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Development of a prototype personal digital assistant-decision support system for the management of adult obesity
1Columbia University School of Nursing, 617 W. 168th Street, New York, NY 10032, USA. nl2027@columbia.edu
Objective:
The purpose of this study was to develop a prototype personal digital assistant-decision support system (PDA-DSS) based on a clinical practice guideline (CPG) for the management of obesity.
Design:
The study was composed of four phases: (1) analysis of advanced practice nurse (APN) students' documentation related to the management of obesity using the Clinical Log-APN (CL-APN), (2) identification of functional requirements and data modeling through use case analysis and unified modeling language (UML), (3) evaluation of representation of obesity-related concepts with standardized terminologies, and (4) design of a web-based prototype user interface.
Results:
The analysis revealed the documentation rate of obesity as an assessment diagnosis and adherence to the CPG for obesity was low. Through use case analysis and UML modeling, the functional requirements - screening, assessment, and documentation of CPG-based obesity treatment plan - were identified and a data model was built. Overall, the standardized terminologies that are used in the database for the CL-APN could represent about 80% of the obesity-related concepts. However, the terms of these standardized terminologies were not specific enough to represent all the concepts. The systematized nomenclature of medicine-clinical terms (SNOMED CT) could represent 83% of the concepts and was used to extend the knowledge base. Based on the functional requirements specification, four prototype screens were designed.
Conclusion:
The PDA-DSS for the management of obesity has potential uses for education, nursing practice, and research. As an educational tool, it can be used to improve APN students' adherence to the CPG's recommendations and to enhance informatics competencies. The PDA-DSS has the potential to improve APN students' clinical decision making at the point-of-care and delivery of CPG-based care, thereby improving patients' outcomes related to the management of obesity. A randomized trial is underway to investigate the PDA-DSS's impact on APN students' screening rates and adherence to obesity CPG recommendations, and users' acceptance of the system.
