title: Analyzing the "CareGap": assessing gaps in adherence to clinical guidelines in adult soft tissue sarcoma.
abstract: Clinical decision support systems (CDSSs) are gaining popularity as tools that assist physicians in optimizing medical care. These systems typically comply with evidence-based medicine and are designed with input from domain experts. Nonetheless, deviations from CDSS recommendations are abundant across a broad spectrum of disorders, raising the question as to why this phenomenon exists. Here, we analyze this gap in adherence to a clinical guidelines-based CDSS by examining the physician treatment decisions for 1329 adult soft tissue sarcoma patients in northern Italy using patient-specific parameters. Dubbing this analysis "CareGap", we find that deviations correlate strongly with certain disease features such as local versus metastatic clinical presentation. We also notice that deviations from the guideline-based CDSS suggestions occur more frequently for patients with shorter survival time. Such observations can direct physicians' attention to distinct patient cohorts that are prone to higher deviation levels from clinical practice guidelines. This illustrates the value of CareGap analysis in assessing quality of care for subsets of patients within a larger pathology.
authors.affiliation: IBM Research - Haifa, Haifa, Israel. zeevw@il.ibm.com
authors.forename: Zeev
authors.initials: Z
authors.lastname: Waks
authors.forename: Esther
authors.initials: E
authors.lastname: Goldbraich
authors.forename: Ariel
authors.initials: A
authors.lastname: Farkash
authors.forename: Michele
authors.initials: M
authors.lastname: Torresani
authors.forename: Rossella
authors.initials: R
authors.lastname: Bertulli
authors.forename: Nicola
authors.initials: N
authors.lastname: Restifo
authors.forename: Paolo
authors.initials: P
authors.lastname: Locatelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Casali
authors.forename: Boaz
authors.initials: B
authors.lastname: Carmeli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020000:Decision Support Systems, Clinical / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008495:Medical Oncology / Q000592:standards; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012307:Risk Factors; D012509:Sarcoma / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D015996:Survival Rate; D055815:Young Adult