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PMID: 15767266 Published · ppublish English Journal Article Research Support, U.S. Gov't, P.H.S. Review Systematic Review

Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success.

BMJ (Clinical research ed.) ·Vol. 330 ·No. 7494 ·2005-04-02 ·Pages 765

Kawamoto K, Houlihan CA, Balas EA, Lobach DF

Abstract

To identify features of clinical decision support systems critical for improving clinical practice. Systematic review of randomised controlled trials. Literature searches via Medline, CINAHL, and the Cochrane Controlled Trials Register up to 2003; and searches of reference lists of included studies and relevant reviews. Studies had to evaluate the ability of decision support systems to improve clinical practice. Studies were assessed for statistically and clinically significant improvement in clinical practice and for the presence of 15 decision support system features whose importance had been repeatedly suggested in the literature. Seventy studies were included. Decision support systems significantly improved clinical practice in 68% of trials. Univariate analyses revealed that, for five of the system features, interventions possessing the feature were significantly more likely to improve clinical practice than interventions lacking the feature. Multiple logistic regression analysis identified four features as independent predictors of improved clinical practice: automatic provision of decision support as part of clinician workflow (P < 0.00001), provision of recommendations rather than just assessments (P = 0.0187), provision of decision support at the time and location of decision making (P = 0.0263), and computer based decision support (P = 0.0294). Of 32 systems possessing all four features, 30 (94%) significantly improved clinical practice. Furthermore, direct experimental justification was found for providing periodic performance feedback, sharing recommendations with patients, and requesting documentation of reasons for not following recommendations. Several features were closely correlated with decision support systems' ability to improve patient care significantly. Clinicians and other stakeholders should implement clinical decision support systems that incorporate these features whenever feasible and appropriate.

MeSH Terms
Decision Making Decision Support Systems, Clinical Professional Practice/standards Randomized Controlled Trials as Topic Regression Analysis
Authors & Affiliations
4 authors, click to expand affiliations / ORCID
Kawamoto Kensaku
Division of Clinical Informatics, Department of Community and Family Medicine, Box 2914, Duke University Medical Center, Durham, NC 27710, USA.
Houlihan Caitlin A
Balas E Andrew
Lobach David F
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Article Info
Journal
BMJ (Clinical research ed.)
Abbr.
BMJ
ISSN
1756-1833
DOI
10.1136/bmj.38398.500764.8F
Published
2005-04-02
Epub
2005-00-14
Pages
765
Language
English
Region
England
NLM ID
8900488
PMCID
PMC555881
Subset
IM
Grants
NLM NIH HHS · F37-LM008161-01 · United States
AHRQ HHS · R01-HS10472 · United States
AHRQ HHS · R03-HS10814 · United States
NIGMS NIH HHS · T32-GM07171 · United States
Corrections
CommentIn
PMID: 15802700
CommentIn
PMID: 16380033
External Links
PubMed source DOI: 10.1136/bmj.38398.500764.8F PMC Full Text View journal details
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