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.
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