Clinical decision support systems for outcome measurement and management.

Clinical decision support systems are the foundation for outcome management programs through the measurement of specific outcomes, data storage, data analysis, predictive modeling, and risk-adjusted comparison of actual outcomes with predicted outcomes. Many clinical decision support tools or databases are available to clinicians. This article reviews two widely available tools that provide clinical decision support for critical care clinicians, the Project IMPACT and APACHE III Critical Care Series clinical decision support systems. These tools are discussed with regard to risk adjustment methodology, validity, reliability, database size and representation, retrospective and prospective data and analysis, and quality control. Clinical application of clinical decision support systems for benchmarking and use in process improvement and outcome management is reviewed.