PROBLEM-BASED KNOWLEDGE ACCESS

这一五年期提案旨在制定、实施和评估一项 基于计算机的临床决策支持系统， 以问题为基础的知识，以医生和护士临床医生为目的， 学习和咨询。基本任务将是1）迭代的 开发界面， 图形索引技术; 2）数据库结构的开发 创建以问题为中心的临床知识的技术和创作工具 基础纳入“块”的专家知识，组织根据 临床医生经常问的问题。 该技术将应用于三个临床重要主题领域 在经常使用专家顾问的地方， 被认为对所做决定的质量有影响：1） 肺动脉患者的故障排除和管理 导管; 2）皮肤破裂的预防和管理;以及3）管理 呼吸机上的病人 该项目将在重叠的阶段进行，开发，测试， 每次改进和实施一个主题领域。技术 将在一个有41张床位的心脏外科重症监护室实施 单位，患者皮肤破裂风险高， 频繁发生通气患者。 评估将包括四个协议：1）评估教学 和技术咨询的充分性。2)评价其效率 传授知识和决策技能， 临床医生用户。3)评估临床结局（即，发生率和 褥疮的管理）在实验单元之前和之后 实现了针对SKIN主题的技术。4)评价 使用该技术进行临床治疗的成本效益 为用户提供知识，并预防不良临床结局相关 皮肤护理。

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.