Zielstorff R D, Barnett G O, Estey G, Hamilton G, Vickery A, Welebob E, Fitzmaurice J B, Shahzad C
Laboratory of Computer Science, Massachusetts General Hospital, Boston 02114, USA.
Stud Health Technol Inform. 1997;46:291-5.
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.
作为一个旨在为临床医生在护理点提供基于问题的知识的研究项目的一部分，我们开发了一个系统，该系统支持护士为患有压疮或有发生压疮风险的患者制定针对特定患者的、基于指南的治疗计划。该系统使用点击界面捕获有关评估、诊断和干预的编码数据。用户可以通过以下方式获取知识：1）数据输入屏幕上的超文本链接；2）明确进入指南的索引版本；3）嵌入的基于知识的规则，对诊断进行评判并提供治疗指导；4）明确进入交互式算法。该系统已在我们医院的一个护理单元进行了实验性实施，在那里将与一个对照单元进行比较来评估其影响。在为期21周的实验期内输入了113名患者的数据。正在对该系统的教学充分性、对临床医生决策和知识的影响以及护理过程进行评估。还在评估用户对该系统的看法。探讨了当今医疗保健环境背景下的传播问题。
