Computerized clinical decision support systems for acute care management: a decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes

Navdeep Sahota, Rob Lloyd, Anita Ramakrishna, Jean A Mackay, Jeanette C Prorok, Lorraine Weise-Kelly, Tamara Navarro, Nancy L Wilczynski, R Brian Haynes, CCDSS Systematic Review Team, Jeanette Prorok, Nathan Souza, Brian Hemens, Robby Nieuwlaat, Shikha Misra, Jasmine Dhaliwal, Navdeep Sahota, Anita Ramakrishna, Pavel Roshanov, Tahany Awad, Nicholas Hobson, Chris Cotoi, Rick Parrish, Navdeep Sahota, Rob Lloyd, Anita Ramakrishna, Jean A Mackay, Jeanette C Prorok, Lorraine Weise-Kelly, Tamara Navarro, Nancy L Wilczynski, R Brian Haynes, CCDSS Systematic Review Team, Jeanette Prorok, Nathan Souza, Brian Hemens, Robby Nieuwlaat, Shikha Misra, Jasmine Dhaliwal, Navdeep Sahota, Anita Ramakrishna, Pavel Roshanov, Tahany Awad, Nicholas Hobson, Chris Cotoi, Rick Parrish

Abstract

Background: Acute medical care often demands timely, accurate decisions in complex situations. Computerized clinical decision support systems (CCDSSs) have many features that could help. However, as for any medical intervention, claims that CCDSSs improve care processes and patient outcomes need to be rigorously assessed. The objective of this review was to systematically review the effects of CCDSSs on process of care and patient outcomes for acute medical care.

Methods: We conducted a decision-maker-researcher partnership systematic review. MEDLINE, EMBASE, Evidence-Based Medicine Reviews databases (Cochrane Database of Systematic Reviews, DARE, ACP Journal Club, and others), and the Inspec bibliographic database were searched to January 2010, in all languages, for randomized controlled trials (RCTs) of CCDSSs in all clinical areas. We included RCTs that evaluated the effect on process of care or patient outcomes of a CCDSS used for acute medical care compared with care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive.

Results: Thirty-six studies met our inclusion criteria for acute medical care. The CCDSS improved process of care in 63% (22/35) of studies, including 64% (9/14) of medication dosing assistants, 82% (9/11) of management assistants using alerts/reminders, 38% (3/8) of management assistants using guidelines/algorithms, and 67% (2/3) of diagnostic assistants. Twenty studies evaluated patient outcomes, of which three (15%) reported improvements, all of which were medication dosing assistants.

Conclusion: The majority of CCDSSs demonstrated improvements in process of care, but patient outcomes were less likely to be evaluated and far less likely to show positive results.

Figures

Figure 1
Figure 1
Flow diagram of included and excluded studies for the update 1 January 2004 to 6 January 2010 with specifics for acute care management*. *Details provided in: Haynes RB et al. [4]. Two updating searches were performed, for 2004 to 2009 and to 6 January 2010 and the results of the search process are consolidated here.

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Source: PubMed

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