Health Information Management Research Center (HIMRC), 5th of Qotb -e Ravandi Blvd, Kashan University of Medical Science, 87159-73449, Kashan, Iran.
Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, Iran.
BMC Med Inform Decis Mak. 2021 Jan 18;21(1):20. doi: 10.1186/s12911-020-01384-8.
Studies have revealed inappropriate laboratory testing as a source of waste. This review aimed at evaluating the effects and features of CDSSs on physicians' appropriate laboratory test ordering in inpatient hospitals.
Medline through PubMed, SCOPUS, Web of Science, and Cochrane were queried without any time period restriction. Studies using CDSSs as an intervention to improve laboratory test ordering as the primary aim were included. The study populations in the included studies were laboratory tests, physicians ordering laboratory tests, or the patients for whom laboratory tests were ordered. The included papers were evaluated for their outcomes related to the effect of CDSSs which were categorized based on the outcomes related to tests, physician, and patients. The primary outcome measures were the number and cost of the ordered laboratory tests. The instrument from The National Heart Lung and Blood Institute (NIH) was used to assess the quality of the included studies. Moreover, we applied a checklist for assessing the quality and features of the CDSSs presented in the included studies. A narrative synthesis was used to describe and compare the designs and the results of included studies.
Sixteen studies met the inclusion criteria. Most studies were conducted based on a quasi-experimental design. The results showed improvement in laboratory test-related outcomes (e.g. proportion and cost of tests) and also physician-related outcomes (e.g. guideline adherence and orders cancellation). Patient-related outcomes (e.g. length of stay and mortality rate) were not well investigated in the included studies. In addition, the evidence about applying CDSS as a decision aid for interpreting laboratory results was rare.
CDSSs increase appropriate test ordering in hospitals through eliminating redundant test orders and enhancing evidence-based practice. Appropriate testing and cost saving were both affected by the CDSSs. However, the evidence is limited about the effects of laboratory test CDSSs on patient-related outcomes.
研究表明，实验室检测不当是造成浪费的一个原因。本综述旨在评估计算机决策支持系统（CDSS）对住院医师适当的实验室检测医嘱的影响和特点。
无时间限制地检索了 Medline 数据库（通过 PubMed）、SCOPUS、Web of Science 和 Cochrane 数据库。纳入以 CDSS 作为干预措施，以改善实验室检测医嘱为主要目的的研究。纳入研究的研究人群为实验室检测、医师下达的实验室检测医嘱或接受实验室检测的患者。根据与 CDSS 效果相关的检测、医师和患者相关的结果对纳入的研究进行评估。主要结局指标为医嘱的实验室检测数量和成本。采用美国国立心肺血液研究所（NIH）的工具评估纳入研究的质量。此外，我们应用了一个评估纳入研究中 CDSS 质量和特点的清单。采用叙述性综合法来描述和比较纳入研究的设计和结果。
16 项研究符合纳入标准。大多数研究基于准实验设计。结果表明，实验室检测相关结局（如检测的比例和成本）和医师相关结局（如指南依从性和医嘱取消）得到改善。纳入研究中并未很好地调查患者相关结局（如住院时间和死亡率）。此外，关于将 CDSS 作为解释实验室结果的决策辅助工具的证据很少。
CDSS 通过消除冗余的检测医嘱和增强基于证据的实践，增加了医院的适当检测医嘱。适当的检测和成本节约都受到 CDSS 的影响。然而，关于实验室检测 CDSS 对患者相关结局的影响的证据有限。
