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Applying Axiomatic Design Methodology to Create Guidelines That Are Locally Adaptable

Abstract 
Clinical guidelines developed at a national level are often difficult to use in specific-settings because of contextual factors. We have created a model for guideline representation that enables local adaptation of nationally developed guidelines. Guidelines are specified in a setting-independent manner and are then locally adapted by each practice. A guideline is represented hierarchically with the top level steps of the guideline specifying broad objectives and the lower level steps providing details of the recommendations. The axiomatic design framework provides a principled method for hierarchical design. The approach has been implemented by incorporation in the GLIF guideline modeling environment.