{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:17:08Z","timestamp":1792783028592,"version":"4.5.0"},"reference-count":56,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Bundesministerium f\u00fcr Forschung, Technologie und Raumfahrt","award":["16SV8869"],"award-info":[{"award-number":["16SV8869"]}],"id":[{"id":"https:\/\/ror.org\/04pz7b180","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Bundesministerium f\u00fcr Forschung, Technologie und Raumfahrt","award":["16SV8869"],"award-info":[{"award-number":["16SV8869"]}],"id":[{"id":"https:\/\/ror.org\/04pz7b180","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Health Care Manag Sci"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Demographic change in Germany is increasing the demand for professional long-term care. Given rising requirements and simultaneous staff shortages, the need for digital systems is growing to effectively support nursing staff and mitigate staffing bottlenecks. This article introduces a hybrid clinical decision support system (CDSS) designed to generate actionable intervention recommendations by combining structured data and narrative nursing documentation. The CDSS consists of three interacting components: (1) knowledge models that encode state-of-the-art nursing knowledge, (2) a rule-based expert system that applies these models to generate individualized nursing interventions within the application fields mobility and pain management, and (3) a large language model (LLM) that extracts indicators that are necessary for knowledge-based decision-making from free-text entries to fill documentation gaps. A prototype was implemented and descriptively evaluated in two German nursing homes. Overall, 72% of the CDSS recommendations were rated as \u201ccorrect\u201d by nursing professionals, meaning appropriate for the care situation. In a separate evaluation, the LLM achieved 76% agreement rate in extracting care-relevant information from narratives. These results suggest that a hybrid architecture integrating expert knowledge, rule-based logic, and language models may have the potential to enhance nursing planning in long-term care settings.<\/jats:p>","DOI":"10.1007\/s10729-026-09794-2","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T20:28:14Z","timestamp":1791664094000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prototyping and evaluation of a clinical decision support system in long-term care in German nursing homes"],"prefix":"10.1007","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9685-1613","authenticated-orcid":false,"given":"Maximilian","family":"Pilz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4895-9890","authenticated-orcid":false,"given":"Anne","family":"Gebert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5588-1012","authenticated-orcid":false,"given":"Matthias","family":"Br\u00fcnett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0014-8590","authenticated-orcid":false,"given":"Laura","family":"Steffny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9935-1412","authenticated-orcid":false,"given":"Christina","family":"Schubert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6408-5344","authenticated-orcid":false,"given":"Jonas","family":"Flechsig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4552-1427","authenticated-orcid":false,"given":"Alexander","family":"Scherrer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,10]]},"reference":[{"key":"9794_CR1","doi-asserted-by":"crossref","unstructured":"Matzk S, Tsiasioti C, Behrendt S, J\u00fcrchott K, Arg\u00fcello Guerra F, Schwinger A (2023) Pflegebed\u00fcrftigkeit in Deutschland. Pflege-Report 2023","DOI":"10.1007\/978-3-662-67669-1_15"},{"issue":"5","key":"9794_CR2","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1007\/s00103-023-03693-5","volume":"66","author":"AJK Schwinger","year":"2023","unstructured":"Schwinger AJK, Tsiasioti C, Matzk S, Behrendt S (2023) Epidemiologie der Pflege: Pr\u00e4valenz und Inanspruchnahme sowie die gesundheitliche Versorgung von Pflegebed\u00fcrftigen in Deutschland. