Accepted for/Published in: JMIR Formative Research
Date Submitted: Oct 8, 2025
Date Accepted: Jan 30, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Utility of A Smartphone-Based Clinical Decision Support System for Pressure Ulcer Management in Physicians: A Randomized Crossover Pilot Study
ABSTRACT
Background:
Clinical decision support systems (CDSSs) are widely used in various healthcare settings. In Japan, pressure ulcers are becoming a major concern in an aging society due to their increasing prevalence.
Objective:
To provide support for non-specialists 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. This study aims to evaluate the utility of this system.
Methods:
In a randomized crossover pilot study, 28 General Internal Medicine (GIM) physicians were randomly assigned to Group A and Group B in a 1:1 ratio using block randomization with the sealed envelope method. Participants evaluated pressure ulcer photographs and answered questions requiring them to select both the most appropriate ointment and wound dressings. Participants in Group A first answered five multiple-choice questions as part of an intervention phase using the CDSS. After a washout period, the participants answered another five questions as part of a control phase without using the CDSS. Participants in Group B first participated in the control phase and then in the intervention phase. The primary outcome was the proportion of participants who selected both the correct ointment and wound dressing options. The secondary outcomes were comparisons of the correct response rates for ointment and for wound dressing options.
Results:
Fourteen participants were randomized to each group. The overall correct response rate was significantly higher with CDSS use than in the control group (49.3% [69/140] vs. 5.0% [7/140], P<.001). Additionally, significantly higher correct response rates were observed for ointments (65.0% [91/140] vs. 45.0% [63/140], P=.001) and wound dressings (59.3% [83/140] vs. 15.0% [21/140], P<.001).
Conclusions:
The CDSS improved the accuracy of GIM physicians’ decisions for pressure ulcer treatment. This improvement was also observed separately in the selection of ointments and wound dressings. Clinical Trial: UMIN Clinical Trials Registry (UMIN000057294) https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000064
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