Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Diabetes Technol Ther. 2013 Feb;15(2):180-92. doi: 10.1089/dia.2012.0201.
Computerized decision support systems (CDSSs) are often part of a multifaceted intervention to improve diabetes care. We reviewed the effects of CDSSs alone or in combination with other supportive tools in primary care for type 2 diabetes mellitus (T2DM).
A systematic literature search was conducted for January 1990-July 2011 in PubMed, Embase, and the Cochrane Database and by consulting reference lists. Randomized controlled trials (RCTs) in general practice were selected if the interventions consisted of a CDSS alone or combined with a reminder system and/or feedback on performance and/or case management. The intervention had to be compared with usual care. Two pairs of reviewers independently abstracted all available data. The data were categorized by process of care and patient outcome measures.
Twenty RCTs met inclusion criteria. In 14 studies a CDSS was combined with another intervention. Two studies were left out of the analysis because of low quality. Four studies with a CDSS alone and four studies with a CDSS and reminders showed improvements of the process of care. CDSS with feedback on performance with or without reminders improved the process of care (one study) and patient outcome (two studies). CDSS with case management improved patient outcome (two studies). CDSS with reminders, feedback on performance, and case management improved both patient outcome and the process of care (two studies).
CDSSs used by healthcare providers in primary T2DM care are effective in improving the process of care; adding feedback on performance and/or case management may also improve patient outcome.
计算机决策支持系统（CDSS）通常是改善糖尿病护理的多方面干预措施的一部分。我们回顾了在 2 型糖尿病（T2DM）的初级保健中，CDSS 单独或与其他支持工具联合使用的效果。
在 1990 年 1 月至 2011 年 7 月期间，我们在 PubMed、Embase 和 Cochrane 数据库中进行了系统的文献检索，并查阅了参考文献列表。如果干预措施仅包括 CDSS 或与提醒系统和/或绩效反馈和/或病例管理相结合，则选择在全科医学中进行的随机对照试验（RCT）。干预措施必须与常规护理进行比较。两对评审员独立提取所有可用数据。根据护理过程和患者结果测量指标对数据进行分类。
20 项 RCT 符合纳入标准。在 14 项研究中，CDSS 与其他干预措施相结合。由于质量低，有两项研究被排除在分析之外。四项单独使用 CDSS 的研究和四项使用 CDSS 和提醒的研究显示出护理过程的改善。具有或不具有提醒的绩效反馈的 CDSS 改善了护理过程（一项研究）和患者结局（两项研究）。具有病例管理的 CDSS 改善了患者结局（两项研究）。具有提醒、绩效反馈和病例管理的 CDSS 改善了患者结局和护理过程（两项研究）。
在 T2DM 初级保健中使用的医疗保健提供者的 CDSS 可有效改善护理过程；添加绩效反馈和/或病例管理可能也会改善患者结局。
