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Implementation Science
Published in: Implementation Science 1/2011

Open Access 01-12-2011 | Systematic review

Computerized clinical decision support systems for acute care management: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes

Authors: Navdeep Sahota, Rob Lloyd, Anita Ramakrishna, Jean A Mackay, Jeanette C Prorok, Lorraine Weise-Kelly, Tamara Navarro, Nancy L Wilczynski, R Brian Haynes, the CCDSS Systematic Review Team

Published in: Implementation Science | Issue 1/2011

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Abstract

Background

Acute medical care often demands timely, accurate decisions in complex situations. Computerized clinical decision support systems (CCDSSs) have many features that could help. However, as for any medical intervention, claims that CCDSSs improve care processes and patient outcomes need to be rigorously assessed. The objective of this review was to systematically review the effects of CCDSSs on process of care and patient outcomes for acute medical care.

Methods

We conducted a decision-maker-researcher partnership systematic review. MEDLINE, EMBASE, Evidence-Based Medicine Reviews databases (Cochrane Database of Systematic Reviews, DARE, ACP Journal Club, and others), and the Inspec bibliographic database were searched to January 2010, in all languages, for randomized controlled trials (RCTs) of CCDSSs in all clinical areas. We included RCTs that evaluated the effect on process of care or patient outcomes of a CCDSS used for acute medical care compared with care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive.

Results

Thirty-six studies met our inclusion criteria for acute medical care. The CCDSS improved process of care in 63% (22/35) of studies, including 64% (9/14) of medication dosing assistants, 82% (9/11) of management assistants using alerts/reminders, 38% (3/8) of management assistants using guidelines/algorithms, and 67% (2/3) of diagnostic assistants. Twenty studies evaluated patient outcomes, of which three (15%) reported improvements, all of which were medication dosing assistants.

