Clinical decision-making tools: how effective are they in improving the quality of health care?

Abstract

Executive summary Clinical decision-making tools can be considered in two broad categories – those designed to be used by clinicians and those designed to promote shared decision making with the clinician and patient together. The potential effect of computerised clinical decision support systems (CDSS) on variations in practice is not well understood, and CDSS are currently not a recommended means of improving evidence-based practice, or patient outcomes, since the mechanisms of success and failure are not well defined and the potential impact on workflows and adverse events are poorly evaluated. Despite numerous randomised controlled trials, there is poor quality evidence for the effect of CDSS on processes of care and patient outcomes. There is moderate-high quality evidence for the role of patient decision aids in preference-sensitive and shared decision making contexts. Recommendations for Commonwealth action: Develop and implement CDSS standards, and ensure they align with evidence-based guidelines. Exercise caution over broader implementation of CDSS until their strengths and weaknesses are better understood. Encourage the development and implementation of shared decision-making tools for preference-sensitive decisions. Show leadership in the development of provider and consumer awareness and training, which should be developed alongside the tools themselves.