of trials to identify features critical to success decision support systems: a systematic review Improving clinical practice using clinical
of trials to identify features critical to success decision support systems: a systematic review Improving clinical practice using clinical
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发表时间：
2006
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通讯作者：
Kensaku Kawamoto;C. Houlihan;A. Balas;D. Lobach
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作者：
Kensaku Kawamoto;C. Houlihan;A. Balas;D. Lobach
目的了解临床决策支持系统的特点，为提高临床实践水平提供参考。设计随机对照试验的系统评价。数据来源：通过Medline、CINAHL和科克伦对照试验注册库检索文献（截至2003年）;检索纳入研究和相关综述的参考文献列表。研究选择研究必须评估决策支持系统改善临床实践的能力。数据提取研究评估了临床实践中的统计学和临床显著性改善以及文献中反复提出的15个决策支持系统功能的存在。结果共纳入70篇文献。在68%的试验中，决策支持系统显著改善了临床实践。单变量分析显示，对于五个系统功能，具有该功能的干预措施比缺乏该功能的干预措施更有可能改善临床实践。多元逻辑回归分析确定了四个特征作为改善临床实践的独立预测因素：自动提供决策支持作为临床医生工作流程的一部分（P < 0.00001），提供建议而不仅仅是评估（P = 0.0187），在决策的时间和地点提供决策支持（P = 0.0263）和基于计算机的决策支持（P = 0.0294）。在32个具有所有四个功能的系统中，30个（94%）显著改善了临床实践。此外，直接的实验理由，发现提供定期的性能反馈，与患者分享建议，并要求文件的原因不遵循的建议。结论：有几个特征与决策支持系统显著改善患者护理的能力密切相关。临床医生和其他利益相关者应实施临床决策支持系统，在可行和适当的情况下纳入这些功能。
Objective To identify features of clinical decision support systems critical for improving clinical practice. Design Systematic review of randomised controlled trials. Data sources Literature searches via Medline, CINAHL, and the Cochrane Controlled Trials Register up to 2003; and searches of reference lists of included studies and relevant reviews. Study selection Studies had to evaluate the ability of decision support systems to improve clinical practice. Data extraction Studies were assessed for statistically and clinically significant improvement in clinical practice and for the presence of 15 decision support system features whose importance had been repeatedly suggested in the literature. Results Seventy studies were included. Decision support systems significantly improved clinical practice in 68% of trials. Univariate analyses revealed that, for five of the system features, interventions possessing the feature were significantly more likely to improve clinical practice than interventions lacking the feature. Multiple logistic regression analysis identified four features as independent predictors of improved clinical practice: automatic provision of decision support as part of clinician workflow (P < 0.00001), provision of recommendations rather than just assessments (P = 0.0187), provision of decision support at the time and location of decision making (P = 0.0263), and computer based decision support (P = 0.0294). Of 32 systems possessing all four features, 30 (94%) significantly improved clinical practice. Furthermore, direct experimental justification was found for providing periodic performance feedback, sharing recommendations with patients, and requesting documentation of reasons for not following recommendations. Conclusions Several features were closely correlated with decision support systems’ ability to improve patient care significantly. Clinicians and other stakeholders should implement clinical decision support systems that incorporate these features whenever feasible and appropriate.