A Collaborative Platform for Management of Chronic Diseases via Guideline-Driven Individualized Care Plans

• Published in: Computational and structural biotechnology journal Vol. 17; pp. 869 - 885
• Main Authors: Laleci Erturkmen, Gokce B., Yuksel, Mustafa, Sarigul, Bunyamin, Arvanitis, Theodoros N., Lindman, Pontus, Chen, Rong, Zhao, Lei, Sadou, Eric, Bouaud, Jacques, Traore, Lamine, Teoman, Alper, Lim Choi Keung, Sarah N., Despotou, George, de Manuel, Esteban, Verdoy, Dolores, de Blas, Antonio, Gonzalez, Nicolas, Lilja, Mikael, von Tottleben, Malte, Beach, Marie, Marguerie, Christopher, Klein, Gunnar O., Kalra, Dipak
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2019; Elsevier; Research Network of Computational and Structural Biotechnology
• Subjects: Bioinformatics; Chronic disease management; Clinical decision support systems; Computer Science; Evidence based clinical guidelines; Integrated care; Medicin och hälsovetenskap; Chronic disease management; Integrated care; Evidence based clinical guidelines; Clinical decision support systems
• ISSN: 2001-0370; 2001-0370
• DOI: 10.1016/j.csbj.2019.06.003

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. We also report the results of usability studies carried out in four pilot sites by patients and clinicians. [Display omitted]