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 66(5):479\u2013489","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"9794_CR3","unstructured":"Destatis (2025) Pflege \u2013 Pflegebed\u00fcrftige in Deutschland. Statistische Berichte"},{"issue":"3","key":"9794_CR4","first-page":"7","volume":"8","author":"B Gaertner","year":"2023","unstructured":"Gaertner B, Scheidt-Nave C, Koschollek C, Fuchs J (2023) Health status of the old and very old people in Germany: results of the Gesundheit 65+ study. J Health Monit 8(3):7\u201329","journal-title":"J Health Monit"},{"key":"9794_CR5","unstructured":"MDB (2022) Richtlinien des GKV-Spitzenverbandes f\u00fcr die Qualit\u00e4tspr\u00fcfung in Pflegeeinrichtungen nach \u00a7 114 SGB XI. Vollstation\u00e4re Pflege. [Online]. Available: http:\/\/bit.ly\/45Bx9dg. Accessed 04 08 2025"},{"issue":"40","key":"9794_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/GRNM5147","volume":"12","author":"C Thompson","year":"2024","unstructured":"Thompson C, Mebrahtu T, Skyrme S, Bloor K, Andre D, Keenan AM, Ledward A, Yang H, Randell R (2024) The effects of computerised decision support systems on nursing and allied health professional performance and patient outcomes: a systematic review and user contextualisation. Health Soc Care Deliv Res 12(40):1\u201393","journal-title":"Health Soc Care Deliv Res"},{"key":"9794_CR7","doi-asserted-by":"crossref","unstructured":"Oniani D, Wu X, Visweswaren S, Kapoor S, Kooragayalu S, Polanska K, Wang Y (2024) Enhancing large language models for clinical decision support by incorporating clinical practice guidelines. Proc IEEE Int Conf Healthc Inform 694\u2013702","DOI":"10.1109\/ICHI61247.2024.00111"},{"key":"9794_CR8","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1038\/s41698-025-01180-5","volume":"10","author":"S Mathes","year":"2026","unstructured":"Mathes S, Ferber D, Dreyer T et al (2026) Collaborative framework on responsible AI in LLM-driven CDSS for precision oncology leveraging real-world patient data. npj Precis Onc 10:15","journal-title":"npj Precis Onc"},{"key":"9794_CR9","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1038\/s41746-025-01684-1","volume":"8","author":"F Gaber","year":"2025","unstructured":"Gaber F, Shaik M, Allega F et al (2025) Evaluating large language model workflows in clinical decision support for triage and referral and diagnosis. npj Digit Med 8:263","journal-title":"npj Digit Med"},{"issue":"6","key":"9794_CR10","doi-asserted-by":"publisher","first-page":"631","DOI":"10.3390\/bioengineering12060631","volume":"12","author":"S Maity","year":"2025","unstructured":"Maity S, Saikia M (2025) Large language models in healthcare and medical applications: a review. Bioengineering (Basel) 12(6):631","journal-title":"Bioengineering (Basel)"},{"key":"9794_CR11","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1038\/s41746-020-0221-y","volume":"3","author":"R Sutton","year":"2020","unstructured":"Sutton R, Pincock D, Baumgart D, Sadowski D, Fedorak R, Kroeker K (2020) An overview of clinical decision support systems: benefits, risks, and strategies for success. npj Digit Med 3:17","journal-title":"npj Digit Med"},{"key":"9794_CR12","doi-asserted-by":"publisher","DOI":"10.1155\/2023\/8550905","author":"M Gholamzadeh","year":"2023","unstructured":"Gholamzadeh M, Abtahi H, Safdari R (2023) The application of knowledge-based clinical decision support systems to enhance adherence to evidence-based medicine in chronic disease. J Healthc Eng. https:\/\/doi.org\/10.1155\/2023\/8550905","journal-title":"J Healthc Eng"},{"key":"9794_CR13","doi-asserted-by":"publisher","DOI":"10.2196\/58036","volume":"13","author":"K