A systematic review of trials evaluating success factors of interventions with computerised clinical decision support
Abstract Background Computerised clinical decision support (CDS) can potentially better inform decisions, and it can help with the management of information overload. It is perceived to be a key component of a learning health care system. Despite its increasing implementation worldwide, it remains u...
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2018-08-01
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Series: | Implementation Science |
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Online Access: | http://link.springer.com/article/10.1186/s13012-018-0790-1 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Stijn Van de Velde Annemie Heselmans Nicolas Delvaux Linn Brandt Luis Marco-Ruiz David Spitaels Hanne Cloetens Tiina Kortteisto Pavel Roshanov Ilkka Kunnamo Bert Aertgeerts Per Olav Vandvik Signe Flottorp |
spellingShingle |
Stijn Van de Velde Annemie Heselmans Nicolas Delvaux Linn Brandt Luis Marco-Ruiz David Spitaels Hanne Cloetens Tiina Kortteisto Pavel Roshanov Ilkka Kunnamo Bert Aertgeerts Per Olav Vandvik Signe Flottorp A systematic review of trials evaluating success factors of interventions with computerised clinical decision support Implementation Science Clinical computerised decision support systems Practice guidelines Guideline adherence Evidence-based medicine Implementation Systematic review |
author_facet |
Stijn Van de Velde Annemie Heselmans Nicolas Delvaux Linn Brandt Luis Marco-Ruiz David Spitaels Hanne Cloetens Tiina Kortteisto Pavel Roshanov Ilkka Kunnamo Bert Aertgeerts Per Olav Vandvik Signe Flottorp |
author_sort |
Stijn Van de Velde |
title |
A systematic review of trials evaluating success factors of interventions with computerised clinical decision support |
title_short |
A systematic review of trials evaluating success factors of interventions with computerised clinical decision support |
title_full |
A systematic review of trials evaluating success factors of interventions with computerised clinical decision support |
title_fullStr |
A systematic review of trials evaluating success factors of interventions with computerised clinical decision support |
title_full_unstemmed |
A systematic review of trials evaluating success factors of interventions with computerised clinical decision support |
title_sort |
systematic review of trials evaluating success factors of interventions with computerised clinical decision support |
publisher |
BMC |
series |
Implementation Science |
issn |
1748-5908 |
publishDate |
2018-08-01 |
description |
Abstract Background Computerised clinical decision support (CDS) can potentially better inform decisions, and it can help with the management of information overload. It is perceived to be a key component of a learning health care system. Despite its increasing implementation worldwide, it remains uncertain why the effect of CDS varies and which factors make CDS more effective. Objective To examine which factors make CDS strategies more effective on a number of outcomes, including adherence to recommended practice, patient outcome measures, economic measures, provider or patient satisfaction, and medical decision quality. Methods We identified randomised controlled trials, non-randomised trials, and controlled before-and-after studies that directly compared CDS implementation with a given factor to CDS without that factor by searching CENTRAL, MEDLINE, EMBASE, and CINAHL and checking reference lists of relevant studies. We considered CDS with any objective for any condition in any healthcare setting. We included CDS interventions that were either displayed on screen or provided on paper and that were directed at healthcare professionals or targeted at both professionals and patients. The reviewers screened the potentially relevant studies in duplicate. They extracted data and assessed risk of bias in independent pairs or individually followed by a double check by another reviewer. We summarised results using medians and interquartile ranges and rated our certainty in the evidence using the GRADE system. Results We identified 66 head-to-head trials that we synthesised across 14 comparisons of CDS intervention factors. Providing CDS automatically versus on demand led to large improvements in adherence. Displaying CDS on-screen versus on paper led to moderate improvements and making CDS more versus less patient-specific improved adherence modestly. When CDS interventions were combined with professional-oriented strategies, combined with patient-oriented strategies, or combined with staff-oriented strategies, then adherence improved slightly. Providing CDS to patients slightly increased adherence versus CDS aimed at the healthcare provider only. Making CDS advice more explicit and requiring users to respond to the advice made little or no difference. The CDS intervention factors made little or no difference to patient outcomes. The results for economic outcomes and satisfaction outcomes were sparse. Conclusion Multiple factors may affect the success of CDS interventions. CDS may be more effective when the advice is provided automatically and displayed on-screen and when the suggestions are more patient-specific. CDS interventions combined with other strategies probably also improves adherence. Providing CDS directly to patients may also positively affect adherence. The certainty of the evidence was low to moderate for all factors. Trial registration PROSPERO, CRD42016033738 |
