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Mirpanahi N, Nabovati E, Sharif R, Amirazodi S, Karami M. Effects and characteristics of clinical decision support systems on the outcomes of patients with kidney disease: a systematic review. Hosp Pract (1995) 2023:1-14. [PMID: 37068105 DOI: 10.1080/21548331.2023.2203051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
OBJECTIVES This systematic review was conducted to investigate the characteristics and effects of clinical decision support systems (CDSSs) on clinical and process-of-care outcomes of patients with kidney disease. METHODS A comprehensive systematic search was conducted in electronic databases to identify relevant studies published until November 2020. Randomized clinical trials evaluating the effects of using electronic CDSS on at least one clinical or process-of-care outcome in patients with kidney disease were included in this study. The characteristics of the included studies, features of CDSSs, and effects of the interventions on the outcomes were extracted. Studies were appraised for quality using the Cochrane risk-of-bias assessment tool. RESULTS Out of 8722 retrieved records, 11 eligible studies measured 32 outcomes, including 10 clinical outcomes and 22 process-of-care outcomes. The effects of CDSSs on 45.5% of the process-of-care outcomes were statistically significant, and all the clinical outcomes were not statistically significant. Medication-related process-of-care outcomes were the most frequently measured (54.5%), and CDSSs had the most effective and positive effect on medication appropriateness (18.2%). The characteristics of CDSSs investigated in the included studies comprised automatic data entry, real-time feedback, providing recommendations, and CDSS integration with the Computerized Provider Order Entry system. CONCLUSION Although CDSS may potentially be able to improve processes of care for patients with kidney disease, particularly with regard to medication appropriateness, no evidence was found that CDSS affects clinical outcomes in these patients. Further research is thus required to determine the effects of CDSSs on clinical outcomes in patients with kidney diseases.
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Affiliation(s)
- Nasim Mirpanahi
- Health Information Management Research Center, Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Ehsan Nabovati
- Health Information Management Research Center, Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Reihane Sharif
- Health Information Management Research Center, Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Shahrzad Amirazodi
- Health Information Management Research Center, Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahtab Karami
- Department of Health Information Management & Technology, School of Public Health, Shahid Sadoughi (Yazd) Kashan University of Medical Sciences, Kashan, Iran
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Chen W, Howard K, Gorham G, O'Bryan CM, Coffey P, Balasubramanya B, Abeyaratne A, Cass A. Design, effectiveness, and economic outcomes of contemporary chronic disease clinical decision support systems: a systematic review and meta-analysis. J Am Med Inform Assoc 2022; 29:1757-1772. [PMID: 35818299 PMCID: PMC9471723 DOI: 10.1093/jamia/ocac110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 01/10/2023] Open
Abstract
Objectives Electronic health record-based clinical decision support (CDS) has the potential to improve health outcomes. This systematic review investigates the design, effectiveness, and economic outcomes of CDS targeting several common chronic diseases. Material and Methods We conducted a search in PubMed (Medline), EBSCOHOST (CINAHL, APA PsychInfo, EconLit), and Web of Science. We limited the search to studies from 2011 to 2021. Studies were included if the CDS was electronic health record-based and targeted one or more of the following chronic diseases: cardiovascular disease, diabetes, chronic kidney disease, hypertension, and hypercholesterolemia. Studies with effectiveness or economic outcomes were considered for inclusion, and a meta-analysis was conducted. Results The review included 76 studies with effectiveness outcomes and 9 with economic outcomes. Of the effectiveness studies, 63% described a positive outcome that favored the CDS intervention group. However, meta-analysis demonstrated that effect sizes were heterogenous and small, with limited clinical and statistical significance. Of the economic studies, most full economic evaluations (n = 5) used a modeled analysis approach. Cost-effectiveness of CDS varied widely between studies, with an estimated incremental cost-effectiveness ratio ranging between USD$2192 to USD$151 955 per QALY. Conclusion We summarize contemporary chronic disease CDS designs and evaluation results. The effectiveness and cost-effectiveness results for CDS interventions are highly heterogeneous, likely due to differences in implementation context and evaluation methodology. Improved quality of reporting, particularly from modeled economic evaluations, would assist decision makers to better interpret and utilize results from these primary research studies. Registration PROSPERO (CRD42020203716)
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Affiliation(s)
- Winnie Chen
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gillian Gorham
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Claire Maree O'Bryan
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Patrick Coffey
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Bhavya Balasubramanya
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Asanga Abeyaratne
