RESUMEN
BACKGROUND: Standardized clinical terminologies are increasingly used to design and support advanced information systems. In order to examine the representativeness of these terminologies for different professional groups or clinical areas, researchers may perform different methods of terminology mapping. OBJECTIVE: The purpose of this study was to evaluate the ability of four mapping methods to identify concepts related to wound care in SNOMED CT. METHODS: A class diagram of 107 concepts was developed to represent the nursing context of wound assessment, wound diagnosis, and goal of care for wound management. All concepts were mapped to SNOMED CT and identified as a direct match, a one-to-many match, or no match using four mapping methods (manual, automated, comparison, and concordance). The manual, automated and comparison methods produced candidate lists of SNOMED CT concepts, which were then used by two nursing wound care experts. The experts completed concordance mapping, which produced the final list. The SNOMED CT concepts from the manual, automated and comparison mappings were compared to the concordance mapping to generate a proportion of representation by each mapping method. RESULTS: The manual, automated and comparison mappings produced partial lists of unique candidate concept matches not found in the other mapping methods. The concordance mapping produced a final list which included: 43 terms (40%) that had direct matches, 2 terms (2%) that had one-to-many matches, and 62 terms (58%) that had no matches to SNOMED CT. All mapping methods were necessary to achieve the representativeness captured in the final list. CONCLUSION: To increase the representativeness of candidate mapping lists, multiple mapping methods and considerations may be necessary.
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Examen Físico , Systematized Nomenclature of Medicine , HumanosRESUMEN
The use of standardized terminologies is an essential component to support interoperability in electronic health records. In British Columbia, Canada, a commonly used nursing wound assessment template was mapped to SNOMED CT. Preliminary results have found that 50.8% of the wound assessment data elements had direct matches to concepts within SNOMED CT. Results of this mapping activity have produced a set of mapped wound assessment parameters to SNOMED CT.
Asunto(s)
Terminología Normalizada de Enfermería , Systematized Nomenclature of Medicine , Heridas y Lesiones/clasificación , Colombia Británica , Registros Electrónicos de Salud , Humanos , Terminología como AsuntoRESUMEN
AIMS: A 2-year project was carried out to evaluate the use of multi-component, computer-assisted strategies for implementing clinical practice guidelines. This paper describes the implementation of the project and lessons learned. The evaluation and outcomes of implementing clinical practice guidelines to prevent and treat pressure ulcers will be reported in a separate paper. BACKGROUND: The prevalence and incidence rates of pressure ulcers, coupled with the cost of treatment, constitute a substantial burden for our health care system. It is estimated that treating a pressure ulcer can increase nursing time up to 50%, and that treatment costs per ulcer can range from US$10,000 to $86,000, with median costs of $27,000. Although evidence-based guidelines for prevention and optimum treatment of pressure ulcers have been developed, there is little empirical evidence about the effectiveness of implementation strategies. METHOD: The study was conducted across the continuum of care (primary, secondary and tertiary) in a Canadian urban Health Region involving seven health care organizations (acute, home and extended care). Trained surveyors (Registered Nurses) determined the prevalence and incidence of pressure ulcers among patients in these organizations. The use of a computerized decision-support system assisted staff to select optimal, evidence-based care strategies, record information and analyse individual and aggregate data. RESULTS: Evaluation indicated an increase in knowledge relating to pressure ulcer prevention, treatment strategies, resources required, and the role of the interdisciplinary team. Lack of visible senior nurse leadership; time required to acquire computer skills and to implement new guidelines; and difficulties with the computer system were identified as barriers. CONCLUSIONS: There is a need for a comprehensive, supported and sustained approach to implementation of evidence-based practice for pressure ulcer prevention and treatment, greater understanding of organization-specific barriers, and mechanisms for addressing the barriers.