A decision support system for prevention and treatment of pressure ulcers based on AHCPR guidelines.
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.
Zielstorff
R D
RD
Laboratory of Computer Science, Massachusetts General Hospital, Boston, USA.
Barnett
G O
GO
Fitzmaurice
J B
JB
Estey
G
G
Hamilton
G
G
Vickery
A
A
Welebob
E
E
Shahzad
C
C
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