Table 4 Type of CCDSS and its effectiveness
Citation | CCDSS setting and format | CCDSS user | Type of CCDSS | Effect of CCDSS | |||
|---|---|---|---|---|---|---|---|
Diagnostic/Drug therapy management only/Multifaceted CCDSS | Health care process outcomes (recommended preventative care, clinical study ordered, treatment ordered) | Clinical outcomes (morbidity, mortality, HRQOL, hospitalization, adverse events) | User workload and Efficiency outcomes (user knowledge, clinician workload, efficiency) | Relationship centered outcomes (patient satisfaction)/Economic outcomes (cost and cost effectiveness)/Use and implementation (health care provider acceptance, satisfaction, use and implementation) | |||
1. Caroll et al. [35], USA. | Community/Integrated with the EMR | Practitioners | Diagnostic CCDSS: Clinician prompted to make an asthma diagnosis based on the results of a pre-screening questionnaire | Â | Primary outcome: Significantly more children diagnosed with asthma (+ effect) | Â | Â |
2. Hashimoto et al. [36], Netherlands. | Hospital/Stand alone (Internet based) | Patients | Drug therapy management based CCDSS: Corticosteroid treatment decision support for the patients based on symptoms, lung function and exhaled NO (nitric oxide) | Primary outcome: Significant decrease in corticosteroid consumption in patients with steroid dependent asthma (+ effect) | No difference in asthma control, quality of life, FEV1, exacerbations, hospitalizations between groups. (+ effect) | Â | No difference in patient satisfaction between groups |
3. Van der Meer et al. [37], Netherlands. | Community/Stand-alone (Internet based) | Patients | Multifaceted CCDSS: Weekly asthma monitoring and advice, online and group education and remote web communications | Patients’ asthma knowledge, inhaler technique improved. Medication changes occurred more often. Health care provider contacts were fewer. (+ but modest effect) | Primary outcome: Asthma related quality of life improved. Secondary: Asthma control, lung function improved, symptom-free days increased, exacerbations did not differ between groups. (+ but modest effect) |  |  |
4. Van der Meer et al. [38], Netherlands. | Community/Stand-alone (Internet based) | Patients | Multifaceted CCDSS: Weekly asthma monitoring and self-management advice. | Secondary: Significant increase in the corticosteroid dose in patients with uncontrolled asthma, but not in patients with well or partly controlled asthma. (+ effect). Adherence to ACQ monitoring gradually declined in the first month to the seventh month and then remained stable. No difference in dose of corticosteroids or LABA or LRTA after 12 months | Primary outcome: Significant improvement in asthma control in patients with partly and uncontrolled asthma. (+ effect) | Â | Â |
5. Taylor et al. [39], Australia. | Hospital/Integrated | Practitioners (ED doctors) | Multifaceted CDSS: The system integrated asthma management pathways based on current guidelines into clinical and discharge documentation. Including triage and registration, clinical documentation, treatment orders, order entry and discharge documentation. | Â | Â | Primary outcome: Significantly higher rate of asthma documentation. Secondary outcome: No significant difference in consultation time. (+ effect) | Â |
6. Fiks et al. [40], USA. | Hospital/Integrated into EHR | Practitioners | Multifaceted CCDSS: EHR based clinical alerts for influenza vaccine | Primary outcome: Increased Influenza vaccination rates. (+ effect, but not significant) | Â | Â | Â |
7. Bell et al. [41], USA. | Hospital/Integrated into EHR | Practitioners | Multifaceted CCDSS: EHR based CDS alerts and reminders based on pediatric asthma management tool (PACT) which captured asthma symptom frequency, asthma severity, facilitated ordering of controller medications, spirometry and ACP (asthma action plan) | Primary outcome: Increase in the number of controller medication prescriptions, and up-to-date asthma action plan (ACP). (+ effect, but not significant). Increase in the use of spirometry in the intervention group (+ effect, but not significant) | Â | Â | Â |
8. Rasmussen et al. [42], Denmark | Stand-alone (internet based) | Patients | Multifaceted CCDSS: Internet based asthma monitoring tool consisting of an asthma diary, action plan and a decision support for the physician | Significantly more patients using inhaled corticosteroids in the internet and specialist group (+ effect) | Primary outcome: Significant improvement in asthma symptoms, AQLQ, lung function, but no change in airway responsiveness (+ effect) | Â | Â |
9. Dexheimer et al. [43], USA. | Hospital/Integrated | Practitioners (ED physician) | Multifaceted CCDSS: Computerized detection system screened and identified patients with asthma exacerbation and a guideline based management protocol | Secondary outcome: No difference in asthma education charted, medication prescribed, follow-up appointment scheduled (No effect) | No difference in admission rate or ED length of stay (no effect) | Primary outcome: No significant difference in the time taken to make a ED disposition decision (no effect) | Â |