Conclusion

The majority of CCDSSs demonstrated improvements in process of care, but patient outcomes were less likely to be evaluated and far less likely to show positive results.
Appendix
Available only for authorised users
Literature
1.
Johnston ME, Langton KB, Haynes RB, Mathieu A: Effects of Computer-based Clinical Decision Support Systems on Clinician Performance and Patient Outcome: A Critical Appraisal of Research. Ann Intern Med. 1994, 120 (2): 135-142.CrossRefPubMed
2.
Hunt DL, Haynes RB, Hanna SE, Smith K: Effects of Computer-Based Clinical Decision Support Systems on Physician Performance and Patient Outcomes: A Systematic Review. JAMA. 1998, 280 (15): 1339-1346. 10.1001/jama.280.15.1339.CrossRefPubMed
3.
Garg AX, Adhikari NK, McDonald H, Rosas-Arellano M, Devereaux PJ, Beyene J, Sam J, Haynes RB: Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005, 293 (10): 1223-1238. 10.1001/jama.293.10.1223.CrossRefPubMed
4.
Haynes RB, Wilczynski N, the Computerized Clinical Decision Support System (CCDSS) Systematic Review Team: Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: Methods of a decision-maker-researcher partnership systematic review. Implement Sci. 2010, 5: 12-CrossRefPubMedPubMedCentral
5.
Berner ES: Clinical decision support systems: State of the Art. 2009, Rockville, Maryland: Agency for Healthcare Research and Quality
6.
Randolph AG, Haynes RB, Wyatt JC, Cook DJ, Guyatt GH: Users' Guides to the Medical Literature: XVIII. How to Use an Article Evaluating the Clinical Impact of a Computer-Based Clinical Decision Support System. JAMA. 1999, 282 (1): 67-74. 10.1001/jama.282.1.67.CrossRefPubMed
7.
Mungall DR, Anbe D, Forrester PL, Luoma T, Genovese R, Mahan J, LeBlanc S, Penney JB: A prospective randomized comparison of the accuracy of computer-assisted versus GUSTO nomogram--directed heparin therapy. Clin Pharmacol Ther. 1994, 55 (5): 591-596. 10.1038/clpt.1994.73.CrossRefPubMed
8.
Lecomte F, Oppenheimer A, Ginsburg C, Dhainaut JF, Claessens YE: Computer-assisted prescription improves the delay of morphine infusion after nurse triage in patients admitted in the emergency department with intense pain: a randomized trial. JEUR. 2006, 19 (4): 177-182.
9.
East TD, Heermann LK, Bradshaw RL, Lugo A, Sailors RM, Ershler L, Wallace CJ, Morris AH, McKinley B, Marquez A, Tonnesen A, Parmley L, Shoemaker W, Meade P, Thaut P, Hill T, Young M, Baughman J, Olterman M, Gooder V, Quinn B, Summer W, Valentine V, Carlson J, Steinberg K: Efficacy of computerized decision support for mechanical ventilation: results of a prospective multi-center randomized trial. Proc AMIA Symp. 1999, 251-255.
10.
McDonald CJ, Hui SL, Smith DM, Tierney WM, Cohen SJ, Weinberger M, McCabe GP: Reminders to physicians from an introspective computer medical record. A two-year randomized trial. Ann Intern Med. 1984, 100 (1): 130-138.CrossRefPubMed
11.
Rogers JL, Haring OM, Goetz JP: Changes in patient attitudes following the implementation of a medical information system. QRB Qual Rev Bull. 1984, 10 (3): 65-74.PubMed
12.
Verstappen SMM, Jacobs JWG, Van der Veen MJ, Heurkens AHM, Schenk Y, Ter Borg EJ, Blaauw AAM, Bijlsma JWJ: Intensive treatment with methotrexate in early rheumatoid arthritis: aiming for remission. Computer Assisted Management in Early Rheumatoid Arthritis (CAMERA, an open-label strategy trial). Ann Rheum Dis. 2007, 66 (11): 1443-1449. 10.1136/ard.2007.071092.CrossRefPubMedPubMedCentral
13.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, McQuay HJ: Assessing the quality of reports of randomized clinical trials: Is blinding necessary?. Control Clin Trials. 1996, 17 (1): 1-12. 10.1016/0197-2456(95)00134-4.CrossRefPubMed
14.
Begg EJ, Atkinson HC, Jeffery GM, Taylor NW: Individualised aminoglycoside dosage based on pharmacokinetic analysis is superior to dosage based on physician intuition at achieving target plasma drug concentrations. Br J Clin Pharmacol. 1989, 28 (2): 137-141.CrossRefPubMedPubMedCentral
15.
Bogusevicius A, Maleckas A, Pundzius J, Skaudickas D: Prospective randomised trial of computer-aided diagnosis and contrast radiography in acute small bowel obstruction. Eur J Surg. 2002, 168 (2): 78-83. 10.1080/11024150252884287.CrossRefPubMed
16.
Burton ME, Ash CL, Hill DP, Handy T, Shepherd MD, Vasko MR: A controlled trial of the cost benefit of computerized bayesian aminoglycoside administration. Clin Pharmacol Ther. 1991, 49 (6): 685-694. 10.1038/clpt.1991.86.CrossRefPubMed
17.
