MitPlan: A planning approach to mitigating concurrently applied clinical practice guidelines

As the population ages, patients’ complexity and the scope of their care is increasing. Over 60% of the population is 65 years of age or older and suffers from multi-morbidity, which is associated with two times as many patient-physician encounters. Yet clinical practice guidelines (CPGs) are developed to treat a single disease. To reconcile these two competing issues, previously we developed a framework for mitigation, i.e., identifying and addressing adverse interactions in multi-morbid patients managed according to multiple CPGs. That framework relies on first-order logic (FOL) to represent CPGs and secondary medical knowledge and FOL theorem proving to establish valid patient management plans. In the work presented here, we leverage our earlier research and simplify the mitigation process by representing it as a planning problem using the Planning Domain Definition Language (PDDL). This new framework, called MitPlan, identifies and addresses adverse interactions using durative planning actions that embody clinical actions (including medication administration and patient testing), supports a physician-defined length of planning horizons, and optimizes plans based on patient preferences and action costs. It supports a variety of criteria when developing management plans, including the total cost of prescribed treatment and the cost of the revisions to be introduced. The solution to MitPlan's planning problem is a sequence of timed actions that are easy to interpret when creating a management plan. We demonstrate MitPlan's capabilities using illustrative and clinical case studies.