PROBLEM-BASED KNOWLEDGE ACCESS

这项为期五年的建议旨在制定、实施和评估 基于计算机的临床决策支持系统，提供访问 为临床医生和护士提供以问题为基础的知识 学习和咨询。基本任务将是迭代的 开发包含易于使用的上下文和 图形标引技术；2)数据库结构化的发展 创建以问题为中心的临床知识的技术和创作工具 包含“大块”专家知识的基地，按 临床医生经常问的问题。 这项技术将应用于三个临床重要课题领域 经常使用专家顾问的地方，以及专家知识的地方 被认为在决策质量方面有所不同：1) 肺动脉高压患者的诊断与处理 导管；2)皮肤破裂的预防和处理；3)管理 使用呼吸机的病人。 该项目将分阶段进行，包括开发、测试、 一次细化和实施一个主题领域。技术 将在41张病床上实施降压心脏外科重症监护 单位，皮肤破裂风险患者的高发率，以及 呼吸机患者频发。 评估将由四个方案组成：1)评估教学 以及技术的咨询充分性。2)评估效果 将知识和决策技能传授给 临床医生用户。3)评估临床结果(即发病率和 压疮管理)前、后试点单位 实现了针对皮肤主题的技术。4)评估 应用该技术传授临床知识的成本-效果 对用户的知识，并用于预防相关的不良临床结果 为了护肤。

This five-year proposal seeks to develop, implement and evaluate a computer-based clinical decision support system that provides access to problem-based knowledge to physician and nurse clinicians for the purpose of learning and consultation. 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 create problem-focused clinical knowledge bases incorporating "chunks" of expert knowledge, organized according to the kinds of questions clinicians frequently ask. The technology will be applied to three clinically important topic areas where expert consultants are frequently used, and where expert knowledge is believed to make a difference in quality of decisions made: 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. The project will proceed in overlapping phases, with development, testing, refinement and implementation of one topic area at a time. The technology will be implemented on a 41-bed step-down cardiac surgical intensive care unit, with high incidence of patients at risk for skin breakdown, and frequent occurrence of ventilated patients. Evaluation will consist of four protocols: 1) Evaluate the instructional and consultative adequacy of the technology. 2) Evaluate the effectiveness of the technology for imparting knowledge and decision-making skills to clinician users. 3) Evaluate clinical outcomes (i.e., incidence and management of decubiti) on the experimental unit prior to and after implementation of the technology for the SKIN topic. 4) Evaluate cost-effectiveness of use of this technology for imparting clinical knowledge to users, and for prevention of adverse clinical outcomes related to skin care.