Grechuta Klaudia, Shokouh Pedram, Alhussein Ahmad, Müller-Wieland Dirk, Meyerhoff Juliane, Gilbert Jeremy, Purushotham Sneha, Rolland Catherine
Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany.
Adivus Medical Consultancy Mpv., Aarhus, Denmark.
Interact J Med Res. 2024 Nov 27;13:e58036. doi: 10.2196/58036.
Clinical decision support systems (CDSSs) are designed to assist in health care delivery by supporting medical practice with clinical knowledge, patient information, and other relevant types of health information. CDSSs are integral parts of health care technologies assisting in disease management, including diagnosis, treatment, and monitoring. While electronic medical records (EMRs) serve as data repositories, CDSSs are used to assist clinicians in providing personalized, context-specific recommendations derived by comparing individual patient data to evidence-based guidelines.
This targeted literature review (TLR) aimed to identify characteristics and features of both stand-alone and EMR-integrated CDSSs that influence their outcomes and benefits based on published scientific literature.
A TLR was conducted using the Embase, MEDLINE, and Cochrane databases to identify data on CDSSs published in a 10-year frame (2012-2022). Studies on computerized, guideline-based CDSSs used by health care practitioners with a focus on chronic disease areas and reporting outcomes for CDSS utilization were eligible for inclusion.
A total of 49 publications were included in the TLR. Studies predominantly reported on EMR-integrated CDSSs (ie, connected to an EMR database; n=32, 65%). The implementation of CDSSs varied globally, with substantial utilization in the United States and within the domain of cardio-renal-metabolic diseases. CDSSs were found to positively impact "quality assurance" (n=35, 69%) and provide "clinical benefits" (n=20, 41%), compared to usual care. Among CDSS features, treatment guidance and flagging were consistently reported as the most frequent elements for enhancing health care, followed by risk level estimation, diagnosis, education, and data export. The effectiveness of a CDSS was evaluated most frequently in primary care settings (n=34, 69%) across cardio-renal-metabolic disease areas (n=32, 65%), especially in diabetes (n=13, 26%). Studies reported CDSSs to be commonly used by a mixed group (n=27, 55%) of users including physicians, specialists, nurses or nurse practitioners, and allied health care professionals.
Overall, both EMR-integrated and stand-alone CDSSs showed positive results, suggesting their benefits to health care providers and potential for successful adoption. Flagging and treatment recommendation features were commonly used in CDSSs to improve patient care; other features such as risk level estimation, diagnosis, education, and data export were tailored to specific requirements and collectively contributed to the effectiveness of health care delivery. While this TLR demonstrated that both stand-alone and EMR-integrated CDSSs were successful in achieving clinical outcomes, the heterogeneity of included studies reflects the evolving nature of this research area, underscoring the need for further longitudinal studies to elucidate aspects that may impact their adoption in real-world scenarios.
临床决策支持系统（CDSS）旨在通过利用临床知识、患者信息及其他相关健康信息类型来支持医疗实践，从而辅助医疗服务的提供。CDSS是协助疾病管理（包括诊断、治疗和监测）的医疗技术的重要组成部分。电子病历（EMR）作为数据存储库，而CDSS则用于通过将个体患者数据与循证指南进行比较，协助临床医生提供个性化的、针对具体情况的建议。
本定向文献综述（TLR）旨在根据已发表的科学文献，确定独立型和与EMR集成型CDSS的特征及功能，这些特征和功能会影响其结果和效益。
使用Embase、MEDLINE和Cochrane数据库进行TLR，以识别在10年时间框架（2012 - 2022年）内发表的关于CDSS的数据。纳入的研究需是医疗从业者使用的基于计算机化、指南的CDSS，重点关注慢性病领域并报告CDSS使用的结果。
TLR共纳入49篇出版物。研究主要报道了与EMR集成的CDSS（即连接到EMR数据库；n = 32，65%）。CDSS的实施在全球范围内各不相同，在美国以及心脏 - 肾脏 - 代谢疾病领域有大量应用。与常规护理相比，发现CDSS对“质量保证”有积极影响（n = 35，69%）并提供“临床效益”（n = 20，41%）。在CDSS功能中，治疗指导和标记一直被报告为增强医疗保健的最常见要素，其次是风险水平估计、诊断、教育和数据导出。CDSS的有效性在心脏 - 肾脏 - 代谢疾病领域（n = 32，65%）的初级保健环境中评估最为频繁（n = 34，69%），尤其是在糖尿病方面（n = 13，26%）。研究报告称，包括医生、专科医生、护士或执业护士以及专职医疗保健专业人员在内的混合用户群体（n = 27，55%）普遍使用CDSS。
总体而言，与EMR集成的CDSS和独立型CDSS均显示出积极结果，表明它们对医疗保健提供者有益且具有成功采用的潜力。标记和治疗推荐功能在CDSS中普遍用于改善患者护理；其他功能，如风险水平估计、诊断、教育和数据导出则根据特定要求进行定制，并共同促进了医疗服务的有效性。虽然本TLR表明独立型和与EMR集成型CDSS在实现临床结果方面均取得成功，但纳入研究的异质性反映了该研究领域的不断发展性质，强调需要进一步进行纵向研究，以阐明可能影响其在实际场景中采用的因素。