Grechuta","year":"2024","unstructured":"Grechuta K, Shokouh P, Alhussein A, M\u00fcller-Wieland D, Meyerhoff J, Gilbert J, Purushotham S, Rolland C (2024) Benefits of clinical decision support systems for the management of noncommunicable chronic diseases: targeted literature review. Interact J Med Res 13:e58036","journal-title":"Interact J Med Res"},{"issue":"4","key":"9794_CR14","volume":"16","author":"M Elhaddad","year":"2024","unstructured":"Elhaddad M, Hamam S (2024) AI-driven clinical decision support systems: an ongoing pursuit of potential. Cureus 16(4):e57728","journal-title":"Cureus"},{"issue":"10","key":"9794_CR15","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1097\/01.NCN.0000432127.99644.25","volume":"31","author":"S Lee","year":"2013","unstructured":"Lee S (2013) Features of computerized clinical decision support systems supportive of nursing practice. A literature review. CIN Comput Inform Nurs 31(10):477\u2013495","journal-title":"CIN Comput Inform Nurs"},{"key":"9794_CR16","doi-asserted-by":"crossref","unstructured":"S. U. K. G. L. R. M. F. Dos Santos FC (2023) Clinical decision support systems for palliative care management: a scoping review. J Pain Symptom Manage 66(2):e205-e218","DOI":"10.1016\/j.jpainsymman.2023.03.006"},{"key":"9794_CR17","doi-asserted-by":"publisher","DOI":"10.2196\/21621","author":"S Araujo","year":"2020","unstructured":"Araujo S, Sousa P, Dutra I (2020) Clinical decision support systems for pressure ulcer management: systematic review. JMIR Med Inform. https:\/\/doi.org\/10.2196\/21621","journal-title":"JMIR Med Inform"},{"issue":"8","key":"9794_CR18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0272846","volume":"17","author":"F Hak","year":"2022","unstructured":"Hak F, Guimar\u00e3es T, Santos M (2022) Towards effective clinical decision support systems: a systematic review. PLoS ONE 17(8):e0272846","journal-title":"PLoS ONE"},{"key":"9794_CR19","doi-asserted-by":"crossref","unstructured":"Scherrer A, R\u00fcdiger P, Dinges A, K\u00fcfer K, Schwidde I, K\u00fcmmel S (2014) A decision support system for advanced treatment planning for breast cancer. In: OR Proceedings \u2013 Selected papers from the International conference on OR 2013, pp 405\u2013411","DOI":"10.1007\/978-3-319-07001-8_55"},{"key":"9794_CR20","doi-asserted-by":"crossref","unstructured":"Bozyel S, Simsek E, Kocyigit D, G\u00fcler A, Kormaz Y (2024) rtificial intelligence-based clinical decision support systems in cardiovascular diseases. Anatol J Cardiol 74\u201386","DOI":"10.14744\/AnatolJCardiol.2023.3685"},{"issue":"9","key":"9794_CR21","doi-asserted-by":"publisher","DOI":"10.2196\/39681","volume":"24","author":"L Lapp","year":"2022","unstructured":"Lapp L, Egan K, McCann L, Mackenzie M, Wales A, Maguire R (2022) Decision support tools in adult long-term care facilities: scoping review. J Med Internet Res 24(9):e39681","journal-title":"J Med Internet Res"},{"key":"9794_CR22","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-025-03272-w","volume":"24","author":"C Abi Khalil","year":"2025","unstructured":"Abi Khalil C, Saab A, Rahme J, Bouaud J, Seroussi B (2025) Capabilities of computerized decision support systems supporting the nursing process in hospital settings: a scoping review. BMC Nurs 24:677","journal-title":"BMC Nurs"},{"key":"9794_CR23","doi-asserted-by":"publisher","first-page":"7010","DOI":"10.1111\/jocn.16823","volume":"32","author":"L Hants","year":"2023","unstructured":"Hants L, Bail K, Paterson C (2023) Clinical decision-making and the nursing process in digital health systems: an integrated systematic review. J Clin Nurs 32:7010\u20137035","journal-title":"J Clin Nurs"},{"issue":"11","key":"9794_CR24","doi-asserted-by":"publisher","first-page":"2502","DOI":"10.1093\/jamia\/ocab123","volume":"28","author":"S Akbar","year":"2021","unstructured":"Akbar