Guideline-based clinical decision support framework for multimorbidity: a protocol for formulation and testing (Preprint)

Introduction: The burden of multimorbidity is increasing globally, which complicates the use of guidelines in clinical practice and healthcare: practitioners may need to increasingly refer to multiple guidelines with potentially conflicting recommendations. We aim to develop a guideline-based decision support framework for the management of multimorbid patients to help clinicians efficiently evaluate, select and adapt recommendations focusing on the different comorbidities and aspects of multimorbidity. Methods and analysis: We will conduct the project in the following steps: 1) Confirming the need for the framework; 2) Establishing international working groups (coordination team, evidence support group, consensus group); 3) Conducting literature reviews and original research to formulate an initial draft framework; 4) Consensus process including expert survey and consensus meeting; 5) Formulating and releasing the final framework; and 6) Testing the framework. We plan to complete the project within three years. Strengths and limitations of this study: This framework will help clinicians from all levels of health care institutions to make decisions in the management of multimorbid patients based on the latest available evidence and reduce potential health risks to their patients. The limitation of this framework is that such a broad framework may not fit all disease combinations or realistic situations so well. To reduce the degree of inapplicability, after completion of the framework, we will continue to monitor its use with regular updates as needed.