An overview of decision table literature 1982-1995.

This report gives an overview of the literature on decision tables over the past 15 years. As much as possible, for each reference, an author supplied abstract, a number of keywords and a classification are provided. In some cases own comments are added. The purpose of these comments is to show where, how and why decision tables are used. The literature is classified according to application area, theoretical versus practical character, year of publication, country or origin (not necessarily country of publication) and the language of the document. After a description of the scope of the interview, classification results and the classification by topic are presented. The main body of the paper is the ordered list of publications with abstract, classification and comments.

Personalized conciliation of clinical guidelines for comorbid patients through multi-agent planning

[EN] The conciliation of multiple single-disease guidelines for comorbid patients entails solving potential clinical interactions, discovering synergies in the diagnosis and the recommendations, and managing clinical equipoise situations. Personalized conciliation of multiple guidelines considering additionally patient preferences brings some further difficulties. Recently, several works have explored distinct techniques to come up with an automated process for the conciliation of clinical guidelines for comorbid patients but very little attention has been put in integrating the patient preferences into this process. In this work, a Multi-Agent Planning (MAP) framework that extends previous work on single-disease temporal Hierarchical Task Networks (HTN) is proposed for the automated conciliation of clinical guidelines with patient-centered preferences. Each agent encapsulates a single-disease Computer Interpretable Guideline (CIG) formalized as an HTN domain and conciliates the decision procedures that encode the clinical recommendations of its CIG with the decision procedures of the other agents' CIGs. During conciliation, drug-related interactions, scheduling constraints as well as redundant actions and multiple support interactions are solved by an automated planning process. Moreover, the simultaneous application of the patient preferences in multiple diseases may potentially bring about contradictory clinical decisions and more interactions. As a final step, the most adequate personalized treatment plan according to the patient preferences is selected by a Multi-Criteria Decision Making (MCDM) process. The MAP approach is tested on a case study that builds upon a simplified representation of two real clinical guidelines for Diabetes Mellitus and Arterial Hypertension.This work has been partially supported by Spanish Government Projects MINECO TIN2014-55637-C2-2-R and TIN2015-71618-R.Fernández-Olivares, J.; Onaindia De La Rivaherrera, E.; Castillo Vidal, L.; Jordán, J.; Cózar, J. (2019). Personalized conciliation of clinical guidelines for comorbid patients through multi-agent planning. Artificial Intelligence in Medicine. 96:167-186. https://doi.org/10.1016/j.artmed.2018.11.003S1671869

A model-driven transformation approach for the modelling of processes in clinical practice guidelines

Clinical Practice Guidelines (CPGs) include recommendations aimed at optimising patient care, informed by a review of the available clinical evidence. To achieve their potential benefits, CPG should be readily available at the point of care. This can be done by translating CPG recommendations into one of the languages for Computer-Interpretable Guidelines (CIGs). This is a difficult task for which the collaboration of clinical and technical staff is crucial. However, in general CIG languages are not accessible to non-technical staff. We propose to support the modelling of CPG processes (and hence the authoring of CIGs) based on a transformation, from a preliminary specification in a more accessible language into an implementation in a CIG language. In this paper, we approach this transformation following the Model-Driven Development (MDD) paradigm, in which models and transformations are key elements for software development. To demonstrate the approach, we implemented and tested an algorithm for the transformation from the BPMN language for business processes to the PROforma CIG language. This implementation uses transformations defined in the ATLAS Transformation Language. Additionally, we conducted a small experiment to assess the hypothesis that a language such as BPMN can facilitate the modelling of CPG processes by clinical and technical staff.Funding for open access charge: CRUE-Universitat Jaume

Process Model Metrics for Quality Assessment of Computer-Interpretable Guidelines in PROform

