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Personalised Care Plan Management Utilizing Guideline-Driven Clinical Decision Support Systems.

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Managing multiple chronic conditions in older adults is complex. This study introduces a tool for semi-automatic care plan management, improving personalized patient care through integrated electronic health records and clinical guidelines.

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Area of Science:

  • Gerontology and Health Services Research
  • Clinical Informatics
  • Chronic Disease Management

Background:

  • Older adults often experience multiple chronic conditions, complicating traditional healthcare delivery.
  • Current care settings face challenges in providing complex, coordinated management for multimorbid patients.
  • Integrated care models are essential for enhancing patient experience and outcomes in long-term care.

Purpose of the Study:

  • To present a method and implementation of a semi-automatic care plan management tool.
  • To integrate clinical decision support services for personalized patient care.
  • To improve the management of patients with multiple chronic conditions.

Main Methods:

  • Developed a semi-automatic tool for care plan management.
  • Integrated the tool with clinical decision support services.
  • Enabled seamless access and assessment of electronic health records (EHRs).
  • Compared EHR data with evidence-based clinical guidelines.

Main Results:

  • The tool suggests personalized recommendations for patient care plans.
  • Facilitates the creation of individualized care plans with defined roles for providers and patients.
  • Aims to provide targeted care for multimorbid and long-term care patients.

Conclusions:

  • The developed tool supports personalized and targeted care for patients with multiple chronic conditions.
  • Integration with EHRs and clinical guidelines enhances care plan management.
  • This approach addresses the complexity of managing multimorbidity in older adults.