S, Lyell D, Magrabi F (2021) Automation in nursing decision support systems: a systematic review of effects on decision making, care delivery, and patient outcomes. J Am Med Inform Assoc 28(11):2502\u20132513","journal-title":"J Am Med Inform Assoc"},{"issue":"12","key":"9794_CR25","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-053886","volume":"11","author":"TF Mebrahtu","year":"2021","unstructured":"Mebrahtu TF, Skyrme S, Randell R, Keenan A-M, Bloor K, Yang H, Andre D, Ledward A, King H, Thompson C (2021) Effects of computerised clinical decision support systems (CDSS) on nursing and allied health professional performance and patient outcomes: a systematic review of experimental and observational studies. BMJ Open 11(12):e053886","journal-title":"BMJ Open"},{"key":"9794_CR26","unstructured":"GKV-Spitzenverband (2025) [Online]. Available: https:\/\/www.gkv-spitzenverband.de\/english\/english.jsp. Accessed 2025"},{"key":"9794_CR27","unstructured":"WHO (2025) ICD-10. [Online]. Available: https:\/\/www.bfarm.de\/EN\/Code-systems\/Classifications\/ICD\/ICD-10-WHO\/_node.html. Accessed 2025"},{"key":"9794_CR28","unstructured":"BfArM (2025) ATC classification. [Online]. Available: https:\/\/www.bfarm.de\/EN\/Code-systems\/Classifications\/ATC\/_node.html. Accessed 2025"},{"key":"9794_CR29","unstructured":"MDB (2024) Richtlinien des Medizinischen Dienstes Bund zur Feststellung der Pflegebed\u00fcrftigkeit nach dem XI. Buch des Sozialgesetzbuches. [Online]. Available: https:\/\/bit.ly\/3Ui4Zh9. Accessed 04 08 2025"},{"key":"9794_CR30","unstructured":"EinSTEP (2019) Einf\u00fchrung des Strukturmodells in der ambulanten, station\u00e4ren und teilstation\u00e4ren Langzeitpflege. Folienpr\u00e4sentation zu den bundeseinheitlichen Informations- und Schulungsunterlagen. Version 2.0"},{"key":"9794_CR31","unstructured":"DNQP (2020) Expertenstandard Schmerzmanagement in der Pflege. Aktualisierung 2020. [Online]. Available: https:\/\/www.dnqp.de\/expertenstandards-und-auditinstrumente\/#c9577741. Accessed 04 08 2025"},{"key":"9794_CR32","unstructured":"German Pain Society & DZNE (2017) S3 Leitlinie Schmerzassessment bei \u00e4lteren Menschen in der vollstation\u00e4ren Altenhilfe. [Online]. Available: https:\/\/register.awmf.org\/assets\/guidelines\/145-001l_S3_Schmerzassessment-bei-aelteren-Menschen_in-der-vollstationaeren_Altenhilfe_2018-02_1-abgelaufen.pdf"},{"key":"9794_CR33","unstructured":"DNQP (2020) Expertenstandard nach \u00a7 113a SGB XI \"Erhaltung und F\u00f6rderung der Mobilit\u00e4t in der Pflege\". [Online]. Available: https:\/\/www.gs-qsa-pflege.de\/wp-content\/uploads\/2020\/12\/Expertenstandard-%E2%80%9EErhaltung-und-Fo%CC%88rderung-der-Mobilita%CC%88t-in-der-Pflege%E2%80%9C-Aktualisierung-2020.pdf. Accessed 04 08 2025"},{"key":"9794_CR34","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-022-08079-y","volume":"22","author":"C Grindell","year":"2022","unstructured":"Grindell C, Coates E, Croot L, O\u2019Cathain A (2022) The use of co-production, co-design and co-creation to mobilise knowledge in the management of health conditions: a systematic review. BMC Health Serv Res 22:877","journal-title":"BMC Health Serv Res"},{"issue":"2","key":"9794_CR35","doi-asserted-by":"publisher","DOI":"10.17061\/phrp3222211","volume":"32","author":"C Vargas","year":"2022","unstructured":"Vargas C, Whelan J, Brimblecombe J, Allender S (2022) Co-creation, co-design, co-production for public health \u2013 a perspective on definitions and distinctions. Public Health Res Pract 32(2):e3222211","journal-title":"Public Health Res Pract"},{"key":"9794_CR36","doi-asserted-by":"crossref","unstructured":"Da Silva T, Martin A, Maurer F, Silveira M (2011) User-centered design and agile methods: a systematic review. In: Proceedings - 2011 Agile Conference, pp 77\u201386","DOI":"10.1109\/AGILE.2011.24"},{"key":"9794_CR37","doi-asserted-by":"crossref","unstructured":"Jurca