Computerised clinical decision support systems and absolute improvements in care: meta-analysis of controlled clinical trials

作者：Janice L. Kwan, Lisha Lo, Jacob Ferguson, Hanna R. Goldberg, Juan Pablo Díaz-Martínez, George Tomlinson, Jeremy Grimshaw, Kaveh G Shojania · 发表于：BMJ · 年份：2020 · DOI：10.1136/bmj.m3216 · 被引用次数：468 · 研究领域：Electronic Health Records Systems、Artificial Intelligence in Healthcare and Education、Clinical Reasoning and Diagnostic Skills

OBJECTIVE: To report the improvements achieved with clinical decision support systems and examine the heterogeneity from pooling effects across diverse clinical settings and intervention targets. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline up to August 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES AND METHODS: 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. RESULTS: =76%), with the top quartile of reported improvements ranging from 10% to 62%. In 30 trials reporting clinical endpoints, clinical decision support systems increased the proportion of patients achieving guideline based targets (eg, blood pressure or lipid control) by a median of 0.3% (interquartile range -0.7% to 1.9%). Two study characteristics (low baseline adherence and paediatric settings) were associated with significantly larger effects. Inclusion of these covariates in the multivariable meta-regression, however, did not reduce heterogeneity. CONCLUSIONS: Most interventions with clinical decision support systems appear to achieve small to moderate improvements in targeted p...