title: A decision support system for prevention and treatment of pressure ulcers based on AHCPR guidelines.
abstract: We have developed a Pressure Ulcer Prevention and Management System to assist clinicians with patient-specific decision making. The system captures coded data about assessment, diagnosis and interventions using a point-and-click interface. Guideline-based knowledge is imbedded into the system, and is accessible in several ways: 1) via hypertext links from the data entry screens; 2) via explicit entry into an indexed version of the guideline; 3) via imbedded knowledge-based rules that critique the diagnosis and offer guidance for treatment; and 4) via explicit entry into interactive algorithms. The system has been implemented experimentally on one care unit at our hospital, where its impact will be assessed in comparison with a control unit. Preliminary usage data are provided. Issues with rendering guideline material useful for patient-specific decision support are discussed. In our setting, these issues had to do with a) incongruity with local standards; b) insufficient specificity; and 3) insufficient comprehensiveness. Issues of use and dissemination in the context of today's health care environment are also addressed.
authors.affiliation: Laboratory of Computer Science, Massachusetts General Hospital, Boston, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Zielstorff
authors.forename: G O
authors.initials: GO
authors.lastname: Barnett
authors.forename: J B
authors.initials: JB
authors.lastname: Fitzmaurice
authors.forename: G
authors.initials: G
authors.lastname: Estey
authors.forename: G
authors.initials: G
authors.lastname: Hamilton
authors.forename: A
authors.initials: A
authors.lastname: Vickery
authors.forename: E
authors.initials: E
authors.lastname: Welebob
authors.forename: C
authors.initials: C
authors.lastname: Shahzad
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005069:Evaluation Studies as Topic; D006801:Humans; D019146:Hypermedia; D017410:Practice Guidelines as Topic; D003668:Pressure Ulcer / Q000517:prevention & control / Q000628:therapy*; D013813:Therapy, Computer-Assisted; D014481:United States; D016270:United States Agency for Healthcare Research and Quality