Project Details


DESCRIPTION (Taken from application abstract): In the rapidly changing
health care environment the increasing prominence of managed care has
prompted a greater reliance on formal clinical guidelines to suppose
clinical decisions. Guidelines have been advocated with increasing
frequency to reduce inappropriate care, control geographic variations in
practice patterns and make more effective use of health care resources.
However, guidelines often have little impact on clinical practice because
physicians are unaware of them, lack confidence in them because the
justification for their recommendations is not clear or because they are
inaccessible at the time of patient care or difficult to apply. Guidelines
also quickly become out of date as new research data becomes available.

In order to enhance the quality and usefulness of clinical guidelines, the
general goal of this project is to develop, deploy and evaluate interactive
computer based guidelines, supported by an integrated decision theoretic
model and a linked knowledge base. This arrangement will use patient
characteristics to tailor guideline advice to the individual patient. The
integrated decision model will provide recommendations for situations not
addressed by the guideline and also will help to justify guideline
recommendations by calculating the effectiveness and costs of various
strategies. The proposed system also contains links to a knowledge base
containing the sources of data used in the guideline and the model, so that
physicians using the system can examine the studies supporting the guideline
recommendations. Natural language explanations, generated automatically
based on the structure of the decision model and the guideline will justify
the recommendations. A query capability will enable physicians to look up
specific data from the knowledge base. The linked knowledge based also
ensures that the supported decision model and guideline will be updated
automatically as new research data is published.

The computer system will be used to implement an interactive version of the
Guidelines for Medical Treatment for Stroke Prevention, developed by the
American College of Physicians. The system will be bench tested using a
series of cases abstracted from the General Medicine practice at the Robert
Wood Johnson Medical School. Faculty and house staff internists will serve
as research subjects to perform a field trial of the system. This will
include the extent of previous compliance with the guideline, pre and
post-testing of medical knowledge pertinent to the guideline, and the degree
to which the computer-based guideline changes behavior compared to the
traditional guideline format. A decision theoretic measure of potential
benefit will be calculated by comparing decision model evaluations of
physicians' unaided choices with those recommended by the guideline system.
Effective start/end date9/30/988/31/02


  • U.S. National Library of Medicine: $248,558.00
  • U.S. National Library of Medicine
  • U.S. National Library of Medicine


  • Medicine(all)


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