APPRAISE-RS: Automated, updated, participatory, and personalized treatment recommender systems based on GRADE methodology

Beatriz López; Oscar Raya; Evgenia Baykova; Marc Saez; David Rigau; Ruth Cunill; Sacramento Mayoral; Carme Carrion; Domènec Serrano; Xavier Castells

doi:10.1016/j.heliyon.2023.e13074

APPRAISE-RS: Automated, updated, participatory, and personalized treatment recommender systems based on GRADE methodology

Heliyon. 2023 Jan 24;9(2):e13074. doi: 10.1016/j.heliyon.2023.e13074. eCollection 2023 Feb.

Authors

Beatriz López¹, Oscar Raya¹, Evgenia Baykova², Marc Saez^{3

4}, David Rigau⁵, Ruth Cunill⁶, Sacramento Mayoral², Carme Carrion⁷, Domènec Serrano², Xavier Castells⁸

Affiliations

¹ Control Engineering and Intelligent Systems (eXiT), University of Girona, Spain.
² Institute of Health Care (ICS-IAS), Girona, Spain.
³ Research Group on Statistics, Econometrics and Health, University of Girona, Spain.
⁴ CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
⁵ Cochrane Iberoamerica, Barcelona, Spain.
⁶ Sant Joan de Deu-Numancia Health Park, Barcelona, Spain.
⁷ Health Lab Research Group, Universitat Oberta de Catalunya, Spain.
⁸ TransLab Research Group, Dept. of Medical Sciences, University of Girona, Spain.

Abstract

Purpose: Clinical practice guidelines (CPGs) have become fundamental tools for evidence-based medicine (EBM). However, CPG suffer from several limitations, including obsolescence, lack of applicability to many patients, and limited patient participation. This paper presents APPRAISE-RS, which is a methodology that we developed to overcome these limitations by automating, extending, and iterating the methodology that is most commonly used for building CPGs: the GRADE methodology.

Method: APPRAISE-RS relies on updated information from clinical studies and adapts and automates the GRADE methodology to generate treatment recommendations. APPRAISE-RS provides personalized recommendations because they are based on the patient's individual characteristics. Moreover, both patients and clinicians express their personal preferences for treatment outcomes which are considered when making the recommendation (participatory). Rule-based system approaches are used to manage heuristic knowledge.

Results: APPRAISE-RS has been implemented for attention deficit hyperactivity disorder (ADHD) and tested experimentally on 28 simulated patients. The resulting recommender system (APPRAISE-RS/TDApp) shows a higher degree of treatment personalization and patient participation than CPGs, while recommending the most frequent interventions in the largest body of evidence in the literature (EBM). Moreover, a comparison of the results with four blinded psychiatrist prescriptions supports the validation of the proposal.

Conclusions: APPRAISE-RS is a valid methodology to build recommender systems that manage updated, personalized and participatory recommendations, which, in the case of ADHD includes at least one intervention that is identical or very similar to other drugs prescribed by psychiatrists.

Keywords: Attention deficit hyperactivity disorder; Evidence-based medicine; Meta-analysis; Treatment recommender systems.