计算机化临床决策支持系统实施与应用的障碍及促进因素：一项系统综述方案

Barriers and facilitators to the implementation and adoption of computerised clinical decision support systems: an umbrella review protocol.

作者信息

Böhm-Hustede Anna Katharina, Lubasch Johanna Sophie, Hoogestraat Anna Thalea, Buhr Eike, Wulff Antje

机构信息

Big Data in Medicine, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany.

Oldenburg Research Network Emergency- and Intensive Care Medicine (OFNI), Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany.

出版信息

Syst Rev. 2025 Jan 2;14(1):2. doi: 10.1186/s13643-024-02745-4.

DOI:10.1186/s13643-024-02745-4

PMID:39748437

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11697958/

Abstract

BACKGROUND

The implementation of computerised clinical decision support systems has the potential to enhance healthcare by improving patient safety, practitioner performance, and patient outcomes. Notwithstanding the numerous advantages, the uptake of clinical decision support systems remains constrained, thereby impeding the full realisation of their potential. To ensure the effective and successful implementation of these systems, it is essential to identify and analyse the reasons for their low uptake and adoption. This protocol outlines an umbrella review, which will synthesise the findings of existing literature reviews to generate a comprehensive overview of the barriers and facilitators to the implementation and adoption of decision support systems across healthcare settings.

METHODS

This umbrella review protocol was developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Searches for eligible articles will be conducted in four electronic bibliographic databases, including PubMed/MEDLINE, IEEE Xplore, Scopus, and Web of Science. Obtained results will be independently screened by four reviewers based on pre-defined eligibility criteria. The risk of bias will be assessed for all eligible articles. Data on barriers and facilitators to the implementation and adoption of clinical decision support systems will be extracted, summarised, and further categorised into themes that aim to describe the originating environment or concept of the respective factor. The frequency of all identified barriers and facilitators within the group of included reviews will be determined in order to establish a prioritisation of the factors.

DISCUSSION

This umbrella review protocol presents a methodology for the systematic synthesis of barriers and facilitators to the implementation and adoption of clinical decision support systems across healthcare settings. The umbrella review will enable the development of novel implementation and adoption strategies that reinforce the identified facilitators and circumvent barriers, thereby promoting the use-oriented evaluation and effective utilisation of clinical decision support systems.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42024507614.

摘要

背景

计算机化临床决策支持系统的实施有潜力通过提高患者安全性、从业者绩效和患者结局来改善医疗保健。尽管有诸多优势，但临床决策支持系统的采用仍然受到限制，从而阻碍了其潜力的充分发挥。为确保这些系统的有效和成功实施，必须识别和分析其采用率低的原因。本方案概述了一项伞状综述，该综述将综合现有文献综述的结果，以全面概述医疗保健环境中决策支持系统实施和采用的障碍及促进因素。

方法

本伞状综述方案是根据系统评价与Meta分析方案的首选报告项目（PRISMA-P）指南制定的。将在四个电子文献数据库中搜索符合条件的文章，包括PubMed/MEDLINE、IEEE Xplore、Scopus和Web of Science。获得的结果将由四名评审员根据预先定义的纳入标准独立筛选。将对所有符合条件的文章进行偏倚风险评估。将提取、总结有关临床决策支持系统实施和采用的障碍及促进因素的数据，并进一步分类为旨在描述各因素起源环境或概念的主题。将确定纳入综述组中所有已识别的障碍和促进因素的频率，以便确定因素的优先级。