Towards personalized decision support in the dementia domain based on clinical practice guidelines

Abstract

A set of evidence-based clinical practice guidelines has been synthesized and integrated in the clinical decision support system DMSS-R (Dementia Management and Support System) to support clinical routines and reasoning processes as performed by individual health professionals in daily practice. DMSS-R provides advice, tailored to individual and often exceptional patient cases, to the user while providing guidance to the next step in the assessments and support for hypothesis generation and evaluation throughout the process. This paper describes DMSS-R and the results of a case study in clinical practice where the system was used. The case study included interviews and observations of the clinical investigation process as undertaken in 41 real patient cases with suspected dementia. Two physicians participated, one of whom was considered a novice regarding dementia while the other had a moderate level of skills. Initially, both physicians were unfamiliar with DMSS-R. A group of nurses together with care personnel and relatives were also involved. The most important contribution of DMSS-R at the point of care, apart from the tailored explanatory support related to a patient case, was the educational support it provided. This was partly manifested in a change of routines in the encounter with patients. Aspects regarding the individual health care professional's need for a personalized support system are discussed and put in relation to the team's need for support, and in relation to the diversity of disease manifestations in this group of patients, which reinforces patient-centric assessments.

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

“…[72][73][74][75] Furthermore, emerging approaches towards personalised electronic decision support systems for targeting dementia care in community settings are being developed. 76 However, these are at an early stage and are yet to be considered for CB.…”

“…The decision support e-tools were based on clinical practice guidelines 76,104 with our assessment questions firmly set within Dementia: A NICE-SCIE Guideline on Supporting People with Dementia and their Carers in Health and Social Care for 'behaviours that challenge' in dementia. 12,105 The questions that were used to provide the 'assessment summary' are found in Appendix 1.…”

“…In essence we were building on preliminary work in the dementia literature that had separately demonstrated the value of clinical algorithms, 63,97,311 and current interest in and the use of e-tool technology, [70][71][72][73][74][75][76] as care staff appeared enthusiastic about access to e-learning dementia care opportunities. 127 If successful we would have produced a cost-effective programme that enabled staff to assess problematic presentations; identify causes and underlying needs; develop appropriate care plans; and, based on the learning from the earlier training modules, execute the plans effectively, with minimal external supervision.…”

Preface to the special issue on personalization for e-health

“…They range from "classic" patient support and empowerment (Camerini et al 2011) to support to the larger patient social community (family and friends) (Colineau and Paris 2011), and, from the medical perspective, from aid for just-in-time decision (Chittaro et al 2011;Lindgren 2011) to a more efficient use of the resources (human time in this case) (Cohen 2011).…”

“…The paper addresses the important e-Health issue of collaboration among different staff, and how efficient exchange of information is crucial to the quality of care. Moving towards decision support as opposed to information provision, Lindgren (2011), in her paper, describes a clinical decision support system to assist medical personnel in the diagnosis of dementia. The system supports a medical practitioner by providing support for reasoning, decision-making and learning.…”