A Personalized Ontology-Based Decision Support System for Complex Chronic Patients: Retrospective Observational Study

Román-Villarán, Esther; Alvarez-Romero, Celia; Martínez-García, Alicia; Escobar-Rodríguez, German Antonio; García-Lozano, María José; Barón‐Franco, Bosco; Moreno-Gaviño, Lourdes; Moreno-Conde, Jesús; Rivas-González, José Antonio; Calderón, Carlos

doi:10.2196/27990

Cited by 5 publications

(1 citation statement)

References 36 publications

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“…Farrish and Grando [ 38 ] built an ontology to assist with the management of polypharmacy prescriptions for patients with multiple chronic conditions to reduce the overall treatment complexity. Recently, Román-Villarán et al [ 39 ] developed an ontology-based CDSS for patients with complex chronic conditions. However, the knowledge sources used were different from ours, including clinical practice guidelines, the LESS-CHRON (List of Evidence-Based Deprescribing for Chronic Patients) criteria, and the STOPP/START (Screening Tool of Older Persons’ Prescriptions and Screening Tool to Alert to Right Treatment) criteria, among others.…”

Section: Discussionmentioning

confidence: 99%

An Ontology-Based Approach to Improving Medication Appropriateness in Older Patients: Algorithm Development and Validation Study

Calvo‐Cidoncha¹,

Verdinelli²,

González-Bueno³

et al. 2023

JMIR Med Inform

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Background: Inappropriate medication in older patients with multimorbidity results in a greater risk of adverse drug events. Clinical decision support systems (CDSSs) are intended to improve medication appropriateness. One approach to improving CDSSs is to use ontologies instead of relational databases. Previously, we developed OntoPharma—an ontology-based CDSS for reducing medication prescribing errors. Objective: The primary aim was to model a domain for improving medication appropriateness in older patients (chronic patient domain). The secondary aim was to implement the version of OntoPharma containing the chronic patient domain in a hospital setting. Methods: A 4-step process was proposed. The first step was defining the domain scope. The chronic patient domain focused on improving medication appropriateness in older patients. A group of experts selected the following three use cases: medication regimen complexity, anticholinergic and sedative drug burden, and the presence of triggers for identifying possible adverse events. The second step was domain model representation. The implementation was conducted by medical informatics specialists and clinical pharmacists using Protégé-OWL (Stanford Center for Biomedical Informatics Research). The third step was OntoPharma-driven alert module adaptation. We reused the existing framework based on SPARQL to query ontologies. The fourth step was implementing the version of OntoPharma containing the chronic patient domain in a hospital setting. Alerts generated from July to September 2022 were analyzed. Results: We proposed 6 new classes and 5 new properties, introducing the necessary changes in the ontologies previously created. An alert is shown if the Medication Regimen Complexity Index is ≥40, if the Drug Burden Index is ≥1, or if there is a trigger based on an abnormal laboratory value. A total of 364 alerts were generated for 107 patients; 154 (42.3%) alerts were accepted. Conclusions: We proposed an ontology-based approach to provide support for improving medication appropriateness in older patients with multimorbidity in a scalable, sustainable, and reusable way. The chronic patient domain was built based on our previous research, reusing the existing framework. OntoPharma has been implemented in clinical practice and generates alerts, considering the following use cases: medication regimen complexity, anticholinergic and sedative drug burden, and the presence of triggers for identifying possible adverse events.

