The Effect of an Electronic Decision Support System on Preventing Pressure Ulcers and Urinary Infections in Home Care

Akdeniz University66 enrolled

Overview

This study evaluated Care-Up, a mobile-compatible web-based decision support system for informal caregivers of patients receiving home healthcare. The system provides guidance on skin care, pressure-injury prevention, urinary-risk indicators, nutrition, hydration and when to seek professional help. The study had two stages: development and formative evaluation of Care-Up, followed by a parallel-group randomised controlled trial. In the trial, 66 patient-caregiver dyads were allocated equally to Care-Up plus routine home healthcare or routine home healthcare alone. Caregivers in the intervention group used Care-Up for eight weeks. Eligible patients were registered with the Burdur State Hospital Home Healthcare Services Unit and had a Barthel Index score of 0-20 or 21-61. There was no separate patient age restriction. The registered primary outcome was pressure-injury risk assessed with the Braden Scale. Other assessments included skin integrity using GLOBIAD and ISTAP, urinalysis, urine colour and nutritional status. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF). Caregivers in the intervention group completed assessments of system usability, mobile-application usability, willingness to use the application and loyalty to the application at the end of the intervention.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Enrollment

Conditions

Support of the Family as a Caregiving System

Interventions

Care-Up Electronic Decision Support SystemOTHER

Eight weeks of access to a mobile-compatible web-based electronic decision support system, following initial training in registration and use. Care-Up provided structured risk assessments, educational materials, personalised recommendations and alerts concerning pressure-injury prevention, skin integrity, urinary-risk indicators, nutrition and hydration, positioning and in-bed mobility, and recognition of findings requiring professional evaluation. The system supported informal caregivers in addition to routine home healthcare.

Eligibility

Sex: ALL

Medical Language ↔ Plain English

Inclusion Criteria: 1. Patients registered with and receiving care from the Burdur State Hospital Home Healthcare Services Unit. Service registration required age 65 years or older or being bedridden. The study imposed no additional patient age restriction. 2. Patients with a Barthel Index total score of 0-20 (fully dependent) or 21-61 (severely dependent). 3. An informal caregiver providing care at home who could use a mobile device and the Care-Up web-based system. 4. Caregivers with an Adult Digital Literacy Scale score of at least 61 on the standardised 0-100 scale. 5. Caregivers who were literate in Turkish and voluntarily agreed to participate. Exclusion Criteria: 1. Patients with a Barthel Index score of 62 or above. 2. Patients with an acute medical condition, such as an infection requiring hospitalisation or a newly developed severe illness. 3. Caregivers with cognitive or technological limitations preventing use of Care-Up, including lack of access to the required technology. 4. Caregivers who were not literate in Turkish. 5. Patients with terminal illness and a short life expectancy. 6. Caregivers with severe cognitive impairment or an untreated psychiatric disorder affecting participation. 7. Patients without an informal caregiver at home. 8. Patients with an existing urinary infection identified from hospital records at baseline. 9. Patients with an existing pressure injury at baseline. Post-enrolment discontinuation criteria described in the study methods: * Patient-caregiver dyads moving outside the province. * Hospitalisation lasting more than one month after the study began. * Inability to complete the remaining study procedures after baseline assessments.

Outcomes

Primary Outcomes

Pressure-Injury Risk

Change in the Braden Scale for Predicting Pressure Sore Risk total score. Total scores range from 6 to 23, with higher scores indicating lower pressure-injury risk.