Health Information Management Research Center, Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran.
Department of Health Information Technology & Management, School of Public Health, Shahid Sadoughi (Yazd) University of Medical Sciences, Yazd, Iran.
Hosp Pract (1995). 2023 Aug;51(3):110-123. doi: 10.1080/21548331.2023.2203051. Epub 2023 Apr 17.
This systematic review was conducted to investigate the characteristics and effects of clinical decision support systems (CDSSs) on clinical and process-of-care outcomes of patients with kidney disease.
A comprehensive systematic search was conducted in electronic databases to identify relevant studies published until November 2020. Randomized clinical trials evaluating the effects of using electronic CDSS on at least one clinical or process-of-care outcome in patients with kidney disease were included in this study. The characteristics of the included studies, features of CDSSs, and effects of the interventions on the outcomes were extracted. Studies were appraised for quality using the Cochrane risk-of-bias assessment tool.
Out of 8722 retrieved records, 11 eligible studies measured 32 outcomes, including 10 clinical outcomes and 22 process-of-care outcomes. The effects of CDSSs on 45.5% of the process-of-care outcomes were statistically significant, and all the clinical outcomes were not statistically significant. Medication-related process-of-care outcomes were the most frequently measured (54.5%), and CDSSs had the most effective and positive effect on medication appropriateness (18.2%). The characteristics of CDSSs investigated in the included studies comprised automatic data entry, real-time feedback, providing recommendations, and CDSS integration with the Computerized Provider Order Entry system.
Although CDSS may potentially be able to improve processes of care for patients with kidney disease, particularly with regard to medication appropriateness, no evidence was found that CDSS affects clinical outcomes in these patients. Further research is thus required to determine the effects of CDSSs on clinical outcomes in patients with kidney diseases.
本系统评价旨在研究临床决策支持系统（CDSS）对肾脏病患者临床和医疗过程结果的特征和影响。
系统检索电子数据库，以查找截至 2020 年 11 月发表的相关研究。本研究纳入了评估使用电子 CDSS 对肾脏病患者至少一项临床或医疗过程结果影响的随机临床试验。提取纳入研究的特征、CDSS 的特征以及干预对结果的影响。使用 Cochrane 偏倚风险评估工具对研究进行质量评估。
在 8722 条检索记录中，有 11 项符合条件的研究测量了 32 项结果，包括 10 项临床结果和 22 项医疗过程结果。CDSS 对 45.5%的医疗过程结果的影响具有统计学意义，而所有临床结果均无统计学意义。药物相关的医疗过程结果是最常测量的（54.5%），CDSS 对药物适宜性的影响最有效和最积极（18.2%）。纳入研究中调查的 CDSS 的特征包括自动数据录入、实时反馈、提供建议以及 CDSS 与计算机医嘱录入系统的整合。
虽然 CDSS 可能能够潜在地改善肾脏病患者的医疗过程，特别是在药物适宜性方面，但没有证据表明 CDSS 影响这些患者的临床结果。因此，需要进一步研究以确定 CDSS 对肾脏病患者临床结果的影响。
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