Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes

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This article studies the downstream effects of CPOE alerts and how critical it really gets. [1]

Background

This study focuses on reviewing whether CDS alerts really improve practitioner performance and patient outcomes.

Methods

They included English-language randomized and nonrandomized trials with a contemporaneous control group that compared patient care with a CDSS to routine care without a CDSS and evaluated clinical performance (ie, a measure of process of care) or a patient outcome. They stipulated that the CDSS had to provide patient-specific advice that was reviewed by a health care practitioner before any clinical action. Studies were excluded if the system (1) was used solely by medical students, (2) only provided summaries of patient information, (3) provided feedback on groups of patients without individual assessment, (4) only provided computer-aided instruction, or (5) was used for image analysis. Studies assessing CDSS diagnostic performance against a defined gold standard were not included in this review unless clinical use of the diagnostic CDSS was also compared with routine care. Based on these criteria, they reevaluated all studies from their previous reviews for inclusion.

Results

Of the 97 controlled trials assessing practitioner performance, the majority (64%) improved diagnosis, preventive care, disease management, drug dosing, or drug prescribing. However, the effects of these systems on patient health remain understudied—and inconsistent when studied. Fifty-two trials assessed patient outcomes, often in a limited capacity without adequate statistical power to detect clinically important differences. Only 7 trials reported improved patient outcomes with the CDSS, and no study reported benefits for major outcomes such as mortality. Surrogate patient outcomes such as blood pressure and glycated hemoglobin were not meaningfully improved in most studies.

Conclusion

It showed that CDS alerts do improve practitioner performance however, patient outcomes were still undermined.

Comments

This study, however, is about 10 years old. The field has rapidly grown since then and it would be interesting to see if there are recent studies measuring if CDS alerts affect patient outcomes.

References

  1. Garg AX, Adhikari NJ, McDonald H, et al. Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes: A Systematic Review. JAMA.2005;293(10):1223-1238. http://jama.jamanetwork.com/article.aspx?articleid=200503&resultClick=3