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GLINDA: GuideLine INteraction Detection Architecture

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Guideline Interaction Ontology

As part of the GLINDA project, we developed an ontology of cross-guideline interactions among recommendations of guidelines. The purpose of the ontology is to guide the development of computerized methods for detecting and managing interactions among recommendations that can be generated from all guidelines that are applicable to a patient who have multiple diseases. The ontology includes the following taxonomy:

Advisory Interaction

Inconsistent Patient Characterizations

Definition
An inconsistent patient characterizations occurs when two guidelines define a patient characteristics differently.
Example
In the JNC 7 guideline for the management of hypertention, for the purpose of setting the target blood pressure or selecting a medication to prescribe, a patient is considered to have chronic kidney disease (CKD) if a recent eGFR is less than 60. In the VA CKD guideline, on the other hand, a patient is considered to have CKD if there are two eGFR results that are less 60 and that are 3 months apart.
 
 
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Inconsistent Goals

Definition
When two guidelines prescribe for the same patient different targets for the same clinical parameters (e.g., blood pressure), the two guidelines have inconsistent goals.
Example
To be completed.
 
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Multi-Activity Interaction

Definition
Multi-activity interaction occurs when two or more interventions recommended by two guidelines interact with each other.
Example
 
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Cumulative Number Constraint

Definition
Cumulative Number Constraint interaction occurs when the cumulative number of recommended interventions from all applicable guidelines violates some constraint indicated by one of the guidelines.
Example
The Institute for Clinical System Improvement Prevention of Falls (Acute Care) guideline suggests that elderly patients on four or more drugs are at greater risk of falls. [1]
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Drug-Drug Interaction

Definition
A drug–drug interaction occurs when two drugs recommended by two different guidelines have physiological effects that are not present when each drug is given alone.
Example
To be completed.
 
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Timing Interactions

Definition
A timing interaction occurs when the timings of two interventions should be adjusted because the presence of both.
Example
Two laboratory tests recommended by two guidelines may be consolidated on the same visit.
 
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Single-Activity Interaction

Definition
A single-activity interaction occurs when, for the same intervention, two guidelines have different recommendations.
Example
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Dose Modification Level Difference

Definition
A dose-modification-level difference occurs when two guidelines recommend different dose levels for the same drug.
Example
To be completed.
 
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Dose Modification Rate Difference

Definition
A dose-modification-rate difference occurs when two guidelines recommend different titration speed.
Example
To be completed.
 
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Support Across Guidelines

Definition
A support-across-guidelines interaction occurs when two guidelines have different levels of support for the same recommendation.
Example
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Collateral Effect

Definition
A collateral effect interaction occurs when a drug recommended in one guideline has physiological effects relevant to the management of a second disease.
Example
According to the ACCF/AHA Practice Guideline for Heart Failure, the use of calcium channel blockers with negative inotropic effects is not recommended in asymptomatic patients with ejection fraction less than 40% after myocardial infarction [2]. In the discussion on the use of calcium channel blocker in the JNC 7 guideline for the management of hypertension, this precaution for patients with ejection fraction less than 40% is not mentioned.
 
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Consistent Negative Support

Definition
A consistent negative support interaction occurs when two guidelines both suggest that a particular intervention is not appropriate for the patient.
Example
To be completed.
 
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Consistent Positive Support

Definition
A consistent positive support interaction occurs when two guidelines both recommend that a intervention be given.
Example
To be completed.
 
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Contradictory Support

Definition
A contradictory support interaction occurs when one guideline recommends one intervention while another guideline opposes its use.
Example
To be completed.
 
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Contraindicated

Definition
A contraindicated interaction is a special case of the contradictory support interaction when one guideline strongly contraindicates one intervention that is recommended by another guideline.
Example
To be completed.
 
 
 
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Mixed Support

Definition
A mixed-support interaction occurs when each of the two guidelines has evidence both for and against the use of an intervention for the patient.
Example
To be completed.
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