Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
Digital Health and Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia.
J Am Med Inform Assoc. 2023 May 19;30(6):1205-1218. doi: 10.1093/jamia/ocad040.
Sustainable investment in computerized decision support systems (CDSS) requires robust evaluation of their economic impacts compared with current clinical workflows. We reviewed current approaches used to evaluate the costs and consequences of CDSS in hospital settings and presented recommendations to improve the generalizability of future evaluations.
A scoping review of peer-reviewed research articles published since 2010. Searches were completed in the PubMed, Ovid Medline, Embase, and Scopus databases (last searched February 14, 2023). All studies reported the costs and consequences of a CDSS-based intervention compared with current hospital workflows. Findings were summarized using narrative synthesis. Individual studies were further appraised against the Consolidated Health Economic Evaluation and Reporting (CHEERS) 2022 checklist.
Twenty-nine studies published since 2010 were included. Studies evaluated CDSS for adverse event surveillance (5 studies), antimicrobial stewardship (4 studies), blood product management (8 studies), laboratory testing (7 studies), and medication safety (5 studies). All studies evaluated costs from a hospital perspective but varied based on the valuation of resources affected by CDSS implementation, and the measurement of consequences. We recommend future studies follow guidance from the CHEERS checklist; use study designs that adjust for confounders; consider both the costs of CDSS implementation and adherence; evaluate consequences that are directly or indirectly affected by CDSS-initiated behavior change; examine the impacts of uncertainty and differences in outcomes across patient subgroups.
Improving consistency in the conduct and reporting of evaluations will enable detailed comparisons between promising initiatives, and their subsequent uptake by decision-makers.
与当前临床工作流程相比，可持续投资于计算机化决策支持系统（CDSS）需要对其经济影响进行强有力的评估。我们回顾了目前用于评估医院环境中 CDSS 成本和结果的方法，并提出了改进未来评估通用性的建议。
对 2010 年以来发表的同行评议研究文章进行范围综述。在 PubMed、Ovid Medline、Embase 和 Scopus 数据库中进行了搜索（最后一次搜索日期为 2023 年 2 月 14 日）。所有研究均报告了基于 CDSS 的干预措施与当前医院工作流程相比的成本和结果。使用叙述性综合法总结研究结果。根据 2022 年健康经济评估和报告综合（CHEERS）清单对个别研究进行了进一步评估。
自 2010 年以来共纳入 29 项研究。这些研究评估了 CDSS 在不良事件监测（5 项研究）、抗菌药物管理（4 项研究）、血液制品管理（8 项研究）、实验室检测（7 项研究）和药物安全（5 项研究）方面的应用。所有研究均从医院角度评估了成本，但因 CDSS 实施所影响资源的估值以及后果的测量方法而存在差异。我们建议未来的研究遵循 CHEERS 清单的指导；使用能够调整混杂因素的研究设计；考虑 CDSS 实施和依从性的成本；评估直接或间接受到 CDSS 启动的行为改变影响的结果；检查不确定性和患者亚组之间结果差异的影响。
提高评估的实施和报告的一致性将使有前景的举措之间能够进行详细比较，并使决策者随后能够采用这些举措。