topic |
Clinical computerised decision support systems Practice guidelines Guideline adherence Evidence-based medicine Implementation Systematic review |
url |
http://link.springer.com/article/10.1186/s13012-018-0790-1 |
work_keys_str_mv |
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doaj-7ee5639c9537441986e14827f2c75fcc2020-11-24T21:54:08ZengBMCImplementation Science1748-59082018-08-0113111110.1186/s13012-018-0790-1A systematic review of trials evaluating success factors of interventions with computerised clinical decision supportStijn Van de Velde0Annemie Heselmans1Nicolas Delvaux2Linn Brandt3Luis Marco-Ruiz4David Spitaels5Hanne Cloetens6Tiina Kortteisto7Pavel Roshanov8Ilkka Kunnamo9Bert Aertgeerts10Per Olav Vandvik11Signe Flottorp12Centre for Informed Health Choices, Division for Health Services, Norwegian Institute of Public HealthDepartment of Public Health and Primary Care, KU LeuvenDepartment of Public Health and Primary Care, KU LeuvenMAGIC non-profit research and innovation programmeNorwegian Centre for E-health ResearchDepartment of Public Health and Primary Care, KU LeuvenFlemish College of General PractitionersDepartment of Internal Medicine, Tampere University HospitalDepartment of Medicine, McMaster UniversityDuodecim, Scientific Society of Finnish PhysiciansDepartment of Public Health and Primary Care, KU LeuvenCentre for Informed Health Choices, Division for Health Services, Norwegian Institute of Public HealthCentre for Informed Health Choices, Division for Health Services, Norwegian Institute of Public HealthAbstract Background Computerised clinical decision support (CDS) can potentially better inform decisions, and it can help with the management of information overload. It is perceived to be a key component of a learning health care system. Despite its increasing implementation worldwide, it remains uncertain why the effect of CDS varies and which factors make CDS more effective. Objective To examine which factors make CDS strategies more effective on a number of outcomes, including adherence to recommended practice, patient outcome measures, economic measures, provider or patient satisfaction, and medical decision quality. Methods We identified randomised controlled trials, non-randomised trials, and controlled before-and-after studies that directly compared CDS implementation with a given factor to CDS without that factor by searching CENTRAL, MEDLINE, EMBASE, and CINAHL and checking reference lists of relevant studies. We considered CDS with any objective for any condition in any healthcare setting. We included CDS interventions that were either displayed on screen or provided on paper and that were directed at healthcare professionals or targeted at both professionals and patients. The reviewers screened the potentially relevant studies in duplicate. They extracted data and assessed risk of bias in independent pairs or individually followed by a double check by another reviewer. We summarised results using medians and interquartile ranges and rated our certainty in the evidence using the GRADE system. Results We identified 66 head-to-head trials that we synthesised across 14 comparisons of CDS intervention factors. Providing CDS automatically versus on demand led to large improvements in adherence. Displaying CDS on-screen versus on paper led to moderate improvements and making CDS more versus less patient-specific improved adherence modestly. When CDS interventions were combined with professional-oriented strategies, combined with patient-oriented strategies, or combined with staff-oriented strategies, then adherence improved slightly. Providing CDS to patients slightly increased adherence versus CDS aimed at the healthcare provider only. Making CDS advice more explicit and requiring users to respond to the advice made little or no difference. The CDS intervention factors made little or no difference to patient outcomes. The results for economic outcomes and satisfaction outcomes were sparse. Conclusion Multiple factors may affect the success of CDS interventions. CDS may be more effective when the advice is provided automatically and displayed on-screen and when the suggestions are more patient-specific. CDS interventions combined with other strategies probably also improves adherence. Providing CDS directly to patients may also positively affect adherence. The certainty of the evidence was low to moderate for all factors. Trial registration PROSPERO, CRD42016033738http://link.springer.com/article/10.1186/s13012-018-0790-1Clinical computerised decision support systemsPractice guidelinesGuideline adherenceEvidence-based medicineImplementationSystematic review |