Improving Clinical Practice Using Clinical Decision Support Systems: A Systematic Review of Trials to Identify Features Critical to Success
This is a review of Kawamoto, K., Houlihan, C. A., Balas, E. A., & Lobach, D. F. (2005) article on Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success
Introduction & Objective
Research and audits have shown that a great number of patients receive suboptimal health care. As a result, many patients die each year from preventable medical errors or adverse events. In order to alleviate these deficiencies, healthcare providers are beginning to implement Clinical Decision Support systems (CDSS) that are geared to assisting clinicians make better or more appropriate patient-specific clinical decisions. The objective of this systematic review was to identify features of CDSSs deemed most important or critical for improving clinical practice, hence patient care.
This was a systematic review of randomized controlled trials. The authors performed literature searches from Medline (1966 to 2003), CINAHL (1982 to 2003), and the Cochrane Controlled Trials Register] (2003). The literature searches included articles that evaluated the positive effects of CDS with regard to improving clinical practice. Data analysis consisted of univariateand meta-regression analyses.
Altogether 71 decision support systems were evaluated with 15 potentially important features identified as important determinants of a system’s ability to improve clinical practice. Overall 48 of the 71 decision support systems significantly improved clinical practice. The success rate of interventions for 5 of the 15 features was significantly greater than that of interventions lacking the features.
Generally, CDSS has been shown to improve patient care and clinical outcomes. While some features may not always show benefits, however, CDSS implementation by healthcare providers has the overall effect or propensity to improve clinical practice.
Why do some CDSS succeed while others fail? The authors, in their literature search, identified factors suggested as important determinants of a system’s ability to improve clinical practice. Some of these features significantly correlated with system success. Healthcare providers should design or implement CDSS that incorporate such critical features, and also provide real-time computer-generated decision support automatically as part of clinician workflow, including evidence-based medicine.
- Kawamoto, K., Houlihan, C. A., Balas, E. A., & Lobach, D. F., (2005). Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC555881/