Abstract：
BACKGROUND: The increasing aging population presents a significant challenge, accompanied by a shortage of professional caregivers, adding to the therapeutic burden. Clinical decision support systems, utilizing computerized clinical guidelines, can improve healthcare quality, reduce expenses, save time, and boost caregiver efficiency.
OBJECTIVE: 1) Develop and evaluate an automated quality assessment (QA) system for retrospective longitudinal care quality analysis, focusing on clinical staff adherence to evidence-based guidelines (GLs). 2) Assess the system\'s technical feasibility and functional capability for senior nurse use in geriatric pressure-ulcer management.
METHODS: A computational QA system using our Quality Assessment Temporal Patterns (QATP) methodology was designed and implemented. Our methodology transforms the GL\'s procedural-knowledge into declarative-knowledge temporal-abstraction patterns representing the expected execution trace in the patient\'s data for correct therapy application. Fuzzy temporal logic allows for partial compliance, reflecting individual and grouped action performance considering their values and temporal aspects. The system was tested using a pressure ulcer treatment GL and data from 100 geriatric patients\' Electronic Medical Records (EMR). After technical evaluation for accuracy and feasibility, an extensive functional evaluation was conducted by an experienced nurse, comparing QA scores with and without system support, and versus automated system scores. Time efficiency was also measured.
RESULTS: QA scores from the geriatric nurse, with and without system\'s support, did not significantly differ from those provided by the automated system (p < 0.05), demonstrating the effectiveness and reliability of both manual and automated methods. The system-supported manual QA process reduced scoring time by approximately two-thirds, from an average of 17.3 min per patient manually to about 5.9 min with the system\'s assistance, highlighting the system\'s efficiency potential in clinical practice.
CONCLUSIONS: The QA system based on QATP, produces scores consistent with an experienced nurse\'s assessment for complex care over extended periods. It enables quick and accurate quality care evaluation for multiple patients after brief training. Such automated QA systems may empower nursing staff, enabling them to manage more patients, accurately and consistently, while reducing costs due to saved time and effort, and enhanced compliance with evidence-based guidelines.
OBJECTIVE: 1) Develop and evaluate an automated quality assessment (QA) system for retrospective longitudinal care quality analysis, focusing on clinical staff adherence to evidence-based guidelines (GLs). 2) Assess the system\'s technical feasibility and functional capability for senior nurse use in geriatric pressure-ulcer management.
METHODS: A computational QA system using our Quality Assessment Temporal Patterns (QATP) methodology was designed and implemented. Our methodology transforms the GL\'s procedural-knowledge into declarative-knowledge temporal-abstraction patterns representing the expected execution trace in the patient\'s data for correct therapy application. Fuzzy temporal logic allows for partial compliance, reflecting individual and grouped action performance considering their values and temporal aspects. The system was tested using a pressure ulcer treatment GL and data from 100 geriatric patients\' Electronic Medical Records (EMR). After technical evaluation for accuracy and feasibility, an extensive functional evaluation was conducted by an experienced nurse, comparing QA scores with and without system support, and versus automated system scores. Time efficiency was also measured.
RESULTS: QA scores from the geriatric nurse, with and without system\'s support, did not significantly differ from those provided by the automated system (p < 0.05), demonstrating the effectiveness and reliability of both manual and automated methods. The system-supported manual QA process reduced scoring time by approximately two-thirds, from an average of 17.3 min per patient manually to about 5.9 min with the system\'s assistance, highlighting the system\'s efficiency potential in clinical practice.
CONCLUSIONS: The QA system based on QATP, produces scores consistent with an experienced nurse\'s assessment for complex care over extended periods. It enables quick and accurate quality care evaluation for multiple patients after brief training. Such automated QA systems may empower nursing staff, enabling them to manage more patients, accurately and consistently, while reducing costs due to saved time and effort, and enhanced compliance with evidence-based guidelines.
摘要：
背景：日益老龄化的人口提出了重大挑战，伴随着专业护理人员的短缺，增加了治疗负担。临床决策支持系统,利用计算机化的临床指南，可以提高医疗保健质量，减少开支,节省时间,并提高护理人员的效率。
目的：1）开发和评估用于回顾性纵向护理质量分析的自动质量评估（QA）系统，重点关注临床工作人员对循证指南（GL）的依从性。2）评估系统的技术可行性和功能能力，用于老年压疮管理的高级护士。
方法：设计并实现了使用我们的质量评估时态模式（QATP）方法的计算QA系统。我们的方法将GL的程序知识转换为声明性知识时间抽象模式，代表患者数据中的预期执行跟踪，以进行正确的治疗应用。模糊时间逻辑允许部分遵从，反映个人和分组行动表现，考虑到他们的价值和时间方面。使用压疮治疗GL和来自100名老年患者的电子病历(EMR)数据对系统进行了测试。在对准确性和可行性进行技术评估后，由经验丰富的护士进行了广泛的功能评估，比较有和没有系统支持的QA分数，和自动系统分数。还测量了时间效率。
结果：来自老年护士的QA评分，有和没有系统的支持，与自动化系统提供的无显著差异(p<0.05)，证明了手动和自动化方法的有效性和可靠性。系统支持的手动QA流程将评分时间减少了约三分之二，在系统的帮助下，从每位患者手动平均17.3分钟到约5.9分钟，突出系统在临床实践中的效率潜力。
结论：基于QATP的QA系统，产生的分数与经验丰富的护士对长期复杂护理的评估一致。它使快速和准确的质量护理评估多个患者经过简短的培训。这种自动化QA系统可以赋予护理人员权力，使他们能够管理更多的病人，准确和一致，同时由于节省了时间和精力而降低成本，并加强对循证指南的遵守。
目的：1）开发和评估用于回顾性纵向护理质量分析的自动质量评估（QA）系统，重点关注临床工作人员对循证指南（GL）的依从性。2）评估系统的技术可行性和功能能力，用于老年压疮管理的高级护士。
方法：设计并实现了使用我们的质量评估时态模式（QATP）方法的计算QA系统。我们的方法将GL的程序知识转换为声明性知识时间抽象模式，代表患者数据中的预期执行跟踪，以进行正确的治疗应用。模糊时间逻辑允许部分遵从，反映个人和分组行动表现，考虑到他们的价值和时间方面。使用压疮治疗GL和来自100名老年患者的电子病历(EMR)数据对系统进行了测试。在对准确性和可行性进行技术评估后，由经验丰富的护士进行了广泛的功能评估，比较有和没有系统支持的QA分数，和自动系统分数。还测量了时间效率。
结果：来自老年护士的QA评分，有和没有系统的支持，与自动化系统提供的无显著差异(p<0.05)，证明了手动和自动化方法的有效性和可靠性。系统支持的手动QA流程将评分时间减少了约三分之二，在系统的帮助下，从每位患者手动平均17.3分钟到约5.9分钟，突出系统在临床实践中的效率潜力。
结论：基于QATP的QA系统，产生的分数与经验丰富的护士对长期复杂护理的评估一致。它使快速和准确的质量护理评估多个患者经过简短的培训。这种自动化QA系统可以赋予护理人员权力，使他们能够管理更多的病人，准确和一致，同时由于节省了时间和精力而降低成本，并加强对循证指南的遵守。
