COMPUTER-BASED ACCESS TO GUIDELINES FOR CLINICAL CARE

这项为期五年的建议旨在制定、实施和评估 基于计算机的系统，为医生和护士提供访问 用于学习和治疗的临床护理指南 咨询。这项技术将应用于以下主题领域 在职教育成本很高，专家顾问在那里 经常被使用，并且专家知识被认为可以使 所做决策的质量差异。前三个主题将 BE：1)肺部疾病患者的诊断和管理 动脉导管；2)皮肤破裂的预防和处理；3) 患者使用呼吸机的管理。 基本任务将是1)迭代开发界面 采用易于使用的上下文和图形索引技术； 2)开发数据库结构化技术和创作工具，以 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的种类进行组织； 3)在临床高发地区实施该系统 受影响的患者；以及4)评估技术对 改善对护理标准、指南和方案的遵守情况。 在可行的情况下，评估还将包括评估是否 更好地遵守指南也可以改善患者的预后。 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)使用 该系统的实施将导致对标准的更好理解， 临床医生用户之间的协议和指南，并将增强 三个主题领域的决策。C)为以下方面提供准则 以计算机为基础预防和管理压疮 系统会减少压疮对实验者的影响 将改善压疮的管理。D)提供 对佩戴呼吸器的患者的管理指南将导致 减少使用呼吸器的总患者天数，缩短脱机时间 病人。E)该系统的使用将降低病人费用 与预防和管理压疮有关。F) 系统将降低与员工定向相关的医院成本， 技术和临床顾问的在职教育和使用 三个主题领域。G)该系统将改善遵守情况 三个主题领域中每一个领域的指导方针。

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.