Effect of Interventions With a Clinical Decision Support System for Hospitalized Older Patients: Systematic Review Mapping Implementation and Design Factors.
Effect of Interventions With a Clinical Decision Support System for Hospitalized Older Patients: Systematic Review Mapping Implementation and Design Factors.
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DOI：
10.2196/28023
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发表时间：
2021-07-16
影响因子：
3.2
通讯作者：
Medlock S
中科院分区：
文献类型：
--
作者：
Damoiseaux-Volman BA;van der Velde N;Ruige SG;Romijn JA;Abu-Hanna A;Medlock S
临床决策支持系统(CDSS)形成了一种实施战略，可以促进和支持卫生保健专业人员护理老年住院患者。我们的研究旨在系统地回顾CDSS干预对老年住院患者的影响。作为次要目标，我们旨在总结有效和无效干预措施中描述的实施和设计因素，并找出当前文献中的差距。我们在MEDLINE、EMBASE和SCOPUS数据库中进行了一项系统的回顾，搜索策略结合了老年患者、老年主题、医院、CDSS和干预的类别。我们纳入了对照研究，提取了所有报告结果的数据，以及潜在有益的设计和实施因素。我们使用GROL和WISTING变革实施模型、指南(指南实施和决策支持)核对表和双流模型构建了这些因素。使用Cochrane协作的有效实践和护理组织的偏倚风险方法来评估纳入研究的偏倚风险。我们的系统评价包括18项干预措施，其中13项(72%)在改善护理方面有效。在这些干预措施中，8例(6例有效)集中在药物评估上，8例(6例有效)集中在神志不清方面，7例(4例有效)用于跌倒，5例(4例有效)用于功能减退，4例(3例有效)用于出院或后续护理，2例(0有效)用于压疮。在77%(10/13)的有效干预措施中，效果基于过程相关的结果，15%(2/13)的干预措施同时基于过程和患者相关的结果，8%(1/13)的干预措施基于患者相关的结果。以下实施和设计因素可能与有效性有关：先验问题或绩效分析(9/13，69%有效对0/5，0%无效干预)，多方面干预(8/13，62%对1/5，20%)，以及对工作流程的考虑(9/13，69%对1/5，20%)。CDSS干预可以改善老年患者的医院护理，主要是与过程相关的结果。我们确定了2个实施因素和1个设计因素，这些因素在有关有效干预的文章中报告得更频繁。需要更多具有强有力设计的研究来衡量CDSS对相关患者相关结果的影响，调查个性化(数据驱动)干预，并量化实施和设计因素对CDSS有效性的影响。国际前瞻性系统评价登记：CRD42019124470；https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=124470.
Clinical decision support systems (CDSSs) form an implementation strategy that can facilitate and support health care professionals in the care of older hospitalized patients. Our study aims to systematically review the effects of CDSS interventions in older hospitalized patients. As a secondary aim, we aim to summarize the implementation and design factors described in effective and ineffective interventions and identify gaps in the current literature. We conducted a systematic review with a search strategy combining the categories older patients, geriatric topic, hospital, CDSS, and intervention in the databases MEDLINE, Embase, and SCOPUS. We included controlled studies, extracted data of all reported outcomes, and potentially beneficial design and implementation factors. We structured these factors using the Grol and Wensing Implementation of Change model, the GUIDES (Guideline Implementation with Decision Support) checklist, and the two-stream model. The risk of bias of the included studies was assessed using the Cochrane Collaboration’s Effective Practice and Organisation of Care risk of bias approach. Our systematic review included 18 interventions, of which 13 (72%) were effective in improving care. Among these interventions, 8 (6 effective) focused on medication review, 8 (6 effective) on delirium, 7 (4 effective) on falls, 5 (4 effective) on functional decline, 4 (3 effective) on discharge or aftercare, and 2 (0 effective) on pressure ulcers. In 77% (10/13) effective interventions, the effect was based on process-related outcomes, in 15% (2/13) interventions on both process- and patient-related outcomes, and in 8% (1/13) interventions on patient-related outcomes. The following implementation and design factors were potentially associated with effectiveness: a priori problem or performance analyses (described in 9/13, 69% effective vs 0/5, 0% ineffective interventions), multifaceted interventions (8/13, 62% vs 1/5, 20%), and consideration of the workflow (9/13, 69% vs 1/5, 20%). CDSS interventions can improve the hospital care of older patients, mostly on process-related outcomes. We identified 2 implementation factors and 1 design factor that were reported more frequently in articles on effective interventions. More studies with strong designs are needed to measure the effect of CDSS on relevant patient-related outcomes, investigate personalized (data-driven) interventions, and quantify the impact of implementation and design factors on CDSS effectiveness. PROSPERO (International Prospective Register of Systematic Reviews): CRD42019124470; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=124470.
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影响因子：
5.7
作者：
Boustani, Malaz A.;Campbell, Noll L.;Callahan, Christopher M.
通讯作者：
Callahan, Christopher M.
DOI：
10.1016/j.ijmedinf.2013.06.012
发表时间：
2013-11-01
影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
Beers, MH
影响因子：
6.3
作者：
American Geriatrics Society 2012 Beers Criteria Update Expert Panel
通讯作者：
American Geriatrics Society 2012 Beers Criteria Update Expert Panel