Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, 610041, PR China.
School of Management, Shanxi Medical University, Taiyuan, 030001, PR China.
J Eval Clin Pract. 2019 Feb;25(1):66-77. doi: 10.1111/jep.12968. Epub 2018 Jun 26.
Systematic reviews (SRs) have shown that clinical decision support systems (CDSSs) have the potential to improve diabetes care. However, methods of measuring and presenting outcomes are varied, and conclusions have been inconsistent. In addition, the reporting and methodological quality in this field is unknown, which could affect the integrity and accuracy of research. Therefore, it is difficult to confirm whether CDSSs are effective in improving diabetes care.
To comprehensively evaluate the effects of CDSS on diabetes care and to examine the methodological and reporting qualities.
We searched PubMed, EMBASE, and Cochrane Library from their inception to February 2017. Systematic reviews investigating the effects of CDSS on diabetes care were included. Outcomes were determined in advance and assessed separately for process of care and patient outcomes. Methodological and reporting qualities were assessed by AMSTAR and PRISMA, respectively.
Seventeen SRs, consisting of 222 unique randomized controlled trials and 102 nonrandomized controlled trials, were included. Evidence that CDDS significantly impacted patient outcomes was found in 32 of 102 unique studies of the 15 SRs that examined this effect (31%). A significant impact of CDSS on process of care was found in 117 out of 143 unique studies of the 11 SRs that examined this effect (82%). Ratings for overall scores of AMSTAR resulted in a mean score of 6.5 with a range of scores from 3.5 to 10.0. Reporting quality related to methodological domains was particularly incomplete.
Clinical decision support systems improved the quality of diabetes care by inconsistently improving process of care or patient outcomes. There is evidence that CDSS for providing alerts, reminders, or feedback to participants were most likely to impact diabetes care. Poor reporting of methodological domains, together with qualitative or narrative methods to combine findings, may limit the confidence in research evidence.
系统评价（SRs）表明，临床决策支持系统（CDSSs）具有改善糖尿病护理的潜力。然而，测量和呈现结果的方法各不相同，结论也不一致。此外，该领域的报告和方法学质量未知，这可能会影响研究的完整性和准确性。因此，难以确认 CDSS 是否能有效改善糖尿病护理。
全面评估 CDSS 对糖尿病护理的影响，并检查方法学和报告质量。
我们检索了 PubMed、EMBASE 和 Cochrane Library 从其成立到 2017 年 2 月的文献。纳入了评估 CDSS 对糖尿病护理影响的系统评价。预先确定了结果，并分别评估了护理过程和患者结局。分别使用 AMSTAR 和 PRISMA 评估方法学和报告质量。
纳入了 17 项 SR，包括 222 项独特的随机对照试验和 102 项非随机对照试验。在 15 项评估该效果的 SR 中，有 32 项（31%）的研究发现 CDDS 显著影响了患者结局。在 11 项评估该效果的 SR 中，有 117 项（82%）的研究发现 CDSS 对护理过程有显著影响。AMSTAR 总分的平均评分为 6.5，范围为 3.5 至 10.0。与方法学领域相关的报告质量特别不完整。
临床决策支持系统通过不一致地改善护理过程或患者结局来提高糖尿病护理质量。有证据表明，为参与者提供警报、提醒或反馈的 CDSS 最有可能影响糖尿病护理。方法学领域报告质量差，以及结合发现的定性或叙述性方法，可能会限制对研究证据的信心。