G, Hellmann D, Maurer F (2014) Integrating agile and user-centered design: a systematic mapping and review of evaluation and validation studies of agile-UX. In: Proceedings \u2013 2014 Agile Conference, pp 24\u201333","DOI":"10.1109\/AGILE.2014.17"},{"key":"9794_CR38","unstructured":"Fraunhofer-Gesellschaft, \"DiADeMa\" (2023) Germany patent 30 2023 104 651.5"},{"key":"9794_CR39","volume-title":"Praxisleitlinien Altenpflege. Planen, Formulieren, Dokumentieren mit ENP-Pflegediagnosen","author":"P Wietek","year":"2018","unstructured":"Wietek P (2018) Praxisleitlinien Altenpflege. Planen, Formulieren, Dokumentieren mit ENP-Pflegediagnosen. Theime Recom"},{"issue":"4","key":"9794_CR40","doi-asserted-by":"publisher","first-page":"1570","DOI":"10.3390\/ijerph18041570","volume":"18","author":"M Jahouh","year":"2021","unstructured":"Jahouh M, Gonz\u00e1lez-Bernal J, Gonz\u00e1lez-Santos J, Fern\u00e1ndez-L\u00e1zaro D, Soto-C\u00e1mara R, Mielgo-Ayuso J (2021) Impact of an intervention with Wii video games on the autonomy of activities of daily living and psychological-cognitive components in the institutionalized elderly. Int J Environ Res Public Health 18(4):1570","journal-title":"Int J Environ Res Public Health"},{"issue":"5","key":"9794_CR41","doi-asserted-by":"publisher","first-page":"559","DOI":"10.29271\/jcpsp.2021.05.559","volume":"31","author":"A Afridi","year":"2021","unstructured":"Afridi A, Rathore F, Nazir S (2021) Wii fit for balance training in elderly: a systematic review. J Coll Physicians Surg Pak 31(5):559\u2013566","journal-title":"J Coll Physicians Surg Pak"},{"key":"9794_CR42","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2022.894397","volume":"13","author":"J Diener","year":"2022","unstructured":"Diener J, Rayling S, Bezold J, Krell-Roesch J, Woll A, Wunsch K (2022) Effectiveness and acceptability of e- and m-health interventions to promote physical activity and prevent falls in nursing homes-a systematic review. Front Physiol 13:894397","journal-title":"Front Physiol"},{"issue":"1\u20132","key":"9794_CR43","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1159\/000491818","volume":"46","author":"M Henskens","year":"2018","unstructured":"Henskens M, Nauta I, van Eekeren M, Scherder E (2018) Effects of physical activity in nursing home residents with dementia: a randomized controlled trial. Dement Geriatr Cogn Disord 46(1\u20132):60\u201380","journal-title":"Dement Geriatr Cogn Disord"},{"key":"9794_CR44","unstructured":"Zegelin A (2019) Mobilit\u00e4tsf\u00f6rderung im Altenheim. Bewegung und Mobilit\u00e4tsf\u00f6rderung. Praxishandbuch f\u00fcr Pflege- und Gesundheitsberufe. Hogrefe, pp 151\u2013156"},{"key":"9794_CR45","unstructured":"German Pain Society and DGG (2025) S3 guideline: pain management in geriatric patients across all care settings. (GeriPAIN). AWMF-Register-Nr. 145\/005. Version 1.0"},{"key":"9794_CR46","volume-title":"Curriculum zum pflegerischen Schmerzmanagement","author":"German Pain Society","year":"2021","unstructured":"German Pain Society (2021) Curriculum zum pflegerischen Schmerzmanagement. Deutsche Schmerzgesellschaft e. V., Berlin"},{"key":"9794_CR47","unstructured":"Romera-Paredes B, Torr P (2015) An embarrassingly simple approach to zero-shot learning. In: Proceedings of the International Conference on Machine Learning pp 2152\u20132161"},{"key":"9794_CR48","unstructured":"Pflegemarkt (2026) Anzahl und Statistik der Altenheime in Deutschland. [Online]. Available: https:\/\/www.pflegemarkt.com\/fachartikel\/anzahl-und-statistik-der-altenheime-in-deutschland\/. Accessed 30 01 2026"},{"key":"9794_CR49","unstructured":"AOK (2026) Personalbemessungsverfahren in der vollstation\u00e4ren Pflege. [Online]. Available: https:\/\/www.aok.de\/gp\/stationaere-pflege\/vollstationaere-pflege\/personalbemessungsverfahren. Accessed 