Computerized clinical decision support systems for chronic disease management
Bibliographic details: Roshanov PS, Misra S, Gerstein HC, Garg AX, Sebaldt RJ, Mackay JA, Weise-Kelly L, Navarro T, Wilczynski NL, Haynes RB, CCDSS Systematic Review Team. Computerized clinical decision support systems for chronic disease management: a decision-maker-researcher partnership systematic review. Implementation Science 2011; 6(92)
Computerized clinical decision support systems are being used for all types of disease management. But does this really help the clinician in treating the patient and their medical condition? Are improvements being made to the patients outcomes related to their disease management? This and many other questions are being asked but there was not enough evidence for validation. The authors conducted a decision-maker researcher partnership review searching different databases for eligible articles. The articles were published before and up to January 2010. The authors also included randomized controlled trials in their study. 
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. 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). 
We 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.
Of 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.
CCDSSs show to improve processes in chronic disease management and potentially patient health outcomes with studies in diabetes chronic care management in particularly. Future research will need to indicate concise "system design local context, implementation strategy, costs, adverse outcomes, user satisfaction, and impact on user workflow will better inform CCDSS development and decisions about local implementation".
Other reviews of related interest:
- Exploring a Clinically Friendly Web-Based Approach to Clinical Decision Support Linked to the Electronic Health Record A Design Philosophy Prototype Implementation and Framework for Assessment
- Reviewing a clinical decision aid for the selection of anticoagulation treatment in patients with nonvalvular atrial fibrillation: applications in a US managed care health plan database
- Computerized clinical decision support systems for chronic disease management: a decision-maker-researcher partnership systematic review.http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmedhealth/PMH0033160/
- clinical decision support reference.http://www.clinfowiki.org/wiki/index.php/CDS
- Healthcare Decision Support System for Administration of Chronic Diseases.http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC4141131/