Using EHR data to predict hospital-acquired pressure ulcers: A prospective study of a Bayesian Network model
Using EHR data to predict hospital-acquired pressure ulcers: A prospective study of a Bayesian Network model
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DOI：
10.1016/j.ijmedinf.2013.06.012
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发表时间：
2013-11-01
影响因子：
4.9
通讯作者：
Bates, David W.
中科院分区：
文献类型：
--
作者：
Cho, Insook;Park, Ihnsook;Bates, David W.
背景资料：医院获得性压疮（HAPU）是常见的住院患者，并创造大量的发病率，死亡率和成本，但预防策略一直只sufficienteffective.Objectives：制定和评估的影响，决策支持干预预测HAPU的溃疡的患病率和住院时间在重症监护病房（ICU），并对用户采用率和态度。方法：比较干预前后HAPU的流行情况，并对HAPU使用者进行问卷调查。我们使用了一个贝叶斯网络模型，该模型在以前的研究中得到了验证，并在一个名为压疮（PU）管理器的应用程序中与电子健康记录系统相关联。干预组包括2009年和2010年6个月期间在三级教学医院外科ICU的866名高危患者;对照组为2006年和2007年6个月基线期的348名患者。在干预组中，总体HAPU患病率从21%下降到4.0%，ICU住院时间从7.6天缩短到5.2天。在调整主要诊断和疾病严重程度后，干预组发生HAPU的可能性显著低于基线组[比值比（OR）= 0.1，p < 0.0001]，ICU住院时间较短（OR = 0.67，p < 0.0001）。关于溃疡严重程度和身体部位的数据输入增加，参与者每天使用PU Manager超过80%的合格病例。对PU Manager.Conclusions的态度是积极的：这种决策支持的方法减少了发病率HAPU十倍，ICU住院时间约三分之一。此外，护士对使用它有良好的态度。（C）2013爱思唯尔爱尔兰有限公司。保留所有权利。
Background: Hospital-acquired pressure ulcers (HAPU) are common among inpatients and create substantial morbidity, mortality, and costs, but prevention strategies have been only variably effective.Objectives: To develop and assess the impact of a decision support intervention to predict HAPU on the prevalence of ulcers and length of stay in an intensive care unit (ICU), and on the user adoption rate and attitudes. Methods: We compared the HAPU prevalence before and after introducing the intervention, and surveyed the users. We used a Bayesian Network model that was validated in previous studies and linked to the electronic health record system in an application called Pressure Ulcer (PU) Manager. The intervention group included 866 at-risk patients in the surgical ICUs of a tertiary teaching hospital over a 6-month period in 2009 and 2010; the controls were 348 patients from a 6-month baseline period in 2006 and 2007.Results: In the intervention group, the overall HAPU prevalence rate fell from 21% to 4.0% and the ICU length of stay shortened from 7.6 to 5.2 days. After adjustment for primary diagnoses and illness severity, the intervention group was significantly less likely than the baseline group to develop HAPU [odds ratio (OR) = 0.1, p < 0.0001] and had a shorter ICU length of stay (OR = 0.67, p < 0.0001). Data entry regarding ulcer severity and body site increased, and the participants used PU Manager more than once a day for over 80% of eligible cases. Attitudes toward PU Manager were positive.Conclusions: This decision support approach reduced the prevalence of HAPU tenfold and the ICU length of stay by about one-third. Furthermore, the nurses had favorable attitudes toward using it. (C) 2013 Elsevier Ireland Ltd. All rights reserved.