Guideline-Based Clinical Decision Support Framework for Multimorbidity: Protocol for a Formulation and Testing Study

The burden of multimorbidity is increasing globally, which complicates the use of guidelines in clinical practice and health care: practitioners may need to increasingly refer to multiple guidelines with potentially conflicting recommendations.

We aim to develop a guideline-based decision support framework for the management of patients with multimorbidity to help clinicians efficiently evaluate, select, and adapt recommendations focusing on the different comorbidities and aspects of multimorbidity.

We will conduct the project using the following steps: (1) needs assessment (searching published literature and documents on guideline use in multimorbidity care through the study initiators, and assessing the necessity of developing a comprehensive decision-making framework focusing on multimorbidity in a broad sense), (2) establishing international working groups (a coordination team, an evidence support group, and a consensus group) by leveraging existing participants' networks and inviting experts with relevant academic publications or activities, (3) conducting literature reviews of multimorbidity guidelines and original qualitative research involving interest-holders in multimorbidity care and/or guideline development to formulate an initial draft framework, (4) a consensus process including an expert survey and a consensus meeting, (5) formulating and releasing the final framework, and (6) testing the framework (collecting feedback through educating health professionals in different settings and applying the framework in practice to evaluate and improve it). We plan to complete the project within 3 years.

The project has started in March 2024 and is due to conclude in June 2026. As of May 2025, we have finished the literature reviews and qualitative studies and are currently conducting the first round of the expert survey.

This framework will help clinicians from all levels of health care institutions to make decisions in the management of patients with multimorbidity based on the latest available evidence, and to reduce potential health risks to their patients. One limitation of this framework is that such a broad framework may not fully fit all disease combinations or realistic situations. To reduce the degree of inapplicability, after completion of the framework, we will continue to monitor its use with regular updates as needed.

DERR1-10.2196/63339.