Case-based reasoning for managing noncompliance with clinical guidelines

Despite the recognized advantages that can be obtained in clinical practice when following clinical guidelines (GL), situations of noncompliance with them may emerge. Keeping track of such deviations from the default GL execution, and documenting the physician's motivations, would clearly be an added value. Moreover, repeated alterations of GL actions (or flow) may highlight the need for an adaptation of the GL itself to the local reality, or may even indicate an improper or weak initial GL definition. In this article, we propose an approach for managing noncompliance with GL, based on the case-based reasoning methodology. In front of a new noncompliance case, our tool allows the physician to retrieve past situations similar to the current one, and to decide whether to reapply the same GL modifications adopted in them. Moreover, the tool is able to learn indications from the ground noncompliance cases that can be deployed for local adaptation, and possibly, for suggesting more formal GL revisions to be carried out by a committee of expert physicians.