Trial reportJMIR formative research2026
Utility of a Smartphone-Based Clinical Decision Support System for Pressure Ulcer Management by Physicians: Randomized Crossover Pilot Study.
Trial report in JMIR formative research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
5 authors.
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Abstract
backgroundClinical decision support systems (CDSSs) are widely used in various health care settings. In Japan, pressure ulcers are becoming a major concern in an aging society due to their increasing prevalence. However, management is often handled by nonspecialists in wound care due to regional disparities in specialist availability.
objectiveTo provide support for nonspecialists in wound care, we developed a prototype smartphone-based CDSS for pressure ulcer management. The system prompts users to answer questions about the wound's condition and recommends appropriate ointments and wound dressings by using a safety-first approach. This study aims to evaluate the utility of this system.
methodsWe conducted a randomized crossover pilot study involving 28 general internal medicine (GIM) physicians. Participants were randomly assigned to group A (intervention-control) or group B (control-intervention). Participants evaluated 10 standardized pressure ulcer photographs and selected the most appropriate ointment and wound dressing for each. The unit of analysis was the individual response to each question (N=280 total observations). We used generalized estimating equations with an exchangeable correlation structure to account for within-subject clustering and adjust for potential period and sequence effects.
resultsThe overall correct response rate during the intervention phase was significantly higher than that during the control phase (49.3% vs 4.3%, respectively). After adjusting for clustering and crossover biases, the use of CDSS was associated with a 29.1-fold increase in the odds of a correct response (95% CI 8.2-103; P<.001). Secondary analyses revealed significant improvements in ointment selection (adjusted odds ratio [aOR] 2.4, 95% CI 1.5-3.8; P<.001) and wound dressing selection (aOR 8.9, 95% CI 4.9-16.1; P<.001). However, no significant period (P=.11) or sequence (P=.25) effects were observed for the primary outcome.
conclusionsThe prototype CDSS improved the accuracy of treatment decisions made by GIM physicians in a pilot study that used photographs and fixed options. Within the parameters of this investigation, CDSS effectively guided participants toward standardized, safety-oriented choices as defined by our scoring criteria.
trial registrationUMIN Clinical Trials Registry UMIN000057294; https://tinyurl.com/36a6vvah.
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