Computerised clinical decision support systems and absolute improvements in care: meta-analysis of controlled clinical trials.
Journal
BMJ (Clinical research ed.)
ISSN: 1756-1833
Titre abrégé: BMJ
Pays: England
ID NLM: 8900488
Informations de publication
Date de publication:
17 09 2020
17 09 2020
Historique:
entrez:
18
9
2020
pubmed:
19
9
2020
medline:
26
9
2020
Statut:
epublish
Résumé
To report the improvements achieved with clinical decision support systems and examine the heterogeneity from pooling effects across diverse clinical settings and intervention targets. Systematic review and meta-analysis. Medline up to August 2019. Randomised or quasi-randomised controlled trials reporting absolute improvements in the percentage of patients receiving care recommended by clinical decision support systems. Multilevel meta-analysis accounted for within study clustering. Meta-regression was used to assess the degree to which the features of clinical decision support systems and study characteristics reduced heterogeneity in effect sizes. Where reported, clinical endpoints were also captured. In 108 studies (94 randomised, 14 quasi-randomised), reporting 122 trials that provided analysable data from 1 203 053 patients and 10 790 providers, clinical decision support systems increased the proportion of patients receiving desired care by 5.8% (95% confidence interval 4.0% to 7.6%). This pooled effect exhibited substantial heterogeneity (I Most interventions with clinical decision support systems appear to achieve small to moderate improvements in targeted processes of care, a finding confirmed by the small changes in clinical endpoints found in studies that reported them. A minority of studies achieved substantial increases in the delivery of recommended care, but predictors of these more meaningful improvements remain undefined.
Identifiants
pubmed: 32943437
doi: 10.1136/bmj.m3216
pmc: PMC7495041
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
m3216Commentaires et corrections
Type : CommentIn
Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Références
Clin Infect Dis. 2019 Dec 09;:
pubmed: 31813967
JAMA. 2001 Dec 12;286(22):2839-44
pubmed: 11735759
JAMA. 2005 Mar 9;293(10):1223-38
pubmed: 15755945
Health Technol Assess. 2004 Feb;8(6):iii-iv, 1-72
pubmed: 14960256
Am J Kidney Dis. 2011 Dec;58(6):894-902
pubmed: 21982456
Thorax. 2012 Dec;67(12):1052-60
pubmed: 22941976
Am J Gastroenterol. 2008 May;103(5):1097-103
pubmed: 18477341
Am J Manag Care. 2018 Apr 1;24(4):e107-e114
pubmed: 29668213
J Am Med Inform Assoc. 2014 Feb;21(e1):e28-34
pubmed: 24052536
Stroke. 2014 Jul;45(7):2066-71
pubmed: 24903985
CMAJ. 2003 Sep 16;169(6):549-56
pubmed: 12975221
Stud Health Technol Inform. 2019 Jul 30;263:75-86
pubmed: 31411154
Arch Intern Med. 2009 Apr 27;169(8):781-7
pubmed: 19398690
J Thromb Haemost. 2017 Nov;15(11):2138-2146
pubmed: 28836340
Implement Sci. 2018 Aug 20;13(1):114
pubmed: 30126421
Int J Epidemiol. 2002 Feb;31(1):72-6
pubmed: 11914297
Health Serv Res. 2005 Apr;40(2):477-97
pubmed: 15762903
CMAJ. 2010 Mar 23;182(5):E216-25
pubmed: 20212028
Ann Intern Med. 2020 Jun 2;172(11_Supplement):S92-S100
pubmed: 32479184
Lancet. 1995 Aug 5;346(8971):341-6
pubmed: 7623532
Med Care. 2006 Jul;44(7):646-57
pubmed: 16799359
BMJ Qual Saf. 2011 May;20(5):453-9
pubmed: 21317181
J Gen Intern Med. 2008 Apr;23(4):429-41
pubmed: 18373141
