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Nafees A, Khan M, Chow R, Fazelzad R, Hope A, Liu G, Letourneau D, Raman S. Evaluation of clinical decision support systems in oncology: An updated systematic review. Crit Rev Oncol Hematol 2023; 192:104143. [PMID: 37742884 DOI: 10.1016/j.critrevonc.2023.104143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 09/26/2023] Open
Abstract
With increasing reliance on technology in oncology, the impact of digital clinical decision support (CDS) tools needs to be examined. A systematic review update was conducted and peer-reviewed literature from 2016 to 2022 were included if CDS tools were used for live decision making and comparatively assessed quantitative outcomes. 3369 studies were screened and 19 were included in this updated review. Combined with a previous review of 24 studies, a total of 43 studies were analyzed. Improvements in outcomes were observed in 42 studies, and 34 of these were of statistical significance. Computerized physician order entry and clinical practice guideline systems comprise the greatest number of evaluated CDS tools (13 and 10 respectively), followed by those that utilize patient-reported outcomes (8), clinical pathway systems (8) and prescriber alerts for best-practice advisories (4). Our review indicates that CDS can improve guideline adherence, patient-centered care, and care delivery processes in oncology.
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Affiliation(s)
- Abdulwadud Nafees
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada
| | - Maha Khan
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada
| | - Ronald Chow
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Institute of Biomedical Engineering, Faculty of Applied Sciences & Engineering, University of Toronto, Toronto, Canada; Library and Information Services, Princess Margaret Cancer Centre, Toronto, Canada
| | - Rouhi Fazelzad
- Institute of Biomedical Engineering, Faculty of Applied Sciences & Engineering, University of Toronto, Toronto, Canada; Library and Information Services, Princess Margaret Cancer Centre, Toronto, Canada
| | - Andrew Hope
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Geoffrey Liu
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Daniel Letourneau
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Srinivas Raman
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
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Teufel A, Binder H. Clinical Decision Support Systems. Visc Med 2021; 37:491-498. [PMID: 35087899 PMCID: PMC8738909 DOI: 10.1159/000519420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND By combining up-to-date medical knowledge and steadily increasing patient data, a new level of medical care can emerge. SUMMARY AND KEY MESSAGES Clinical decision support systems (CDSSs) are an arising solution to handling rich data and providing them to health care providers in order to improve diagnosis and treatment. However, despite promising examples in many areas, substantial evidence for a thorough benefit of these support solutions is lacking. This may be due to a lack of general frameworks and diverse health systems around the globe. We therefore summarize the current status of CDSSs in medicine but also discuss potential limitations that need to be overcome in order to further foster future development and acceptance.
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Affiliation(s)
- Andreas Teufel
- Department of Medicine II, Section of Hepatology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Harald Binder
- Institute of Medical Biometry and Statistics (IMBI), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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Pawloski PA, Brooks GA, Nielsen ME, Olson-Bullis BA. A Systematic Review of Clinical Decision Support Systems for Clinical Oncology Practice. J Natl Compr Canc Netw 2020; 17:331-338. [PMID: 30959468 DOI: 10.6004/jnccn.2018.7104] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Electronic health records are central to cancer care delivery. Electronic clinical decision support (CDS) systems can potentially improve cancer care quality and safety. However, little is known regarding the use of CDS systems in clinical oncology and their impact on patient outcomes. METHODS A systematic review of peer-reviewed studies was performed to evaluate clinically relevant outcomes related to the use of CDS tools for the diagnosis, treatment, and supportive care of patients with cancer. Peer-reviewed studies published from 1995 through 2016 were included if they assessed clinical outcomes, patient-reported outcomes (PROs), costs, or care delivery process measures. RESULTS Electronic database searches yielded 2,439 potentially eligible papers, with 24 studies included after final review. Most studies used an uncontrolled, pre-post intervention design. A total of 23 studies reported improvement in key study outcomes with use of oncology CDS systems, and 12 studies assessing the systems for computerized chemotherapy order entry demonstrated reductions in prescribing error rates, medication-related safety events, and workflow interruptions. The remaining studies examined oncology clinical pathways, guideline adherence, systems for collection and communication of PROs, and prescriber alerts. CONCLUSIONS There is a paucity of data evaluating clinically relevant outcomes of CDS system implementation in oncology care. Currently available data suggest that these systems can have a positive impact on the quality of cancer care delivery. However, there is a critical need to rigorously evaluate CDS systems in oncology to better understand how they can be implemented to improve patient outcomes.
