We propose to implement practice guidelines for the management of three conditions - deep vein thrombosis, asthma and acute myocardial infarction - in a computerized Problem-Oriented Patient Management System, as part of a hospital information system called HELP. The Problem-Oriented Patient Management System will provide practice guidelines that are specific to the patient's particular problems, based on the patient's clinical data obtained from the computerized patient database in the HELP system. We propose to perform a retrospective evaluation to demonstrate the potential impact of physician compliance with guidelines on patient outcomes as measured by the total charges for the admission, the number of complications developed, the number of investigations performed, and the length of stay. We hypothesize that better physician compliance with management guidelines predicts lower total charges for the hospitalization, fewer complications developed, fewer investigations performed and a shorter length of stay, controlling for disease severity. Clinical data and physician management decisions of 90 patient cases (30 for each disease condition) will be obtained from the HELP database. We will identify every critical stage in the case, defined as the times when the case physician made management decisions. The Problem-Oriented Patient Management System will generate the relevant guidelines for each of these critical times. These retrospectively generated guidelines can then be compared to the case physician's management decisions in a """"""""gold standard"""""""" review by two specialists from the respective disease domain. We propose a regression model to predict patient outcomes as a function of physician compliance with guidelines.
