Applying axiomatic design methodology to enable adaptation of clinical guidelines to local contexts

Background: Local adaptation of guidelines may increase compliance with guidelines that have been developed at a national level and are often not used in practice because of contextual factors. We have developed a representation scheme known as HieroGLIF, that facilitates a two-step approach to development and implementation of guidelines. In the first step, professional medical societies create a setting-independent guideline. In the second step, the guideline is adapted to local settings. The scheme represents the setting-independent guideline knowledge in a hierarchical structure for which we use axiomatic design theory to guide a top-down design. This representation extends the Guideline Interchange Format (GLIF), a frame-based ontology that has been previously developed for representation of guidelines. Methods: We encoded conventional national guidelines in the setting-independent format which were adapted to local clinical settings of their practice by primary care physicians (PCPs). We conducted a qualitative analysis of the type of changes that were made by the local adaptors. For each of the guidelines two patients' scenarios were created for which two sets of guideline recommendations were generated, one from the adapted hierarchical guideline and one from the conventional, non-hierarchical guideline. We evaluated in a randomized controlled trial the potential impact of the local adaptation methodology on adherence to guidelines. For each recommendation, 70 PCPs responded to a questionnaire that inquired if PCPs would follow the recommendations and their ratings for several relevant attributes. We also analyzed the data to look for attributes of recommendations that are important for their acceptance by PCPs. Results: In 8 out of

Department dc:contributor.department

Harvard University--MIT Division of Health Sciences and Technology.

Grantor dc:publisher

Massachusetts Institute of Technology

Year dc:date.issued

2004

Author dc:creator

• Denekamp, Yaron, 1963-

Advisor dc:contributor.advisor

• Aziz A. Boxwala.

• Harvard University--MIT Division of Health Sciences and Technology.

Statement dc:rights

• M.I.T. theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission. See provided URL for inquiries about permission.

Licence dc:rights.uri

• http://dspace.mit.edu/handle/1721.1/7582

Language dc:language.iso

en_US

Handle dc:identifier.uri

http://hdl.handle.net/1721.1/28585

OAI identifier oai:identifier

oai:dspace.mit.edu:1721.1/28585