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Affiliation(s)
- Pamala A Pawloski
- aHealthPartners Institute, Minneapolis, Minnesota.,bThe Health Care Systems Research Network (HCSRN) Cancer Research Network (CRN)
| | - Gabriel A Brooks
- cDartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and
| | - Matthew E Nielsen
- dUniversity of North Carolina School of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
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Pickering JD. Measuring learning gain: Comparing anatomy drawing screencasts and paper-based resources. ANATOMICAL SCIENCES EDUCATION 2017; 10:307-316. [PMID: 27922727 DOI: 10.1002/ase.1666] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 05/25/2023]
Abstract
The use of technology-enhanced learning (TEL) resources is now a common tool across a variety of healthcare programs. Despite this popular approach to curriculum delivery there remains a paucity in empirical evidence that quantifies the change in learning gain. The aim of the study was to measure the changes in learning gain observed with anatomy drawing screencasts in comparison to a traditional paper-based resource. Learning gain is a widely used term to describe the tangible changes in learning outcomes that have been achieved after a specific intervention. In regard to this study, a cohort of Year 2 medical students voluntarily participated and were randomly assigned to either a screencast or textbook group to compare changes in learning gain across resource type. Using a pre-test/post-test protocol, and a range of statistical analyses, the learning gain was calculated at three test points: immediate post-test, 1-week post-test and 4-week post-test. Results at all test points revealed a significant increase in learning gain and large effect sizes for the screencast group compared to the textbook group. Possible reasons behind the difference in learning gain are explored by comparing the instructional design of both resources. Strengths and weaknesses of the study design are also considered. This work adds to the growing area of research that supports the effective design of TEL resources which are complimentary to the cognitive theory of multimedia learning to achieve both an effective and efficient learning resource for anatomical education. Anat Sci Educ 10: 307-316. © 2016 American Association of Anatomists.
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Affiliation(s)
- James D Pickering
- Division of Anatomy, Leeds Institute of Medical Education, School of Medicine, University of Leeds, Leeds, United Kingdom
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Abstract
Objective: Evaluation of the effect of implementing clinical pathways is a relatively new field in health care research. Little is known about the way in which practice is influenced by the implementation of clinical pathways, and to what degree. This review takes significant steps in answering these questions by describing the parameters that are used in literature as indicators to evaluate clinical pathways. Methods: A Medline-based review of literature published between 2000 and 2002 was carried out using the keywords ‘clinical pathway’, ‘critical pathway’, ‘care map’, ‘care pathway’ and ‘integrated care pathway’. Articles were selected if they contained any form of evaluation, outcome or indicator concerning the use of clinical pathways. This included all types of research design and sample size. A total of 200 articles were selected. Relevant data were summarized using the following characteristics: country of origin, clinical field of expertise, research design, sample size, clinical outcome indicators, service indicators, team indicators, process indicators and financial indicators. For each domain a positive, negative or ‘no effect’ conclusion was recorded. Excel® and Statistica® were used to obtain percentages and graphics. Results: A total of 34% of the articles on clinical pathways contained some form of evaluation concerning the effect of the implementation. Out of these articles, clinical outcome was emphasized in 65.5%, financial effects in 53%) and process effects were investigated by 50% of the studies. Team and service effects were discussed less often (24% and 18.5%), respectively). For clinical outcome, team, process and financial effects a variety of indicators were recorded. Service effects were almost always measured as ‘patient satisfaction’. The majority of the literature concluded that positive effects result from the implementation of clinical pathways. Conclusion: On a macro level clinical pathways result globally in positive effects. Negative results, however, were also present in the literature. In particular for process, team and service evaluation concerning the use of clinical pathways there is still a great need for research.
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Affiliation(s)
- P Van Herck
- Centre for Health Services and Nursing Research, School of Public Health, Catholic University Leuven, Belgium
| | - K Vanhaecht
- Centre for Health Services and Nursing Research, School of Public Health, Catholic University Leuven, Belgium
| | - W Sermeus
- Centre for Health Services and Nursing Research, School of Public Health, Catholic University Leuven, Belgium
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Ye Y, Jiang Z, Diao X, Yang D, Du G. An ontology-based hierarchical semantic modeling approach to clinical pathway workflows. Comput Biol Med 2009; 39:722-32. [PMID: 19539278 DOI: 10.1016/j.compbiomed.2009.05.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 05/18/2009] [Indexed: 11/18/2022]
Abstract
This paper proposes an ontology-based approach of modeling clinical pathway workflows at the semantic level for facilitating computerized clinical pathway implementation and efficient delivery of high-quality healthcare services. A clinical pathway ontology (CPO) is formally defined in OWL web ontology language (OWL) to provide common semantic foundation for meaningful representation and exchange of pathway-related knowledge. A CPO-based semantic modeling method is then presented to describe clinical pathways as interconnected hierarchical models including the top-level outcome flow and intervention workflow level along a care timeline. Furthermore, relevant temporal knowledge can be fully represented by combing temporal entities in CPO and temporal rules based on semantic web rule language (SWRL). An illustrative example about a clinical pathway for cesarean section shows the applicability of the proposed methodology in enabling structured semantic descriptions of any real clinical pathway.
