COMPUTER-BASED ACCESS TO GUIDELINES FOR CLINICAL CARE

这一五年期提案旨在制定、实施和评估一项 基于计算机的系统，为医生和护士提供访问 以学习为目的的临床护理指南， 协商 该技术将应用于主题领域， 在职教育费用很高，专家顾问 经常使用，并且专家知识被认为是 决策质量的差异。 前三个主题将 be：1）肺动脉高压患者的故障排除和管理 动脉导管; 2）皮肤破裂的预防和管理;以及3） 管理呼吸机上的患者。 基本任务将是1）接口的迭代开发 结合易于使用的上下文和图形索引技术; 2)开发数据库结构技术和编写工具， 允许内容专家创建以问题为中心的临床指南， 根据临床医生经常问的问题分类; 3)该系统的实施，在临床领域与高频率的 受影响的患者;以及4）评估技术对 改善对护理标准、准则和规程的遵守。 在可行的情况下，评价还将包括评估是否 改善对指南的遵守也改善了患者的结果。 将测试以下假设：a）系统将 主题专家和临床用户都可以接受。B）用途 将有助于提高对标准的理解， 临床医生用户之间的协议和指南，并将加强 三个专题领域的决策。（c）提供准则， 预防和管理压疮通过计算机为基础的 系统将减少实验性压疮的发生率 单位;压疮的管理将得到改善。（d）提供 使用呼吸机的患者管理指南将导致 使用呼吸机的总患者天数减少，脱机时间缩短 患者e）使用该系统将降低患者成本 与压疮的预防和管理有关。f） 系统将减少与工作人员培训相关的医院成本， 技术和临床顾问的在职教育和使用 三个主题领域。（g）该系统将导致更好地遵守 在三个主题领域中的每一个领域都有指导方针。

This five-year proposal seeks to develop, implement and evaluate a computer-based system that provides physicians and nurses access to clinical guidelines of care for the purpose of learning and consultation. The technology will be applied to topic areas where inservice education costs are high, where expert consultants are frequently used, and where expert knowledge is believed to make a difference in quality of decisions made. The first three topics will be: 1) troubleshooting and management of patients with a pulmonary artery catheter; 2) prevention and management of skin breakdown; and 3) management of patients on a ventilator. Essential tasks will be 1) iterative development of interfaces incorporating easy-to-use contextual and graphical indexing techniques; 2) development of database structuring techniques and authoring tools to allow content experts to create problem-focused clinical guidelines, organized according to the kinds of questions clinicians frequently ask; 3) implementation of the system in clinical areas with high frequency of affected patients; and 4) assessment of the impact of the technology on improving adherence to standards, guidelines and protocols of care. Where feasible, evaluation will also include assessment of whether improved adherence to guidelines also improves patient outcomes. The following hypotheses will be tested: a) The system will be acceptable to both subject matter experts and to clinical users. b) Use of the system will result in improved understanding of the standards, protocols and guidelines among clinician users, and will enhance decision-making in the three topic areas. c) Provision of guidelines for prevention and management of pressure sores via the computer-based system will lessen the incidence of pressure sores on the experimental unit; management of pressure sores will be improved. d) Provision of guidelines for management of patients on respirators will result in fewer overall patient days on respirators, and shortened time to wean patients. e) Use of the system will result in decreased patient costs associated with prevention and management of pressure sores. f) The system will decrease hospital costs associated with staff orientation, inservice education and use of technical and clinical consultants in the three topic areas. g)The system will result in improved compliance with guidelines in each of the three topic areas.