Update on Decision Support for Clinicians and Patients

We have written extensively and provide many examples of decision support materials on our website. An easy way to round them up is to go to our website search window http://www.delfini.org/index_SiteGoogleSearch.htm and type in the terms “decision support.”

A nice systematic review of the topic funded by AHRQ—Clinical Decision Support Systems (CDSSs)— has recently been published in the Annals of Internal Medicine.[1]  The aim of the review was to evaluate the effect of CDSSs on clinical outcomes, health care processes, workload and efficiency, patient satisfaction, cost, and provider use and implementation. CDSSs include alerts, reminders, order sets, drug-dose information, care summary dashboards that provide performance feedback on quality indicators, and information and other aids designed to improve clinical decision-making.

Findings:  148 randomized controlled trials were included in the review. A total of 128 (86%) assessed health care process measures, 29 (20%) assessed clinical outcomes, and 22 (15%) measured costs. Both commercially and locally developed CDSSs improved health care process measures related to performing preventive services (n =25; odds ratio [OR] 1.42, 95% CI [1.27 to 1.58]), ordering clinical studies (n=20; OR 1.72, 95% CI [1.47 to 2.00]), and prescribing therapies (n=46; OR 1.57, 95% CI [1.35 to 1.82]). There was heterogeneity in interventions, populations, settings and outcomes as would be expected. The authors conclude that commercially and locally developed CDSSs are effective at improving health care process measures across diverse settings, but evidence for clinical, economic, workload and efficiency outcomes remains sparse.

Delfini Comment: Although this review focused on decision support systems, the entire realm of decision support for end users is of great importance to all health care decision-makers. Without good decision support, we will all make suboptimal decisions. This area is huge and is worth spending time understanding how to move evidence from a synthesis to decision support. Interested readers might want to look at some examples of wonderful decision support materials created at the Mayo Clinic. The URL is—

http://webpages.charter.net/vmontori/Wiser_Choices_Program_Aids_Site/Welcome.html

Reference

1.  Bright TJ, Wong A, Dhurjati R, Bristow E, Bastian L, Coeytaux RR, Samsa G, Hasselblad V, Williams JW, Musty MD, Wing L, Kendrick AS, Sanders GD, Lobach D. Effect of clinical decision-support systems: a systematic review. Ann Intern Med. 2012 Jul 3;157(1):29-43. PubMed PMID: 22751758.