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Adoption of clinical decision support in multimorbidity: a systematic review.

Fraccaro P, Arguello Casteleiro M, Ainsworth J, Buchan I - JMIR Med Inform (2015)

Bottom Line: For articles appropriate for this review, data were collected on clinical tasks, diseases, decision maker, methods, data input context, user interface considerations, and evaluation of effectiveness.There were no rigorous evaluations of usability or effectiveness of the CDS systems reported.The data needed to build this evidence base exist in many electronic health record systems and are underused.

View Article: PubMed Central - HTML - PubMed

Affiliation: NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health, The University of Manchester, Manchester, United Kingdom. paolo.fraccaro@postgrad.manchester.ac.uk.

ABSTRACT

Background: Patients with multiple conditions have complex needs and are increasing in number as populations age. This multimorbidity is one of the greatest challenges facing health care. Having more than 1 condition generates (1) interactions between pathologies, (2) duplication of tests, (3) difficulties in adhering to often conflicting clinical practice guidelines, (4) obstacles in the continuity of care, (5) confusing self-management information, and (6) medication errors. In this context, clinical decision support (CDS) systems need to be able to handle realistic complexity and minimize iatrogenic risks.

Objective: The aim of this review was to identify to what extent CDS is adopted in multimorbidity.

Methods: This review followed PRISMA guidance and adopted a multidisciplinary approach. Scopus and PubMed searches were performed by combining terms from 3 different thesauri containing synonyms for (1) multimorbidity and comorbidity, (2) polypharmacy, and (3) CDS. The relevant articles were identified by examining the titles and abstracts. The full text of selected/relevant articles was analyzed in-depth. For articles appropriate for this review, data were collected on clinical tasks, diseases, decision maker, methods, data input context, user interface considerations, and evaluation of effectiveness.

Results: A total of 50 articles were selected for the full in-depth analysis and 20 studies were included in the final review. Medication (n=10) and clinical guidance (n=8) were the predominant clinical tasks. Four studies focused on merging concurrent clinical practice guidelines. A total of 17 articles reported their CDS systems were knowledge-based. Most articles reviewed considered patients' clinical records (n=19), clinical practice guidelines (n=12), and clinicians' knowledge (n=10) as contextual input data. The most frequent diseases mentioned were cardiovascular (n=9) and diabetes mellitus (n=5). In all, 12 articles mentioned generalist doctor(s) as the decision maker(s). For articles reviewed, there were no studies referring to the active involvement of the patient in the decision-making process or to patient self-management. None of the articles reviewed adopted mobile technologies. There were no rigorous evaluations of usability or effectiveness of the CDS systems reported.

Conclusions: This review shows that multimorbidity is underinvestigated in the informatics of supporting clinical decisions. CDS interventions that systematize clinical practice guidelines without considering the interactions of different conditions and care processes may lead to unhelpful or harmful clinical actions. To improve patient safety in multimorbidity, there is a need for more evidence about how both conditions and care processes interact. The data needed to build this evidence base exist in many electronic health record systems and are underused.

No MeSH data available.


Related in: MedlinePlus

Review flow diagram.
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Related In: Results  -  Collection

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figure1: Review flow diagram.

Mentions: In Scopus, the query created imposed that the relevant terms selected appear in the title, abstract, or keywords. The search yielded 954 articles (see Figure 1). Only literature from the social sciences, arts, and humanities was excluded from the search, and no restriction on the type of publication was imposed. Therefore, a wider selection of articles beyond the grey literature was retrieved.


Adoption of clinical decision support in multimorbidity: a systematic review.

Fraccaro P, Arguello Casteleiro M, Ainsworth J, Buchan I - JMIR Med Inform (2015)

Review flow diagram.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4318680&req=5

figure1: Review flow diagram.
Mentions: In Scopus, the query created imposed that the relevant terms selected appear in the title, abstract, or keywords. The search yielded 954 articles (see Figure 1). Only literature from the social sciences, arts, and humanities was excluded from the search, and no restriction on the type of publication was imposed. Therefore, a wider selection of articles beyond the grey literature was retrieved.

Bottom Line: For articles appropriate for this review, data were collected on clinical tasks, diseases, decision maker, methods, data input context, user interface considerations, and evaluation of effectiveness.There were no rigorous evaluations of usability or effectiveness of the CDS systems reported.The data needed to build this evidence base exist in many electronic health record systems and are underused.

View Article: PubMed Central - HTML - PubMed

Affiliation: NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health, The University of Manchester, Manchester, United Kingdom. paolo.fraccaro@postgrad.manchester.ac.uk.

ABSTRACT

Background: Patients with multiple conditions have complex needs and are increasing in number as populations age. This multimorbidity is one of the greatest challenges facing health care. Having more than 1 condition generates (1) interactions between pathologies, (2) duplication of tests, (3) difficulties in adhering to often conflicting clinical practice guidelines, (4) obstacles in the continuity of care, (5) confusing self-management information, and (6) medication errors. In this context, clinical decision support (CDS) systems need to be able to handle realistic complexity and minimize iatrogenic risks.

Objective: The aim of this review was to identify to what extent CDS is adopted in multimorbidity.

Methods: This review followed PRISMA guidance and adopted a multidisciplinary approach. Scopus and PubMed searches were performed by combining terms from 3 different thesauri containing synonyms for (1) multimorbidity and comorbidity, (2) polypharmacy, and (3) CDS. The relevant articles were identified by examining the titles and abstracts. The full text of selected/relevant articles was analyzed in-depth. For articles appropriate for this review, data were collected on clinical tasks, diseases, decision maker, methods, data input context, user interface considerations, and evaluation of effectiveness.

Results: A total of 50 articles were selected for the full in-depth analysis and 20 studies were included in the final review. Medication (n=10) and clinical guidance (n=8) were the predominant clinical tasks. Four studies focused on merging concurrent clinical practice guidelines. A total of 17 articles reported their CDS systems were knowledge-based. Most articles reviewed considered patients' clinical records (n=19), clinical practice guidelines (n=12), and clinicians' knowledge (n=10) as contextual input data. The most frequent diseases mentioned were cardiovascular (n=9) and diabetes mellitus (n=5). In all, 12 articles mentioned generalist doctor(s) as the decision maker(s). For articles reviewed, there were no studies referring to the active involvement of the patient in the decision-making process or to patient self-management. None of the articles reviewed adopted mobile technologies. There were no rigorous evaluations of usability or effectiveness of the CDS systems reported.

Conclusions: This review shows that multimorbidity is underinvestigated in the informatics of supporting clinical decisions. CDS interventions that systematize clinical practice guidelines without considering the interactions of different conditions and care processes may lead to unhelpful or harmful clinical actions. To improve patient safety in multimorbidity, there is a need for more evidence about how both conditions and care processes interact. The data needed to build this evidence base exist in many electronic health record systems and are underused.

No MeSH data available.


Related in: MedlinePlus