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August 8, 1977

Problem-Oriented Approach to Practice: II. Development of the System Through Audit and Implication

JAMA. 1977;238(6):502-505. doi:10.1001/jama.1977.03280060046020

WHEN Weed first described the Problem-Oriented Medical Record (POMR), he identified four phases of medical action: (1) data base, (2) problem formulation, (3) plans, and (4) follow-up.1 Bjorn and Cross2 described the records' usefulness in private practice. An important body of literature has evolved since then, discussing both the benefits and deficiencies of this approach to clinical record keeping. We have previously described the steps taken in developing a practice based on the principles of problem-orientation coupled to a performance audit.3 We have designated this coupling of the principles of problem-orientation to audit as the problem-oriented system (POS).

The first step in the problem-oriented approach to care involves the creation of a defined data base, standardized so that important omissions are readily identified. The next step is formulation of a problem list, the dynamic list providing a precise compilation of the patient's health-related problems. It includes not