30 01 2026"},{"key":"9794_CR50","unstructured":"R Core Team (2024) R: A language and environment for statistical computing. R Foundation for Statistical Computing. [Online]. Available: https:\/\/www.R-project.org"},{"key":"9794_CR51","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1186\/s12911-023-02372-4","volume":"23","author":"M van Velzen","year":"2023","unstructured":"van Velzen M, de Graaf-Waar HI, Ubert T, van der Willigen RF, Muilwijk L, Schmitt MA, Scheper MC, van Meeteren NL (2023) 21st century (clinical) decision support in nursing and allied healthcare. Developing a learning health system: a reasoned design of a theoretical framework. BMC Med Inform Decis 23:279","journal-title":"BMC Med Inform Decis"},{"key":"9794_CR52","doi-asserted-by":"publisher","DOI":"10.2196\/43053","volume":"11","author":"XMH Jing","year":"2023","unstructured":"Jing XMH, Gong YBP, Robinson D, Law TNC, Faxvaag A, Rennert L, Hubig N, Gimbel R (2023) Ontologies applied in clinical decision support system rules: systematic review. JMIR Med Inform 11:e43053","journal-title":"JMIR Med Inform"},{"issue":"11","key":"9794_CR53","doi-asserted-by":"publisher","first-page":"1865","DOI":"10.1093\/jamia\/ocad095","volume":"30","author":"E Umberfield","year":"2023","unstructured":"Umberfield E, Ball DPHM (2023) The case for expressing nursing theories using ontologies. J Am Med Inform Assoc 30(11):1865\u20131867","journal-title":"J Am Med Inform Assoc"},{"key":"9794_CR54","doi-asserted-by":"publisher","DOI":"10.1177\/14604582221099826","author":"F Freguia","year":"2022","unstructured":"Freguia F, Danielis M, Moreale R, Palese A (2022) Nursing minimum data sets: findings from an umbrella review. Health Informatics J. https:\/\/doi.org\/10.1177\/14604582221099826","journal-title":"Health Informatics J"},{"issue":"6","key":"9794_CR55","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1024\/1012-5302\/a000393","volume":"27","author":"R Ranegger","year":"2014","unstructured":"Ranegger R, Ammenwerth E (2014) Nursing Minimum Data Sets (NMDS) \u2013 eine Literatur\u00fcbersicht bez\u00fcglich Zielsetzungen und Datenelementen. Pflege 27(6):405\u2013425","journal-title":"Pflege"},{"key":"9794_CR56","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-015-0198-7","volume":"15","author":"R Ranegger","year":"2015","unstructured":"Ranegger R, Hackl W, Ammenwerth E (2015) Implementation of the Austrian Nursing Minimum Data Set (NMDS-AT): a feasibility study. BMC Med Inform Decis Mak 15:75","journal-title":"BMC Med Inform Decis Mak"}],"container-title":["Health Care Management Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10729-026-09794-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10729-026-09794-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10729-026-09794-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T20:28:25Z","timestamp":1791664105000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10729-026-09794-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,10]]},"references-count":56,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,12]]}},"alternative-id":["9794"],"URL":"https:\/\/doi.org\/10.1007\/s10729-026-09794-2","relation":{},"ISSN":["1386-9620","1572-9389"],"issn-type":[{"value":"1386-9620","type":"print"},{"value":"1572-9389","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,10]]},"assertion":[{"value":"8 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was approved by the Research Ethics Committee of the Catholic University of Applied Science North Rhine-Westphalia, Cologne (Ethics Approval 2024\/5).","order":1,"name":"Ethics","label":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no further relevant financial or non-financial interests to disclose.","order":2,"name":"Ethics","label":"Conflicts of interest","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"50"}}