, we also extend our approach to consider (vi) interactions between guideline recommendations and patient status. In such a way, we provide physicians with a framework for investigating different ways to reconcile guidelines, coping (with different modalities) with the focused interactions.