TY - JOUR
T1 - Design, effectiveness, and economic outcomes of contemporary chronic disease clinical decision support systems
T2 - A systematic review and meta-analysis
AU - Chen, Winnie
AU - Howard, Kirsten
AU - Gorham, Gillian
AU - O'Bryan, Claire Maree
AU - Coffey, Patrick
AU - Balasubramanya, Bhavya
AU - Abeyaratne, Asanga
AU - Cass, Alan
N1 - Funding Information:
This research was supported by the Royal Australian College of General
Practitioners (RACGP), the Australian Government Research Training
Program (RTP) Scholarship, and Menzies School of Health Research
scholarship.
PY - 2022/9/12
Y1 - 2022/9/12
N2 - OBJECTIVES: Electronic health record-based clinical decision support (CDS) has the potential to improve health outcomes. This systematic review investigates the design, effectiveness, and economic outcomes of CDS targeting several common chronic diseases. MATERIAL AND METHODS: We conducted a search in PubMed (Medline), EBSCOHOST (CINAHL, APA PsychInfo, EconLit), and Web of Science. We limited the search to studies from 2011 to 2021. Studies were included if the CDS was electronic health record-based and targeted one or more of the following chronic diseases: cardiovascular disease, diabetes, chronic kidney disease, hypertension, and hypercholesterolemia. Studies with effectiveness or economic outcomes were considered for inclusion, and a meta-analysis was conducted. RESULTS: The review included 76 studies with effectiveness outcomes and 9 with economic outcomes. Of the effectiveness studies, 63% described a positive outcome that favored the CDS intervention group. However, meta-analysis demonstrated that effect sizes were heterogenous and small, with limited clinical and statistical significance. Of the economic studies, most full economic evaluations (n = 5) used a modeled analysis approach. Cost-effectiveness of CDS varied widely between studies, with an estimated incremental cost-effectiveness ratio ranging between USD$2192 to USD$151 955 per QALY. CONCLUSION: We summarize contemporary chronic disease CDS designs and evaluation results. The effectiveness and cost-effectiveness results for CDS interventions are highly heterogeneous, likely due to differences in implementation context and evaluation methodology. Improved quality of reporting, particularly from modeled economic evaluations, would assist decision makers to better interpret and utilize results from these primary research studies. REGISTRATION: PROSPERO (CRD42020203716).
AB - OBJECTIVES: Electronic health record-based clinical decision support (CDS) has the potential to improve health outcomes. This systematic review investigates the design, effectiveness, and economic outcomes of CDS targeting several common chronic diseases. MATERIAL AND METHODS: We conducted a search in PubMed (Medline), EBSCOHOST (CINAHL, APA PsychInfo, EconLit), and Web of Science. We limited the search to studies from 2011 to 2021. Studies were included if the CDS was electronic health record-based and targeted one or more of the following chronic diseases: cardiovascular disease, diabetes, chronic kidney disease, hypertension, and hypercholesterolemia. Studies with effectiveness or economic outcomes were considered for inclusion, and a meta-analysis was conducted. RESULTS: The review included 76 studies with effectiveness outcomes and 9 with economic outcomes. Of the effectiveness studies, 63% described a positive outcome that favored the CDS intervention group. However, meta-analysis demonstrated that effect sizes were heterogenous and small, with limited clinical and statistical significance. Of the economic studies, most full economic evaluations (n = 5) used a modeled analysis approach. Cost-effectiveness of CDS varied widely between studies, with an estimated incremental cost-effectiveness ratio ranging between USD$2192 to USD$151 955 per QALY. CONCLUSION: We summarize contemporary chronic disease CDS designs and evaluation results. The effectiveness and cost-effectiveness results for CDS interventions are highly heterogeneous, likely due to differences in implementation context and evaluation methodology. Improved quality of reporting, particularly from modeled economic evaluations, would assist decision makers to better interpret and utilize results from these primary research studies. REGISTRATION: PROSPERO (CRD42020203716).
KW - chronic disease
KW - clinical decision support systems
KW - economic evaluation
KW - meta-analysis
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85138444990&partnerID=8YFLogxK
U2 - 10.1093/jamia/ocac110
DO - 10.1093/jamia/ocac110
M3 - Article
C2 - 35818299
AN - SCOPUS:85138444990
SN - 1067-5027
VL - 29
SP - 1757
EP - 1772
JO - Journal of the American Medical Informatics Association : JAMIA
JF - Journal of the American Medical Informatics Association : JAMIA
IS - 10
ER -
