Home Care Personalisation with Individual Intervention Plans

The adoption of general intervention plans (guidelines) according to the particular circumstances of both the patient and the doctor's diagnostic is a very challenging task. Although there are some available geriatric guidelines, the usual Home Care patients suffer from a set of co-morbid conditions and diseases that hampers the direct application of standard protocols. The representation, creation and execution of individual intervention plans in a Home Care unit are complex tasks to be accomplished by different kinds of actors. This paper presents an architecture for dealing with the whole Home Care scenario but paying special attention to two issues. The first is the creation of Individual Intervention Plans by merging several clinical guidelines. The second is the accurate description of medical knowledge in order to know which data are contained in every step of the pathway and which actor is able to perform it.

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