Carter BL, Taylor JW, Becker A: Evaluation of three dosage-prediction methods for initial in-hospital stabilization of warfarin therapy. Clin Pharm. 1987, 6 (1): 37-45.PubMed
18.
Casner PR, Reilly R, Ho H: A randomized controlled trial of computerized pharmacokinetic theophylline dosing versus empiric physician dosing. Clin Pharmacol Ther. 1993, 53 (6): 684-690. 10.1038/clpt.1993.90.CrossRefPubMed
19.
Dexter PR, Perkins S, Overhage JM, Maharry K, Kohler RB, McDonald CJ: A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med. 2001, 345 (13): 965-970. 10.1056/NEJMsa010181.CrossRefPubMed
20.
21.
Hickling K, Begg E, Moore ML: A prospective randomised trial comparing individualised pharmacokinetic dosage prediction for aminoglycosides with prediction based on estimated creatinine clearance in critically ill patients. Intensive Care Med. 1989, 15 (4): 233-237. 10.1007/BF00271057.CrossRefPubMed
22.
Gonzalez ER, Vanderheyden BA, Ornato JP, Comstock TG: Computer-assisted optimization of aminophylline therapy in the emergency department. Am J Emerg Med. 1989, 7 (4): 395-401. 10.1016/0735-6757(89)90046-6.CrossRefPubMed
23.
Kuperman GJ, Teich JM, Tanasijevic MJ, Ma'Luf N, Rittenberg E, Jha A, Fiskio J, Winkelman J, Bates DW: Improving response to critical laboratory results with automation: results of a randomized controlled trial. J Am Med Inform Assoc. 1999, 6 (6): 512-522. 10.1136/jamia.1999.0060512.CrossRefPubMedPubMedCentral
24.
Hurley SF, Dziukas LJ, McNeil JJ, Brignell MJ: A randomized controlled clinical trial of pharmacokinetic theophylline dosing. Am Rev Respir Dis. 1986, 134 (6): 1219-1224.PubMed
25.
Overhage JM, Tierney WM, McDonald CJ: Computer reminders to implement preventive care guidelines for hospitalized patients. Arch Intern Med. 1996, 156 (14): 1551-1556. 10.1001/archinte.156.14.1551.CrossRefPubMed
26.
Overhage JM, Tierney WM, Zhou XH, McDonald CJ: A randomized trial of 'corollary orders' to prevent errors of omission. J Am Med Inform Assoc. 1997, 4 (5): 364-375. 10.1136/jamia.1997.0040364.CrossRefPubMedPubMedCentral
27.
Rodman JH, Jelliffe RW, Kolb E, Tuey DB, de Guzman MF, Wagers PW, Haywood LJ: Clinical studies with computer-assisted initial lidocaine therapy. Arch Intern Med. 1984, 144 (4): 703-709. 10.1001/archinte.144.4.703.CrossRefPubMed
28.
Poller L, Shiach CR, MacCallum PK, Johansen AM, Munster AM, Magalhaes A, Jespersen J: Multicentre randomised study of computerised anticoagulant dosage. European Concerted Action on Anticoagulation Lancet. 1998, 352 (9139): 1505-1509.PubMed
29.
Selker HP, Beshansky JR, Griffith JL, TPI Trial Investigators: Use of the electrocardiograph-based thrombolytic predictive instrument to assist thrombolytic and reperfusion therapy for acute myocardial infarction. A multicenter, randomized, controlled, clinical effectiveness trial. Ann Intern Med. 2002, 137 (2): 87-95.CrossRefPubMed
30.
Vadher B, Patterson DL, Leaning M: Evaluation of a decision support system for initiation and control of oral anticoagulation in a randomised trial. BMJ. 1997, 314 (7089): 1252-1256.CrossRefPubMedPubMedCentral
31.
White KS, Lindsay A, Pryor TA, Brown WF, Walsh K: Application of a computerized medical decision-making process to the problem of digoxin intoxication. J Am Coll Cardiol. 1984, 4 (3): 571-576. 10.1016/S0735-1097(84)80104-7.CrossRefPubMed
32.
White RH, Hong R, Venook AP, Daschbach MM, Murray W, Mungall DR, Coleman RW: Initiation of warfarin therapy: comparison of physician dosing with computer-assisted dosing. J Gen Intern Med. 1987, 2 (3): 141-148. 10.1007/BF02596140.CrossRefPubMed
33.
Wyatt J: Lessons learnt from the field trial of ACORN, an expert system to advise on chest pain. Proc Sixth World Conf Med Inform. 1989, 111-115.
34.
Rood E, Bosman RJ, van der Spoel JI, Taylor P, Zandstra DF: Use of a computerized guideline for glucose regulation in the intensive care unit improved both guideline adherence and glucose regulation. J Am Med Inform Assoc. 2005, 12 (2): 172-180.CrossRefPubMedPubMedCentral
35.
Roukema J, Steyerberg EW, van der Lei J, Moll HA: Randomized trial of a clinical decision support system: impact on the management of children with fever without apparent source. J Am Med Inform Assoc. 2008, 15 (1): 107-113.CrossRefPubMedPubMedCentral
36.
Peterson JF, Rosenbaum BP, Waitman LR, Habermann R, Powers J, Harrell D, Miller RA: Physicians' response to guided geriatric dosing: initial results from a randomized trial. Stud Health Technol Inform. 2007, 129 (Pt 2): 1037-1040.PubMed
37.
Rothschild JM, McGurk S, Honour M, Fiskio J, Avorn J, Cook EF, Kaufman R, Churchill WH, Bates DW: The impact of computerized decision support guidelines on transfusion practice. Transfusion. 2004, 44 (s1): 3A-