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
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Abdellatif A, Bouaud J, Lafuente-Lafuente C, Belmin J, Séroussi B. Computerized Decision Support Systems for Nursing Homes: A Scoping Review. J Am Med Dir Assoc 2021; 22:984-994. [PMID: 33639117 DOI: 10.1016/j.jamda.2021.01.080] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/15/2021] [Accepted: 01/24/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To summarize the research literature describing the outcomes of computerized decision support systems (CDSSs) implemented in nursing homes (NHs). DESIGN Scoping review. METHODS Search of relevant articles published in the English language between January 1, 2000, and February 29, 2020, in the Medline database. The quality of the selected studies was assessed according to PRISMA guidelines and the Mixed Method Appraisal Tool. RESULTS From 1828 articles retrieved, 24 studies were selected for review, among which only 6 were randomized controlled trials. Although clinical outcomes are seldom studied, some studies show that CDSSs have the potential to decrease pressure ulcer incidence and malnutrition prevalence. Improvement of process outcomes such as increased compliance with practice guidelines, better documentation of nursing assessment, improved teamwork and communication, and cost saving, also are reported. CONCLUSIONS AND IMPLICATIONS Overall, the use of CDSSs in NHs may be effective to improve patient clinical outcomes and health care delivery; however, most of the retrieved studies were observational studies, which significantly weakens the evidence. High-quality studies are needed to investigate CDSS effects and limitations in NHs.
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Affiliation(s)
- Abir Abdellatif
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, LIMICS, UMR S_1142, Paris, France; APHP, Hôpital Charles-Foix, Ivry-sur-Seine, France; Teranga Software, Paris, France
| | - Jacques Bouaud
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, LIMICS, UMR S_1142, Paris, France; AP-HP, Direction de la Recherche Clinique et de l'Innovation, Paris, France
| | - Carmelo Lafuente-Lafuente
- APHP, Hôpital Charles-Foix, Ivry-sur-Seine, France; Faculté de Médecine, Sorbonne Université, Paris, France
| | - Joël Belmin
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, LIMICS, UMR S_1142, Paris, France; APHP, Hôpital Charles-Foix, Ivry-sur-Seine, France; Faculté de Médecine, Sorbonne Université, Paris, France.
| | - Brigitte Séroussi
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, LIMICS, UMR S_1142, Paris, France; APHP, Hôpital Tenon, Paris, France
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De Pietro C, Francetic I. E-health in Switzerland: The laborious adoption of the federal law on electronic health records (EHR) and health information exchange (HIE) networks. Health Policy 2018; 122:69-74. [PMID: 29153922 DOI: 10.1016/j.healthpol.2017.11.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 09/28/2017] [Accepted: 11/03/2017] [Indexed: 11/23/2022]
Abstract
Within the framework of a broader e-health strategy launched a decade ago, in 2015 Switzerland passed a new federal law on patients' electronic health records (EHR). The reform requires hospitals to adopt interoperable EHRs to facilitate data sharing and cooperation among healthcare providers, ultimately contributing to improvements in quality of care and efficiency in the health system. Adoption is voluntary for ambulatories and private practices, that may however be pushed towards EHRs by patients. The latter have complete discretion in the choice of the health information to share. Moreover, careful attention is given to data security issues. Despite good intentions, the high institutional and organisational fragmentation of the Swiss healthcare system, as well as the lack of full agreement with stakeholders on some critical points of the reform, slowed the process of adoption of the law. In particular, pilot projects made clear that the participation of ambulatories is doomed to be low unless appropriate incentives are put in place. Moreover, most stakeholders point at the strategy proposed to finance technical implementation and management of EHRs as a major drawback. After two years of intense preparatory work, the law entered into force in April 2017.
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Degenholtz HB, Resnick A, Lin M, Handler S. Development of an Applied Framework for Understanding Health Information Technology in Nursing Homes. J Am Med Dir Assoc 2016; 17:434-40. [PMID: 26975206 DOI: 10.1016/j.jamda.2016.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 11/28/2022]
Abstract
There is growing evidence that Health Information Technology (HIT) can play a role in improving quality of care and increasing efficiency in the nursing home setting. Most research in this area, however, has examined whether nursing homes have or use any of a list of available technologies. We sought to develop an empirical framework for understanding the intersection between specific uses of HIT and clinical care processes. Using the nominal group technique, we conducted a series of focus groups with different types of personnel who work in nursing homes (administrators, directors of nursing, physicians, mid-level practitioners, consultant pharmacists, and aides). The resulting framework identified key domain areas that can benefit from HIT: transfer of data, regulatory compliance, quality improvement, structured clinical documentation, medication use process, and communication. The framework can be used to guide both descriptive and normative research.
