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Computer-Based Clinical Decision Support Systems and Patient-Reported Outcomes: A Systematic Review

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Abstract

Background

Evidence-based treatment guidelines embedded in computer-based clinical decision support systems (CCDSS) may improve patient-reported outcomes (PRO). We systematically reviewed the literature for content and application of CCDSS, and their effects on PRO.

Methods

A systematic review in MEDLINE and EMBASE was conducted according to PRISMA standards. Searches were limited to the publication period 1996–May 2014 and the English language. The search terms covered “computerized clinical decision systems” and “patient-reported outcomes”. Screening and extraction was done independently by two reviewers according to predefined inclusion (computer and guideline) and exclusion criteria (no trial, no PRO). Study and CCDSS quality was rated according to predefined criteria.

Results

The database searches identified 1,331 references. Eighty-seven full-text articles were analyzed. The main reason for exclusion was no PRO as a study outcome measure. Fifteen studies met the inclusion criteria, representing 13,480 patients. Nine studies used a computerized device to fill in data; in four studies, this was used by the patients themselves. Most of the studies presented the data to the clinician at point of care and incorporated international guidelines. Three studies showed a positive effect on PRO, but only on symptoms. Overall, no negative effects were reported. There was no association with study quality or year of study publication.

Conclusion

There are marginal positive effects of CCDSS on specific PRO. Factors that facilitate the use and effect are identified. Easy to use systems with difficult to ignore evidence-based advice need to be developed and tested.

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Acknowledgments

This review has been funded by EURO IMPACT, European Intersectorial and Multidisciplinary Palliative Care Research Training, which was funded by the European Union Seventh Framework Programme (FP7/2007-2013, under Grant agreement n° [264697]).

Competing interests

We do not report any competing interest.

Authors’ contributions

DB, SR, RO, IR, FS and SK made substantial contributions to the conception of the design and the acquisition, analysis and interpretation of data, were involved in preparing the manuscript, and have given final approval.

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Authors and Affiliations

  1. Faculty of Medicine, European Palliative Care Research Centre (PRC), Norwegian University of Science and Technology (NTNU), Cancer Clinic, St. Olavs Hospital, University Hospital in Trondheim, Trondheim, Norway

    David Blum, Sunil X. Raj & Stein Kaasa

  2. Unit for Applied Clinical Research, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway

    Ingrid I. Riphagen

  3. Kantonsspital St. Gallen, St. Gallen, Switzerland

    Rolf Oberholzer & Florian Strasser

  4. Department of Cancer Research and Molecular Medicine NTNU, Faculty of Medicine, European Palliative Research Center, 7491, Trondheim, Norway

    David Blum

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EURO IMPACT, European Intersectorial Multidisciplinary Palliative Care Research Training

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Correspondence to David Blum.

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Appendix: Collaborators

Appendix: Collaborators

Van den Block Lievea, Meeussen Koena, Brearley Sarahe, Caraceni Augustog, Cohen Joachima, Costantini Massimoh, Francke Annekeb, Harding Richardc,d, Higginson Irene Jc,d, Kaasa Steinf, Linden Karenk, Miccinesi Guidoi, Onwuteaka-Philipsen Bregjeb, Pardon Koena, Pasman Roelineb, Pautex Sophiej, Payne Sheilae, Deliens Luca,b.

EURO IMPACT aims to develop a multidisciplinary, multi-professional and inter-sectorial educational and research training framework for palliative care research in Europe. EURO IMPACT is coordinated by Prof. Luc Deliens and Prof. Lieve Van den Block of the End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgiuma. Other partners are VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, the Netherlandsb; King’s College London, Cicely Saunders Institute, Londonc; Cicely Saunders International, Londond; International Observatory on End-of-Life Care, Lancaster University, Lancaster, UKe; Norwegian University of Science and Technologyf and EAPC Research Networkg, Trondheim, Norway; Regional Palliative Care Network, IRCCS AOU San Martino-IST, Genoah and Cancer Research and Prevention Institute, Florence, Italyi; EUGMS European Union Geriatric Medicine Society, Geneva, Switzerlandj; and Springer Science and Business Media, Houten, the Netherlandsk.

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Blum, D., Raj, S.X., Oberholzer, R. et al. Computer-Based Clinical Decision Support Systems and Patient-Reported Outcomes: A Systematic Review. Patient 8, 397–409 (2015). https://doi.org/10.1007/s40271-014-0100-1

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