Guideline-based modeling of therapeutic strategies in the special case of chronic diseases

Despite the availability of evidence-based clinical practice guidelines in most countries, patients with chronic diseases are still generally inadequately managed. One difficulty lies in the optimal synchronization of a patient with the guideline therapeutic strategy, especially when the history of her past treatments does not follow the recommended sequence of therapies. We propose a formal model to represent guideline-based therapeutic strategies as a two-level decision tree. The clinical level is used to identify a patient-specific clinical situation, on the basis of key elements of clinical examination (complication of hypertension, associated diseases). The therapeutic level is derived from the formalization of guideline-based strategies first represented as bidimensional matrices structured in lines of therapy and levels of therapeutic intention. A revised version based on the ordering of levels of therapeutic combination is then developed. The aim is to dynamically provide the best next step of treatment from the patient's therapeutic-history-based customization of the general therapeutic sequence established in the guideline for the corresponding clinical situation. A preliminary in vitro evaluation of the system on actual clinical cases showed a positive impact on physician compliance with a significant increase from 16 to 57%.