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Affiliation(s)
- Howard B Degenholtz
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA.
| | - Abby Resnick
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA
| | - Michael Lin
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA
| | - Steven Handler
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA
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Moja L, Kwag KH, Lytras T, Bertizzolo L, Brandt L, Pecoraro V, Rigon G, Vaona A, Ruggiero F, Mangia M, Iorio A, Kunnamo I, Bonovas S. Effectiveness of computerized decision support systems linked to electronic health records: a systematic review and meta-analysis. Am J Public Health 2014; 104:e12-22. [PMID: 25322302 PMCID: PMC4232126 DOI: 10.2105/ajph.2014.302164] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2014] [Indexed: 01/18/2023]
Abstract
We systematically reviewed randomized controlled trials (RCTs) assessing the effectiveness of computerized decision support systems (CDSSs) featuring rule- or algorithm-based software integrated with electronic health records (EHRs) and evidence-based knowledge. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Abstracts of Reviews of Effects. Information on system design, capabilities, acquisition, implementation context, and effects on mortality, morbidity, and economic outcomes were extracted. Twenty-eight RCTs were included. CDSS use did not affect mortality (16 trials, 37395 patients; 2282 deaths; risk ratio [RR] = 0.96; 95% confidence interval [CI] = 0.85, 1.08; I(2) = 41%). A statistically significant effect was evident in the prevention of morbidity, any disease (9 RCTs; 13868 patients; RR = 0.82; 95% CI = 0.68, 0.99; I(2) = 64%), but selective outcome reporting or publication bias cannot be excluded. We observed differences for costs and health service utilization, although these were often small in magnitude. Across clinical settings, new generation CDSSs integrated with EHRs do not affect mortality and might moderately improve morbidity outcomes.
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Affiliation(s)
- Lorenzo Moja
- Lorenzo Moja is with the Department of Biomedical Sciences for Health, University of Milan, and the Unit of Clinical Epidemiology, IRCCS Orthopedic Institute Galeazzi, Milan, Italy. Koren H. Kwag is with the Unit of Clinical Epidemiology, IRCCS Orthopedic Institute Galeazzi, Milan. Theodore Lytras is with the Department of Epidemiological Surveillance and Intervention, Hellenic Centre for Disease Control and Prevention, Athens, Greece, the Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain, and the Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona. Lorenzo Bertizzolo and Francesca Ruggiero are with the Department of Biomedical Sciences for Health, University of Milan. Linn Brandt is with the Department of Internal Medicine, Inland Hospital Trust, Oslo, Norway, the Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, and HELSAM, University of Oslo. Valentina Pecoraro is with the University of Milan. Giulio Rigon and Alberto Vaona are with Azienda ULSS 20, Verona, Italy. Massimo Mangia is with Medilogy SRL, Milan. Alfonso Iorio is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario. Ilkka Kunnamo is with Duodecim Medical Publications Ltd, Helsinki, Finland. Stefanos Bonovas is with the Laboratory of Drug Regulatory Policies, IRCCS Mario Negri Institute for Pharmacological Research, Milan, and the Department of Pharmacology, School of Medicine, University of Athens, Athens
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Abstract
In a growing interdisciplinary field like biomedical informatics, information dissemination and citation trends are changing rapidly due to many factors. To understand these factors better, we analyzed the evolution of the number of articles per major biomedical informatics topic, download/online view frequencies, and citation patterns (using Web of Science) for articles published from 2009 to 2012 in JAMIA. The number of articles published in JAMIA increased significantly from 2009 to 2012, and there were some topic differences in the last 4 years. Medical Record Systems, Algorithms, and Methods are topic categories that are growing fast in several publications. We observed a significant correlation between download frequencies and the number of citations per month since publication for a given article. Earlier free availability of articles to non-subscribers was associated with a higher number of downloads and showed a trend towards a higher number of citations. This trend will need to be verified as more data accumulate in coming years.
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Affiliation(s)
- Xiaoqian Jiang
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California, USA
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