Towards personalized decision support in the dementia domain based on clinical practice guidelines

A set of evidence-based clinical practice guidelines has been synthesized and integrated in the clinical decision support system DMSS-R (Dementia Management and Support System) to support clinical routines and reasoning processes as performed by individual health professionals in daily practice. DMSS-R provides advice, tailored to individual and often exceptional patient cases, to the user while providing guidance to the next step in the assessments and support for hypothesis generation and evaluation throughout the process. This paper describes DMSS-R and the results of a case study in clinical practice where the system was used. The case study included interviews and observations of the clinical investigation process as undertaken in 41 real patient cases with suspected dementia. Two physicians participated, one of whom was considered a novice regarding dementia while the other had a moderate level of skills. Initially, both physicians were unfamiliar with DMSS-R. A group of nurses together with care personnel and relatives were also involved. The most important contribution of DMSS-R at the point of care, apart from the tailored explanatory support related to a patient case, was the educational support it provided. This was partly manifested in a change of routines in the encounter with patients. Aspects regarding the individual health care professional’s need for a personalized support system are discussed and put in relation to the team’s need for support, and in relation to the diversity of disease manifestations in this group of patients, which reinforces patient-centric assessments.