Abstract
BackgroundThe use of computerized clinical decision support systems (CCDSSs) may improve chronic disease management, which requires recurrent visits to multiple health professionals, ongoing disease and treatment monitoring, and patient behavior modification. The objective of this review was to determine if CCDSSs improve the processes of chronic care (such as diagnosis, treatment, and monitoring of disease) and associated patient outcomes (such as effects on biomarkers and clinical exacerbations).MethodsWe conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for potentially eligible articles published up to January 2010. We included randomized controlled trials that compared the use of CCDSSs to usual practice or non-CCDSS controls. Trials were eligible if at least one component of the CCDSS was designed to support chronic disease management. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of relevant outcomes.ResultsOf 55 included trials, 87% (n = 48) measured system impact on the process of care and 52% (n = 25) of those demonstrated statistically significant improvements. Sixty-five percent (36/55) of trials measured impact on, typically, non-major (surrogate) patient outcomes, and 31% (n = 11) of those demonstrated benefits. Factors of interest to decision makers, such as cost, user satisfaction, system interface and feature sets, unique design and deployment characteristics, and effects on user workflow were rarely investigated or reported.ConclusionsA small majority (just over half) of CCDSSs improved care processes in chronic disease management and some improved patient health. Policy makers, healthcare administrators, and practitioners should be aware that the evidence of CCDSS effectiveness is limited, especially with respect to the small number and size of studies measuring patient outcomes.
Highlights
The use of computerized clinical decision support systems (CCDSSs) may improve chronic disease management, which requires recurrent visits to multiple health professionals, ongoing disease and treatment monitoring, and patient behavior modification
Computerized clinical decision support systems (CCDSSs) may help practitioners meet the requirements of chronic care
As with any health intervention, rigorous testing is warranted to determine whether CCDSSs improve chronic care processes and patient outcomes
Summary
The use of computerized clinical decision support systems (CCDSSs) may improve chronic disease management, which requires recurrent visits to multiple health professionals, ongoing disease and treatment monitoring, and patient behavior modification. For the many patients with multiple co-morbidities [1], Computerized clinical decision support systems (CCDSSs) may help practitioners meet the requirements of chronic care These systems analyze a patient’s characteristics to provide tailored recommendations for diagnosis, treatment, patient education, adequate follow-up, and timely monitoring of disease indicators. In our previous review of the effects of CCDSSs [4], we analyzed 100 randomized and non-randomized studies published until September 2004, 40 of which assessed the effects of CCDSSs on disease management Of these 40 studies, 37 measured processes of care of which 62% (23) showed an improvement, and 27 measured patient outcomes of which 19% (5) showed an improvement. The quality of the studies varied widely, but improved over time
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