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Section: Discussionmentioning

confidence: 99%

An Ontology-Based Approach to Improving Medication Appropriateness in Older Patients: Algorithm Development and Validation Study

Calvo‐Cidoncha¹,

Verdinelli²,

González-Bueno³

et al. 2023

JMIR Med Inform

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The Application of Knowledge-Based Clinical Decision Support Systems to Enhance Adherence to Evidence-Based Medicine in Chronic Disease

Gholamzadeh

Abtahi

Safdari

2023

Journal of Healthcare Engineering

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Among the technology-based solutions, clinical decision support systems (CDSSs) have the ability to keep up with clinicians with the latest evidence in a smart way. Hence, the main objective of our study was to investigate the applicability and characteristics of CDSSs regarding chronic disease. The Web of Science, Scopus, OVID, and PubMed databases were searched using keywords from January 2000 to February 2023. The review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Then, an analysis was done to determine the characteristics and applicability of CDSSs. The quality of the appraisal was assessed using the Mixed Methods Appraisal Tool checklist (MMAT). A systematic database search yielded 206 citations. Eventually, 38 articles from sixteen countries met the inclusion criteria and were accepted for final analysis. The main approaches of all studies can be classified into adherence to evidence-based medicine (84.2%), early and accurate diagnosis (81.6%), identifying high-risk patients (50%), preventing medical errors (47.4%), providing up-to-date information to healthcare providers (36.8%), providing patient care remotely (21.1%), and standardizing care (71.1%). The most common features among the knowledge-based CDSSs included providing guidance and advice for physicians (92.11%), generating patient-specific recommendations (84.21%), integrating into electronic medical records (60.53%), and using alerts or reminders (60.53%). Among thirteen different methods to translate the knowledge of evidence into machine-interpretable knowledge, 34.21% of studies utilized the rule-based logic technique while 26.32% of studies used rule-based decision tree modeling. For CDSS development and translating knowledge, diverse methods and techniques were applied. Therefore, the development of a standard framework for the development of knowledge-based decision support systems should be considered by informaticians.

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STOPP/START Anti-aggregation and Anticoagulation Alerts in Atrial Fibrillation

Salis

Palimodde

Rundeddu

et al. 2023

CVP

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aims: The aim of the present study is to check with STOPP/START Criteria if such drugs are subjected to potentially inappropriate prescriptions/omissions in a population with AF, and to determine their impact on mortality in elderly. background: Atrial Fibrillation (AF) is a common pathology in elderly. One of the keys to its management is blood-thinning therapy, in particular, Oral Anticoagulant Therapy (OAT), consisting of Vitamin K Antagonists (VKAs) and the more recent Direct Oral Anticoagulants (DOACs). method: This study included subjects with AF consecutively evaluated between 2013 and 2019 at the Geriatric Outpatient Service, University Hospital of Monserrato, Cagliari, Italy, and followed-up for 36 months. A sum of 427 subjects met the inclusion criteria. The OAT-group was made up of 330 people, and the other 97 people constitute the non-OAT-group. The sample was assessed for STOPP/START criteria. result: We found no difference (p>0.1) in comorbidity burden, frailty, and cardio-cerebro-vascular diseases’ prevalence in the two groups, who also did not present difference in 36-months mortality (p=0.97). OAT was overall appropriately taken, and 62.4% of OAT-group presented the START criterion to take antiplatelets but also the STOPP criterion not to take them, because of the simultaneous anticoagulants’ intake. In non-OAT-group, 69.1% presented the START criterion to take anticoagulants, and 21.6% the START criterion to take antiplatelets. conclusion: Our study demonstrated that patients with AF are often prone to under- or over-prescriptions, particularly of antithrombotic drugs, and STOPP/START criteria are valid tool in assessing and correcting any wrong therapeutic choices. Moreover, in frail and comorbid subjects, survival is not correlated with the assumption of OAT.

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A Personalized Ontology-Based Decision Support System for Complex Chronic Patients: Retrospective Observational Study

Cited by 5 publications

References 36 publications

An Ontology-Based Approach to Improving Medication Appropriateness in Older Patients: Algorithm Development and Validation Study

An Ontology-Based Approach to Improving Medication Appropriateness in Older Patients: Algorithm Development and Validation Study

The Application of Knowledge-Based Clinical Decision Support Systems to Enhance Adherence to Evidence-Based Medicine in Chronic Disease

STOPP/START Anti-aggregation and Anticoagulation Alerts in Atrial Fibrillation

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