viernes, 27 de abril de 2012

Effect of Clinical Decision-Support Systems: ... [Ann Intern Med. 2012] - PubMed - NCBI

AHRQ study shows clinical decision support systems are effective but research is needed to promote widespread use

An AHRQ-funded article found that clinical decision support systems (CDSSs) are effective in improving health care process measures across diverse settings, and that limited evidence is available about the impact on clinical and economic outcome measures. The article, titled Effect of Clinical Decision-Support Systems: A Systematic Review, furthers current knowledge by demonstrating the benefits of CDSSs outside of experienced academic centers. Authors also suggested more research is required to promote widespread use of CDSSs and to increase the clinical effectiveness of the systems. The article is featured in the April 24 online issue of Annals of Internal Medicine.

In the article, the authors assessed healthcare process measures and clinical outcome measures associated with commercially and locally-developed CDSSs.

This article expands on an evidence report from AHRQ, titled Enabling Health Care Decisionmaking through Health Information Technology (Health IT), which discusses features key to successful implementation of CDSSs.

Effect of Clinical Decision-Support Systems: ... [Ann Intern Med. 2012] - PubMed - NCBI

Ann Intern Med. 2012 Apr 23. [Epub ahead of print]

Effect of Clinical Decision-Support Systems: A Systematic Review.

Bright TJ, Wong A, Dhurjati R, Bristow E, Bastian L, Coeytaux RR, Samsa G, Hasselblad V, Williams JW, Musty MD, Wing L, Kendrick AS, Sanders GD, Lobach D.

Source

Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; and School of Medicine, University of Utah, Salt Lake City, Utah.

Abstract

Background: Despite increasing emphasis on the role of clinical decision-support systems (CDSSs) for improving care and reducing costs, evidence to support widespread use is lacking. Purpose: To evaluate the effect of CDSSs on clinical outcomes, health care processes, workload and efficiency, patient satisfaction, cost, and provider use and implementation. Data Sources: MEDLINE, CINAHL, PsycINFO, Web of Science, and the Cochrane Database of Systematic Reviews through January 2011. Study Selection: Investigators independently screened reports to identify randomized trials published in English of electronic CDSSs that were implemented in clinical settings; used by providers to aid decision making at the point of care; and reported clinical, health care process, workload, relationship-centered, economic, or provider use outcomes. Data Extraction: Investigators extracted data about study design, participant characteristics, interventions, outcomes, and quality. Data Synthesis: 148 randomized, controlled trials were included. A total of 128 (86%) assessed health care process measures, 29 (20%) assessed clinical outcomes, and 22 (15%) measured costs. Both commercially and locally developed CDSSs improved health care process measures related to performing preventive services (n = 25; odds ratio [OR], 1.42 [95% CI, 1.27 to 1.58]), ordering clinical studies (n = 20; OR, 1.72 [CI, 1.47 to 2.00]), and prescribing therapies (n = 46; OR, 1.57 [CI, 1.35 to 1.82]). Few studies measured potential unintended consequences or adverse effects. Limitations: Studies were heterogeneous in interventions, populations, settings, and outcomes. Publication bias and selective reporting cannot be excluded. Conclusion: Both commercially and locally developed CDSSs are effective at improving health care process measures across diverse settings, but evidence for clinical, economic, workload, and efficiency outcomes remains sparse. This review expands knowledge in the field by demonstrating the benefits of CDSSs outside of experienced academic centers. Primary Funding Source: Agency for Healthcare Research and Quality.