38.
Rothschild JM, McGurk S, Honour M, Lu L, McClendon AA, Srivastava P, Churchill WH, Kaufman RM, Avorn J, Cook EF, Bates DW: Assessment of education and computerized decision support interventions for improving transfusion practice. Transfusion. 2007, 47 (2): 228-239. 10.1111/j.1537-2995.2007.01093.x.CrossRefPubMed
39.
Kroth PJ, Dexter PR, Overhage JM, Knipe C, Hui SL, Belsito A, McDonald CJ: A computerized decision support system improves the accuracy of temperature capture from nursing personnel at the bedside. AMIA Annu Symp Proc. 2006, 444-448.
40.
Paul M, Andreassen S, Tacconelli E, Nielsen AD, Almanasreh N, Frank U, Cauda R, Leibovici L, TREAT Study G: Improving empirical antibiotic treatment using TREAT, a computerized decision support system: cluster randomized trial. J Antimicrob Chemother. 2006, 58 (6): 1238-1245. 10.1093/jac/dkl372.CrossRefPubMed
41.
Kuilboer MM, van Wijk MA, Mosseveld M, van der Does E, de Jongste JC, Overbeek SE, Ponsioen B, van der Lei J: Computed critiquing integrated into daily clinical practice affects physicians' behavior--a randomized clinical trial with AsthmaCritic. Methods Inf Med. 2006, 45 (4): 447-454.PubMed
42.
Davis RL, Wright J, Chalmers F, Levenson L, Brown JC, Lozano P, Christakis DA: A cluster randomized clinical trial to improve prescribing patterns in ambulatory pediatrics. PLoS Clin Trials. 2007, 2 (5): e25-10.1371/journal.pctr.0020025.CrossRefPubMedPubMedCentral
43.
Helder OK, Mulder PG, van Goudoever JB: Computer-generated versus nurse-determined strategy for incubator humidity and time to regain birthweight. J Obstet Gynecol Neonatal Nurs. 2008, 37 (3): 255-261. 10.1111/j.1552-6909.2008.00237.x.CrossRefPubMed
44.
Hamilton E, Platt R, Gauthier R, McNamara H, Miner L, Rothenberg S, Asselin G, Sabbah R, Benjamin A, Lake M, Vintzileos A: The effect of computer-assisted evaluation of labor on cesarean rates. J Health Care Qual. 2004, 26 (1): 37-44.CrossRef
45.
Stengel D, Bauwens K, Walter M, Kopfer T, Ekkernkamp A: Comparison of handheld computer-assisted and conventional paper chart documentation of medical records. A randomized, controlled trial. J Bone Joint Surg Am. 2004, 86A (3): 553-560.
46.
Brothers TE, Cox MH, Robison JG, Elliott BM, Nietert P: Prospective decision analysis modeling indicates that clinical decisions in vascular surgery often fail to maximize patient expected utility. J Surg Res. 2004, 120 (2): 278-287. 10.1016/j.jss.2004.01.004.CrossRefPubMed
47.
Zanetti G, Flanagan HL, Cohn LH, Giardina R, Platt R: Improvement of intraoperative antibiotic prophylaxis in prolonged cardiac surgery by automated alerts in the operating room. Infect Control Hosp Epidemiol. 2003, 24 (1): 13-16. 10.1086/502109.CrossRefPubMed
48.
Terrell KM, Perkins AJ, Dexter PR, Hui SL, Callahan CM, Miller DK: Computerized decision support to reduce potentially inappropriate prescribing to older emergency department patients: a randomized, controlled trial. J Am Geriatr Soc. 2009, 57 (8): 1388-1394. 10.1111/j.1532-5415.2009.02352.x.CrossRefPubMed
49.
Cavalcanti AB, Silva E, Pereira AJ, Caldeira-Filho M, Almeida FP, Westphal GA, Beims R, Fernandes CC, Correa TD, Gouvea MR, Eluf-Neto J: A randomized controlled trial comparing a computer-assisted insulin infusion protocol with a strict and a conventional protocol for glucose control in critically ill patients. J Crit Care. 2009, 24 (3): 371-378. 10.1016/j.jcrc.2009.05.005.CrossRefPubMed
50.
Saager L, Collins GL, Burnside B, Tymkew H, Zhang L, Jacobsohn E, Avidan M: A randomized study in diabetic patients undergoing cardiac surgery comparing computer-guided glucose management with a standard sliding scale protocol. J Cardiothorac Vasc Anesth. 2008, 22 (3): 377-382. 10.1053/j.jvca.2007.09.013.CrossRefPubMed
51.
Lexchin J, Bero LA, Djulbegovic B, Clark O: Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ. 2003, 326 (7400): 1167-1170. 10.1136/bmj.326.7400.1167.CrossRefPubMedPubMedCentral
52.
Metadata
Title
Computerized clinical decision support systems for acute care management: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes
Authors
Navdeep Sahota
Rob Lloyd
Anita Ramakrishna
Jean A Mackay
Jeanette C Prorok
Lorraine Weise-Kelly
Tamara Navarro
Nancy L Wilczynski
R Brian Haynes
the CCDSS Systematic Review Team
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2011
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-6-91

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