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Affiliation(s)
- Yan Ye
- Department of Industrial Engineering & Logistics Management, Shanghai Jiao Tong University, Min Hang District, 200240 Shanghai, China
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Hung SH, Hwang SL, Su MJ, Lue SH, Hsu CY, Chen HL, Chen HS. An evaluation of a weight-loss program incorporating E-learning for obese junior high school students. Telemed J E Health 2009; 14:783-92. [PMID: 18954248 DOI: 10.1089/tmj.2007.0121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Obesity in adolescents is continuing to rise at an alarming rate and is becoming an important public health problem in Taiwan. Therefore, the aims of this study were (1) to evaluate the effectiveness of a Weight-loss E-learning Program (WEP) on obese Chinese adolescents and (2) to gauge this group's satisfaction with the WEP. The design was quasi-experimental, using purposive samples from two junior high schools in Taipei, Taiwan. Obese adolescents between 12 and 14 years of age with body mass indexes (BMI) over 25 kg/m2 were recruited. A 14-week WEP was developed to expedite weight loss for the selected adolescents. Data such as BMI, waist-to-hip ratio, waist circumference, hip circumference, mid-arm circumference, triceps skinfold, blood pressure, and physical fitness were collected through standardized instruments and methods before and after the WEP. The satisfaction of the subjects and four psychosocial variables were evaluated and taken into account by authoritative scales and questionnaires. In total, 37 adolescents participated in this study. After the WEP, we found significant decreases in BMI (p < 0.05), waist circumference (p < 0.05), and triceps skinfold (p < 0.001) in the sample population. Improvements were found in three of four tests of physical fitness (p < 0.001, p < 0.05, and p < 0.01, respectively). All psychosocial variables showed significant favorable changes (p < 0.01 for self-esteem scores, p < 0.001 for the other three variables) and satisfaction levels for the WEP ranged from 56.6% to 83.8% in four different criteria. The WEP was effective in helping obese Chinese adolescents lose weight. However, there is still room for improvement.
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Chang WY, Hsiao Sheen ST, Chang PC, Lee PH. Developing an E-learning education programme for staff nurses: processes and outcomes. NURSE EDUCATION TODAY 2008; 28:822-828. [PMID: 18384917 DOI: 10.1016/j.nedt.2008.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 01/18/2008] [Accepted: 02/18/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To describe the Instructional System Design Processes (analysis, design, development, implementation, and evaluation) used to develop an e-learning education programme for staff nurses at a 700-bed teaching medical center in Taiwan. BACKGROUND Evidence has shown that education via e-learning improves knowledge and skills; however, with cost constraints and limited resources, finding effective alternatives is critical for health professionals. METHODS Five courses required for N2 to N3 level nurses were designed for both e-learning and traditional in-classroom programmes. Multiple-choice written test questions and a satisfaction questionnaire were used to compare outcomes between programmes. Nursing care skills were rated as pass or fail. Both programmes were begun at the same time and completed within a 3-month period. RESULTS Forty-two staff nurses participated in this study. All nurses' knowledge scores were >70 points (out of 100) and all passed nursing care skills. In five courses, only teaching and learning and communication were statistically significantly different (p=0.001). Nearly all nurses (97.6%) felt satisfied or very satisfied with the programmes. CONCLUSIONS Instructional System Design Processes provide an alternative delivery system for in-service nursing education which allows for individualized leaning.
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Affiliation(s)
- Wen-Yin Chang
- College of Nursing, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei 110, Taiwan, ROC.
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Patard JJ, Leray E, Cindolo L, Ficarra V, Rodriguez A, De La Taille A, Tostain J, Artibani W, Abbou CC, Guillé F, Chopin DK, Lobel B. Multi-institutional validation of a symptom based classification for renal cell carcinoma. J Urol 2004; 172:858-62. [PMID: 15310983 DOI: 10.1097/01.ju.0000135837.64840.55] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We validate the prognostic value of a symptom based classification (S classification) in a multi-institutional study. MATERIALS AND METHODS A total of 2,242 patients from 5 European centers were included in this study. Based on symptoms at diagnosis, patients were stratified into 3 groups of S1-asymptomatic tumors, S2-tumors with local symptoms and S3-tumors with systemic symptoms. Variables such as age, gender, tumor size, TNM stage, Fuhrman grade, Eastern Cooperative Oncology Group (ECOG) performance status, perinephric fat, renal vein and adrenal invasion were also considered for prognostic value. The end point of the study was cancer specific survival. Survival assessment was made with univariate and multivariate analyses using the Kaplan-Meier method and Cox regression analysis. RESULTS Of the patients 1,018 (45.4%) were classified as S1, 865 (38.6%) S2 and 339 (16.0%) S3. The S classification correlated to tumor stage, grade and ECOG (p <0.001). On univariate analysis ECOG performance status, S classification, tumor size, TNM stage, Fuhrman grade, and adrenal, perinephric fat or vein invasion were significant prognostic factors (p <0.001). The S classification provided a significant prognostic stratification in the aggregate as well at each of the 5 centers. On multivariate analysis the S classification, TNM stage, Fuhrman grade, and perinephric fat and renal vein invasion remained independent prognostic factors (p <0.001). CONCLUSIONS This study confirms that it is possible to graduate symptoms for a prognostic purpose. The proposed symptom score should be evaluated for its integration in prognostic algorithms.
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Affiliation(s)
- Jean-Jacques Patard
- Department of Urology, Rennes University Hospital, CHU Pontchaillou, rue Henri Le Guilloux, 35033 Rennes, France.
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