Enabling health care decisionmaking through clinical decision support and knowledge management.

摘要: Objectives To catalogue study designs used to assess the clinical effectiveness of CDSSs and KMSs, identify features that impact success CDSSs/KMSs, document CDSSs/KMSs on outcomes, knowledge types can be integrated into CDSSs/KMSs. Data sources MEDLINE(®), CINAHL(®), PsycINFO(®), Web Science(®). Review methods We included studies published in English from January 1976 through December 2010. After screening titles abstracts, full-text versions articles were reviewed by two independent reviewers. Included abstracted evidence tables Meta-analyses performed for seven domains which sufficient with common outcomes included. Results identified 15,176 articles, 323 describing 311 unique including 160 reports 148 randomized control trials (RCTs) selected inclusion. RCTs comprised 47.5 percent comparative Both commercially locally developed effectively improved health care process measures related performing preventive services (n = 25; OR 1.42, 95% confidence interval [CI] 1.27 1.58), ordering 20; 1.72, CI 1.47 2.00), prescribing therapies 46; 1.57, 1.35 1.82). Fourteen CDSS/KMS assessed correlation across all endpoints. six new features: Integration charting or order entry system. Promotion action rather than inaction. No need additional clinician data entry. Justification decision support via research evidence. Local user involvement. Provision results patients as well providers. Three previously confirmed: Automatic provision part workflow. at time location decisionmaking. a recommendation, not just an assessment. Only 29 (19.6%) 22 (14.9%) costs, 3 KMSs any outcomes. The primary source was derived structured protocols. Conclusions Strong shows are effective improving diverse settings using both systems. Evidence costs is minimal. Nine correlate successful have been newly confirmed.