JAMA Intern Med. 2013 Feb 25;173(4):267-73
pubmed: 23319069
Nat Med. 2018 Nov;24(11):1716-1720
pubmed: 30349085
Am J Med Qual. 2019 Mar/Apr;34(2):182-188
pubmed: 30095983
J Gen Intern Med. 2003 Dec;18(12):967-76
pubmed: 14687254
BMJ. 2002 Aug 17;325(7360):367
pubmed: 12183309
Diabetes Care. 2003 Mar;26(3):750-7
pubmed: 12610033
Appl Clin Inform. 2017 Jul 05;8(3):686-697
pubmed: 28678892
Arch Intern Med. 2011 Sep 26;171(17):1552-8
pubmed: 21949163
Ann Intern Med. 2012 Jul 3;157(1):29-43
pubmed: 22751758
Pharmacotherapy. 2004 Mar;24(3):324-37
pubmed: 15040645
Health Aff (Millwood). 2015 Dec;34(12):2174-80
pubmed: 26561387
PLoS Med. 2018 Mar 13;15(3):e1002528
pubmed: 29534063
BMJ. 2009 Apr 27;338:b1440
pubmed: 19398471
BMJ. 2013 Feb 14;346:f657
pubmed: 23412440
J Patient Saf. 2017 Feb 28;:
pubmed: 28248749
Am J Prev Med. 2018 Dec;55(6):777-786
pubmed: 30361140
BMJ. 2006 Mar 25;332(7543):692-6
pubmed: 16565124
J Am Med Inform Assoc. 2012 Jul-Aug;19(4):555-61
pubmed: 22215056
JAMA Intern Med. 2013 Sep 23;173(17):1584-91
pubmed: 23896675
Med Care. 2008 Aug;46(8):847-62
pubmed: 18665065
Circ Heart Fail. 2014 Jan;7(1):140-5
pubmed: 24319096
BMJ Qual Saf. 2019 Sep;28(9):693-696
pubmed: 31015377
BMC Infect Dis. 2016 Aug 05;16:373
pubmed: 27495917
J Am Med Inform Assoc. 2006 Jul-Aug;13(4):385-90
pubmed: 16622171
N Engl J Med. 2005 Mar 10;352(10):969-77
pubmed: 15758007
J Med Internet Res. 2019 Jul 05;21(7):e13719
pubmed: 31278734
J Gen Intern Med. 2012 May;27(5):561-7
pubmed: 22302355
Cochrane Database Syst Rev. 2019 Oct 3;10:ED000142
pubmed: 31643080
JAMA Pediatr. 2015 Jun;169(6):535-42
pubmed: 25895016
BMJ Qual Saf. 2013 Oct;22(10):816-25
pubmed: 23708439
Implement Sci. 2018 Jan 10;13(1):7
pubmed: 29321043
Am J Public Health. 2014 Dec;104(12):e12-22
pubmed: 25322302
Ann Intern Med. 2018 Jul 3;169(1):50-51
pubmed: 29801050
J Gen Intern Med. 2012 Aug;27(8):933-9
pubmed: 22402982
Fam Med. 2009 Jul-Aug;41(7):502-7
pubmed: 19582636
BMJ. 2019 Feb 12;364:l236
pubmed: 30755451
BMJ. 2019 Aug 28;366:l4898
pubmed: 31462531
Circulation. 2008 Jan 22;117(3):371-8
pubmed: 18172036
JAMA. 2018 Dec 4;320(21):2199-2200
pubmed: 30398550
Prev Med Rep. 2016 May 21;4:107-12
pubmed: 27413670
PLoS One. 2017 Feb 28;12(2):e0170974
pubmed: 28245247
JMIR Med Inform. 2016 Sep 30;4(3):e28
pubmed: 27694098
BMJ. 2009 Jul 21;339:b2535
pubmed: 19622551
BMJ. 2005 Apr 2;330(7494):765
pubmed: 15767266
BMJ. 2002 Oct 26;325(7370):941
pubmed: 12399345
Cochrane Database Syst Rev. 2009 Jul 08;(3):CD001096
pubmed: 19588323
Am J Med. 2013 Oct;126(10):853-7
pubmed: 24054954
Crit Care Med. 2016 Feb;44(2):368-74
pubmed: 26771782
JAMA. 1998 Oct 21;280(15):1339-46
pubmed: 9794315
Lancet. 2014 Jul 5;384(9937):8-9
pubmed: 24998803
Health Aff (Millwood). 2017 Aug 1;36(8):1416-1422
pubmed: 28784734
Stroke. 2017 Mar;48(3):787-790
pubmed: 28119433
Ann Emerg Med. 2015 Nov;66(5):511-20
pubmed: 25725592
J Am Med Inform Assoc. 2011 Jan-Feb;18(1):17-23
pubmed: 21131606
BMJ Qual Saf. 2015 Mar;24(3):228-38
pubmed: 25616279
Qual Saf Health Care. 2010 Oct;19 Suppl 3:i68-74
pubmed: 20959322
J Am Med Inform Assoc. 2014 Oct;21(e2):e297-303
pubmed: 24671361
N Engl J Med. 2009 Apr 16;360(16):1628-38
pubmed: 19321858
Jt Comm J Qual Patient Saf. 2016 Feb;42(2):70-6
pubmed: 26803035
Ann Fam Med. 2011 Jan-Feb;9(1):22-30
pubmed: 21242557
J Am Med Inform Assoc. 2014 Jul-Aug;21(4):664-70
pubmed: 24064443