Effects of computerized decision support system implementations on patient outcomes in inpatient care: a systematic review

Varghese J, Kleine M, Gessner SI, Sandmann S, Dugas M (2018)

Zeitschriftenaufsatz | Veröffentlicht | Englisch
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Varghese, Julian; Kleine, MarenUniBi; Gessner, Sophia Isabella; Sandmann, Sarah; Dugas, Martin
Abstract / Bemerkung
Objectives: To systematically classify the clinical impact of computerized clinical decision support systems (CDSSs) in inpatient care. Materials and Methods: Medline, Cochrane Trials, and Cochrane Reviews were searched for CDSS studies that assessed patient outcomes in inpatient settings. For each study, 2 physicians independently mapped patient outcome effects to a predefined medical effect score to assess the clinical impact of reported outcome effects. Disagreements were measured by using weighted kappa and solved by consensus. An example set of promising disease entities was generated based on medical effect scores and risk of bias assessment. To summarize technical characteristics of the systems, reported input variables and algorithm types were extracted as well. Results: Seventy studies were included. Five (7%) reported reduced mortality, 16 (23%) reduced life-threatening events, and 28 (40%) reduced non-life-threatening events, 20 (29%) had no significant impact on patient outcomes, and 1 showed a negative effect (weighted kappa: 0.72, P<.001). Six of 24 disease entity settings showed high effect scores with medium or low risk of bias: blood glucose management, blood transfusion management, physiologic deterioration prevention, pressure ulcer prevention, acute kidney injury prevention, and venous thromboembolism prophylaxis. Most of the implemented algorithms (72%) were rule-based. Reported input variables are shared as standardized models on a metadata repository. Discussion and Conclusion: Most of the included CDSS studies were associated with positive patient outcomes effects but with substantial differences regarding the clinical impact. A subset of 6 disease entities could be filtered in which CDSS should be given special consideration at sites where computer-assisted decision-making is deemed to be underutilized.
clinical decision support systems; medical order entry systems; reminder; systems; outcome and process assessment
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Varghese J, Kleine M, Gessner SI, Sandmann S, Dugas M. Effects of computerized decision support system implementations on patient outcomes in inpatient care: a systematic review. JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION. 2018;25(5):593-602.
Varghese, J., Kleine, M., Gessner, S. I., Sandmann, S., & Dugas, M. (2018). Effects of computerized decision support system implementations on patient outcomes in inpatient care: a systematic review. JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION, 25(5), 593-602. doi:10.1093/jamia/ocx100
Varghese, J., Kleine, M., Gessner, S. I., Sandmann, S., and Dugas, M. (2018). Effects of computerized decision support system implementations on patient outcomes in inpatient care: a systematic review. JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION 25, 593-602.
Varghese, J., et al., 2018. Effects of computerized decision support system implementations on patient outcomes in inpatient care: a systematic review. JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION, 25(5), p 593-602.
J. Varghese, et al., “Effects of computerized decision support system implementations on patient outcomes in inpatient care: a systematic review”, JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION, vol. 25, 2018, pp. 593-602.
Varghese, J., Kleine, M., Gessner, S.I., Sandmann, S., Dugas, M.: Effects of computerized decision support system implementations on patient outcomes in inpatient care: a systematic review. JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION. 25, 593-602 (2018).
Varghese, Julian, Kleine, Maren, Gessner, Sophia Isabella, Sandmann, Sarah, and Dugas, Martin. “Effects of computerized decision support system implementations on patient outcomes in inpatient care: a systematic review”. JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION 25.5 (2018): 593-602.

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