Improving clinical practice using clinical decision support systems: A systematic review of trials to identify features critical to success

Kensaku Kawamoto, Caitlin A. Houlihan, E Andrew Balas, David F. Lobach

Research output: Contribution to journalReview article

1434 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)765-768
Number of pages4
JournalBritish Medical Journal
Volume330
Issue number7494
StatePublished - Apr 2 2005
Externally publishedYes

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Clinical Decision Support Systems
Aptitude
Workflow
Information Storage and Retrieval
Documentation
Decision Making
Patient Care
Randomized Controlled Trials
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Improving clinical practice using clinical decision support systems : A systematic review of trials to identify features critical to success. / Kawamoto, Kensaku; Houlihan, Caitlin A.; Balas, E Andrew; Lobach, David F.

In: British Medical Journal, Vol. 330, No. 7494, 02.04.2005, p. 765-768.

Research output: Contribution to journalReview article

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