10. Smith et al. [44], UK. | Community/Integrated (with the EHR) | Practitioners | Multifaceted CCDSS: EHR based alerts to flag the at-risk status of patients to improve patient access and opportunistic management | Relative increase in LABA usage and decrease in nebulized B-agonists (+ effect) | Primary outcome: No significant difference in the number of people experiencing exacerbations. Relative reduction in people experiencing hospitalizations, accident and emergency attendances, out-of-hour contacts and other health care use. (+ effect, but not significant) |  | Cost –effectiveness outcome: Adjusted mean health care (NHS) cost lower among intervention practices compared to control practices (+ effect) |
11. Kattan et al. [45], USA. | Community/Stand-alone | Practitioners | Drug therapy management based CCDSS: Computer generated letter recommending change in controller medications based on NAEPP guidelines | Primary outcome: Significant increase in scheduled visits leading to stepping up of asthma medications (+ effect) | Significant decrease in ED visits. No difference in maximum number of symptom days and school days missed, decrease in the number of days with activity limitation. | Â | Intervention-reduced asthma related cost to the health services and was cost-effective. (+ effect) |
12. Tierney et al. [46], USA. | Hospital/Integrated | Practitioners (Physicians and pharmacists) | Multifaceted CCDSS: Care suggestions focusing on immunization, prescription and smoking advice | Primary outcome: No difference in the adherence to guideline-based care suggestions measured as the number of tests and treatment ordered (No effect) | No effect on quality of life, clinical symptoms, medication adherence and compliance, ED visits or hospitalizations (No effect) | Â | Significantly higher health care costs in the group receiving only physician intervention. Physicians attitude towards guidelines was mixed |
13. Martens et al. [47], Netherlands. | Community/Integrated | Practitioners (GPs) | Drug therapy management based CCDSS: Guideline based reminders when prescribing antibiotics, asthma/COPD and cholesterol prescriptions | Primary outcome: Reductions in the number of prescriptions according to the guidelines (+ effect, but not significant) | Â | Â | Providers perceived the CRS as stable and user friendly (+ effect, but not significant) |
14. Martens et al. [48], Netherlands. | Community/Integrated | Practitioners (GPs) | Drug therapy management based CCDSS: Guideline based reminders when prescribing antibiotics, asthma/COPD and cholesterol prescriptions | Primary outcome: Clinically meaningful results seen in not prescribing certain drugs in the intervention group (+ effect, but not significant) | Â | Â | Â |
15. Martens et al. [49], Netherlands. | Community/Integrated | Practitioners (GPs) | Drug therapy management based CCDSS: Guideline based reminders when prescribing antibiotics, asthma/COPD and cholesterol prescriptions | Â | Â | Significant learning curve was found (shows improvement in user knowledge) (+ effect) | Primary outcome: Provider use: Only 9% drop-out rate (because of technical problems requiring multiple updates) (+but not significant effect) Provider satisfaction: Positive attitude to the content of the reminders and satisfied with the user friendliness |
16. Kuilboer et al. [50], Netherlands. | Community/Integrated | Practitioners (General practitioners) | Multifaceted CCDSS: Asthma critic evaluates whether the patient has asthma or COPD, reviews the physicians treatment, and generates feedback | Primary outcome: Significant increase in the average number of contacts. Significant decrease in the average number of cromogylate prescriptions. No statistically significant change in the antihistamines, deptropine, and oral bronchodilator prescriptions per asthma/COPD patient per practice (+ effect) | Significant increase in FEV1 (forced expiratory volume), and peak-flow measurements per asthma/COPD patient per practice (+ effect) | Â | Â |
17. Poels et al. [51], Netherlands. | Community/Stand-alone (spirometry expert system) | Practitioners (GPs) | Multifaceted CCDSS: Presentation of data for diagnosis and management of chronic airway disease | Primary outcome: No difference in between the two groups (Spirometry expert system and sham information) in the diagnosis of COPD, asthma and absence of respiratory disease or in medication changes. Secondary: Slightly more additional diagnostic tests in the expert group (No effect) | Â | Â | Â |
18. Poels et al. [52], Netherlands. | Community/Integrated? (not clear) | Practitioners (GPs) | Multifaceted CCDSS: Spirometry expert support for change in diagnosis and management | Primary outcome: No differences in the proportion of changed diagnosis between the three groups (spirometry expert system, chest physician and usual care). Also no difference between the groups in referral rate, additional diagnostic tests and medication changes (No effect) | Â | Â | Â |
19. Frickton et al. [53], USA. | Community/Integrated (with the EDR) | Practitioners (Dentists) and patients | Multifaceted CCDSS: EDR (Electronic dental record) based alerts notifying the dentists of the presence of a medically complex condition in a patient with a link to modify dental care appropriately | Â | Â | Â | Primary outcome: Significant increase in the frequency of dentists accessing guidelines (number of website hits and number of providers using the guideline). Only number of hits sustained after 6 months. After 9 months provider use returned to baseline levels (+ effect) |