Standiford Taylor C, Farlow Janice L, Brenner Michael J, Conte Marisa L, Terrell Jeffrey E
University of Michigan Medical School, Ann Arbor, Michigan, USA.
Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Otolaryngol Head Neck Surg. 2022 Jan;166(1):35-47. doi: 10.1177/01945998211004529. Epub 2021 Apr 20.
To offer practical, evidence-informed knowledge on clinical decision support systems (CDSSs) and their utility in improving care and reducing costs in otolaryngology-head and neck surgery. This primer on CDSSs introduces clinicians to both the capabilities and the limitations of this technology, reviews the literature on current state, and seeks to spur further progress in this area.
PubMed/MEDLINE, Embase, and Web of Science.
Scoping review of CDSS literature applicable to otolaryngology clinical practice. Investigators identified articles that incorporated knowledge-based computerized CDSSs to aid clinicians in decision making and workflow. Data extraction included level of evidence, Osheroff classification of CDSS intervention type, otolaryngology subspecialty or domain, and impact on provider performance or patient outcomes.
Of 3191 studies retrieved, 11 articles met formal inclusion criteria. CDSS interventions included guideline or protocols support (n = 8), forms and templates (n = 5), data presentation aids (n = 2), and reactive alerts, reference information, or order sets (all n = 1); 4 studies had multiple interventions. CDSS studies demonstrated effectiveness across diverse domains, including antibiotic stewardship, cancer survivorship, guideline adherence, data capture, cost reduction, and workflow. Implementing CDSSs often involved collaboration with health information technologists.
While the published literature on CDSSs in otolaryngology is finite, CDSS interventions are proliferating in clinical practice, with roles in preventing medical errors, streamlining workflows, and improving adherence to best practices for head and neck disorders. Clinicians may collaborate with information technologists and health systems scientists to develop, implement, and investigate the impact of CDSSs in otolaryngology.
提供关于临床决策支持系统（CDSS）的实用、基于证据的知识，以及其在改善耳鼻喉科 - 头颈外科护理和降低成本方面的效用。这本关于CDSS的入门读物向临床医生介绍了这项技术的功能和局限性，回顾了当前状态的文献，并力求推动该领域的进一步发展。
PubMed/MEDLINE、Embase和科学网。
对适用于耳鼻喉科临床实践的CDSS文献进行范围综述。研究人员确定了纳入基于知识的计算机化CDSS以协助临床医生进行决策和工作流程的文章。数据提取包括证据水平、CDSS干预类型的奥谢罗夫分类、耳鼻喉科亚专业或领域，以及对提供者表现或患者结局的影响。
在检索到的3191项研究中，11篇文章符合正式纳入标准。CDSS干预包括指南或方案支持（n = 8）、表格和模板（n = 5）、数据呈现辅助工具（n = 2）以及反应性警报、参考信息或医嘱集（均n = 1）；4项研究有多种干预措施。CDSS研究在包括抗生素管理、癌症幸存者护理、指南依从性、数据采集、成本降低和工作流程等不同领域均显示出有效性。实施CDSS通常需要与健康信息技术人员合作。
虽然耳鼻喉科CDSS的已发表文献有限，但CDSS干预在临床实践中正在激增，在预防医疗错误、简化工作流程以及提高对头颈疾病最佳实践的依从性方面发挥作用。临床医生可与信息技术人员和卫生系统科学家合作，开发、实施和研究CDSS在耳鼻喉科的影响。