Background: Clinical Practice Guidelines (CPGs) include recommendations to optimize patient care and thus have the potential to improve the quality and outcomes of healthcare. To achieve this, CPG recommendations are usually formalized in terms of Computer-Interpretable Guideline (CIG) languages. However, a clear understanding of CIG models may prove complicated, due to the inherent complexity of CPGs and the specificities of CIG languages. Drawing a parallel with the Business Process Management (BPM) and the Software Engineering fields, understandability and modifiability of CIG models can be regarded as primary quality attributes, in order to facilitate their validation, as well as their adaptation to accommodate evolving clinical evidence, by modelers (typically teams made up of clinical and IT experts). This constitutes a novel approach in this area of CIG development, where understandability and modifiability aspects have not been considered to date. Objective: In this paper, we define a comprehensive set of process model metrics for CIGs described in the PROforma CIG language, with the main objective of providing tools for quality assessment of CIG models in this language. Methods: To this end, we first reinterpret a set of metrics from the BPM field in terms of PROforma and then we define new metrics to capture the singularities of PROforma models. Additionally, we report on a set of experiments to assess the relationship between the structural and logical properties of CIG models, as measured by the proposed metrics, and their understandability and modifiability from the point of view of modelers, both clinicians and IT staff. For the analysis of the experiment results, we perform statistical analysis based on a generalized linear mixed model with binary logistic regression. Results: Our contribution includes the definition of a comprehensive set of metrics that allow measuring model quality aspects of PROforma CIG models, the implementation of tools and algorithms to assess the metrics for PROforma models, and the empirical validation of the proposed metrics as quality indicators. Conclusions: In light of the results, we conclude that the proposed metrics can be of great value, as they capture the PROforma-specific features in addition to those inspired by the general-purpose BPM metrics in the literature. In particular, the newly defined metrics for PROforma prevail as statistically significant when the whole CIG model is considered, which means that they better characterize its complexity. Consequently, the proposed metrics can be used as quality indicators of the understandability, and thereby maintainability, of PROforma CIGs

Patient Pathways for Comprehensive Care Networks - A Development Method and Lessons from its Application in Oncology Care

Patient pathways are recognized as a valuable tool to support standardization, comparability, quality, and transparency of care processes in comprehensive care networks. Still, existing development approaches lack real practical guidance as well as an integration of the network and patient perspectives. Therefore, a user-centered and requirements-based approach was chosen to design a patient pathway development method. It defines a role model and procedural steps. The method’s innovative character lies in the development of generic patient pathway templates to be adapted to national, regional, and local conditions of specific comprehensive care networks. The method was positively assessed in terms of demonstrating its applicability and the fulfilment of user requirements with a use case from oncology care – the development of a colorectal cancer patient pathway template. This work drives the standardization of patient pathway development and their large-scale implementation in comprehensive care networks, supporting the analysis, design, and optimization of healthcare processes

A Methodological Framework for the Integrated Design of Decision-Intensive Care Pathways\u2014an Application to the Management of COPD Patients

Healthcare processes are by nature complex, mostly due to their multi-disciplinary character that requires continuous coordination between care providers. They encompass both organizational and clinical tasks, the latter ones driven by med- ical knowledge, which is inherently incomplete and distributed among people having different expertise and roles. Care pathways refer to planning and coordination of care processes related to specific groups of patients in a given setting. The goal in defining and following care pathways is to improve the quality of care in terms of patient satisfaction, costs reduction, and medical outcome. Thus, care pathways are a promising methodological tool for standardizing care and decision-making. Business process management techniques can successfully be used for representing organiza- tional aspects of care pathways in a standard, readable, and accessible way, while supporting process development, analysis, and re-engineering. In this paper, we intro- duce a methodological framework that fosters the integrated design, implementation, and enactment of care processes and related decisions, while considering proper rep- resentation and management of organizational and clinical information. We focus here and discuss in detail the design phase, which encompasses the simulation of care pathways. We show how business process model and notation (BPMN) and decision model and notation (DMN) can be combined for supporting intertwined aspects of decision-intensive care pathways. As a proof-of-concept, the proposed methodology has been applied to design care pathways related to chronic obstructive pulmonary disease (COPD) in the region of Veneto, in Italy

Scoping a vision for formative e-assessment: a project report for JISC

Assessment is an integral part of teaching and learning. If the relationship between teaching and learning were causal, i. e. if students always mastered the intended learning outcomes of a particular sequence of instruction, assessment would be superfluous. Experience and research suggest this is not the case: what is learnt can often be quite different from what is taught. Formative assessment is motivated by a concern with the elicitation of relevant information about student understanding and / or achievement, its interpretation and an exploration of how it can lead to actions that result in better learning. In the context of a policy drive towards technology-enhanced approaches to teaching and learning, the question of the role of digital technologies is key and it is the latter on which this project particularly focuses. The project and its deliverables have been informed by recent and relevant literature, in particular recent work by Black andIn this work, they put forward a framework which suggests that assessment for learning their term for formative assessment can be conceptualised as consisting of a number of aspects and five keystrategies. The key aspects revolve around the where the learner is going, where the learner is right now and how she can get there and examines the role played by the teacher, peers and the learner. Language: English Keywords: assessments, case studies, design patterns, e-assessmen