title: A knowledge-based decision support system for prevention and treatment of pressure ulcers.
abstract: As part of a research project intended to provide problem-based knowledge to clinicians at the point of care, we have developed a system that supports the nurse's development of patient-specific, guideline-based treatment plans for patients who have pressure ulcers or are at risk for developing them. The system captures coded data about assessment, diagnosis and interventions using a point-and-click interface. Knowledge is accessible to the user via: 1) hypertext links from the data entry screens; 2) explicit entry into an indexed version of the guideline; 3) imbedded knowledge-based rules that critique the diagnosis and offer guidance for treatment; and 4) 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. Data on 113 patients were entered during the 21-week experimental period. The system is being evaluated for its instructional adequacy, its impact on clinicians' decision-making and knowledge, and on processes of care. Users' perceptions of the system are also being evaluated. Dissemination issues in the context of today's health care environment are addressed.
authors.affiliation: Laboratory of Computer Science, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Zielstorff
authors.forename: G O
authors.initials: GO
authors.lastname: Barnett
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: J B
authors.initials: JB
authors.lastname: Fitzmaurice
authors.forename: C
authors.initials: C
authors.lastname: Shahzad
mesh_terms: D001900:Boston; D003658:Decision Making, Computer-Assisted; D005103:Expert Systems; D006801:Humans; D010347:Patient Care Planning; D003668:Pressure Ulcer / Q000451:nursing* / Q000517:prevention & control; D015397:Program Evaluation; D014584:User-Computer Interface