Clare E Ronan1, Erika L Crable2,3, Mari-Lynn Drainoni4,5,6, Allan J Walkey4,7. 1. Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA. 2. Department of Psychiatry, Child and Adolescent Services Research Center, University of California, San Diego, La Jolla, California, USA. 3. ACTRI UCSD Dissemination and Implementation Science Center, University of California San Diego, La Jolla, California, USA. 4. Department of Medicine, Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, Massachusetts, USA. 5. Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts, USA. 6. Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA. 7. Department of Medicine, The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA.
Abstract
BACKGROUND: Clinical decision support systems (CDSS) are used to improve processes of care. CDSS proliferation may have unintended consequences impacting effectiveness. OBJECTIVE: To evaluate the effectiveness of CDSS in altering clinician behavior. DESIGN: Electronic searches were performed in EMBASE, PubMed, and Cochrane Central Register of Control Trials for randomized controlled trials testing the impacted of CDSS on clinician behavior from 2000-2021. Extracted data included study design, CDSS attributed and outcomes, user characteristics, settings, and risk of bias. Eligible studies were analyzed qualitatively to describe CDSS types. Studies with sufficient outcome data were included in the meta-analysis. SETTING AND PARTICIPANTS: Adult inpatients in the United States. INTERVENTION: Clinical decision support system versus non-clinical decision support system. MAIN OUTCOME AND MEASURE: A random-effects model measured the pooled risk difference (RD) and odds ratio of clinicians' adherence to CDSS; subgroup analyses tested differences in CDSS effectiveness over time and by CDSS type. RESULTS: Qualitative synthesis included 22 studies. Eleven studies reported sufficient outcome data for inclusion in the meta-analysis. CDSS did not result in a statistically significant increase in clinician adoption of desired practicies (RD = 0.04 [95% confidence interval {CI} 0.00, 0.07]). CDSS from 2010-2015 (n = 5) did not increase clinician adoption of desired practice [RD -0.01, (95% CI -0.04, 0.02)].CDSS from 2016-2021 (n = 6) were associated with an increase in targeted practices [RD 0.07 (95% CI0.03, 0.12)], pInteraction = 0.004. EHR [RD 0.04 (95% CI 0.00, 0.08)] vs. non-EHR [RD 0.01 (95% CI -0.01, 0.04)] based CDSS interventions did not result in different adoption of desired practices (pInteraction = 0.27). The meta-analysis did not find an overall positive impact of CDSS on clinician behavior in the inpatient setting.
BACKGROUND: Clinical decision support systems (CDSS) are used to improve processes of care. CDSS proliferation may have unintended consequences impacting effectiveness. OBJECTIVE: To evaluate the effectiveness of CDSS in altering clinician behavior. DESIGN: Electronic searches were performed in EMBASE, PubMed, and Cochrane Central Register of Control Trials for randomized controlled trials testing the impacted of CDSS on clinician behavior from 2000-2021. Extracted data included study design, CDSS attributed and outcomes, user characteristics, settings, and risk of bias. Eligible studies were analyzed qualitatively to describe CDSS types. Studies with sufficient outcome data were included in the meta-analysis. SETTING AND PARTICIPANTS: Adult inpatients in the United States. INTERVENTION: Clinical decision support system versus non-clinical decision support system. MAIN OUTCOME AND MEASURE: A random-effects model measured the pooled risk difference (RD) and odds ratio of clinicians' adherence to CDSS; subgroup analyses tested differences in CDSS effectiveness over time and by CDSS type. RESULTS: Qualitative synthesis included 22 studies. Eleven studies reported sufficient outcome data for inclusion in the meta-analysis. CDSS did not result in a statistically significant increase in clinician adoption of desired practicies (RD = 0.04 [95% confidence interval {CI} 0.00, 0.07]). CDSS from 2010-2015 (n = 5) did not increase clinician adoption of desired practice [RD -0.01, (95% CI -0.04, 0.02)].CDSS from 2016-2021 (n = 6) were associated with an increase in targeted practices [RD 0.07 (95% CI0.03, 0.12)], pInteraction = 0.004. EHR [RD 0.04 (95% CI 0.00, 0.08)] vs. non-EHR [RD 0.01 (95% CI -0.01, 0.04)] based CDSS interventions did not result in different adoption of desired practices (pInteraction = 0.27). The meta-analysis did not find an overall positive impact of CDSS on clinician behavior in the inpatient setting.
Authors: Junsang Yoo; Jeonghoon Lee; Ji Young Min; Sae Won Choi; Joon-Myoung Kwon; Insook Cho; Chiyeon Lim; Mi Young Choi; Won Chul Cha Journal: J Med Internet Res Date: 2022-07-27 Impact factor: 7.076