title: Computerized clinical decision support systems for primary preventive care: a decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes.
abstract: BACKGROUND
  Computerized clinical decision support systems (CCDSSs) are claimed to improve processes and outcomes of primary preventive care (PPC), but their effects, safety, and acceptance must be confirmed. We updated our previous systematic reviews of CCDSSs and integrated a knowledge translation approach in the process. The objective was to review randomized controlled trials (RCTs) assessing the effects of CCDSSs for PPC on process of care, patient outcomes, harms, and costs.
  
  
  METHODS
  We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews Database, Inspec, and other databases, as well as reference lists through January 2010. We contacted authors to confirm data or provide additional information. We included RCTs that assessed the effect of a CCDSS for PPC on process of care and patient outcomes compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive.
  
  
  RESULTS
  We added 17 new RCTs to our 2005 review for a total of 41 studies. RCT quality improved over time. CCDSSs improved process of care in 25 of 40 (63%) RCTs. Cumulative scientifically strong evidence supports the effectiveness of CCDSSs for screening and management of dyslipidaemia in primary care. There is mixed evidence for effectiveness in screening for cancer and mental health conditions, multiple preventive care activities, vaccination, and other preventive care interventions. Fourteen (34%) trials assessed patient outcomes, and four (29%) reported improvements with the CCDSS. Most trials were not powered to evaluate patient-important outcomes. CCDSS costs and adverse events were reported in only six (15%) and two (5%) trials, respectively. Information on study duration was often missing, limiting our ability to assess sustainability of CCDSS effects.
  
  
  CONCLUSIONS
  Evidence supports the effectiveness of CCDSSs for screening and treatment of dyslipidaemia in primary care with less consistent evidence for CCDSSs used in screening for cancer and mental health-related conditions, vaccinations, and other preventive care. CCDSS effects on patient outcomes, safety, costs of care, and provider satisfaction remain poorly supported.
authors.affiliation: Health Research Methodology Program, McMaster University, 1280 Main Street West, Hamilton, ON, Canada.
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Souza
authors.forename: Rolf J
authors.initials: RJ
authors.lastname: Sebaldt
authors.forename: Jean A
authors.initials: JA
authors.lastname: Mackay
authors.forename: Jeanette C
authors.initials: JC
authors.lastname: Prorok
authors.forename: Lorraine
authors.initials: L
authors.lastname: Weise-Kelly
authors.forename: Tamara
authors.initials: T
authors.lastname: Navarro
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Wilczynski
authors.forename: R Brian
authors.initials: RB
authors.lastname: Haynes
mesh_terms: D003299:Cooperative Behavior; D020000:Decision Support Systems, Clinical; D050171:Dyslipidemias / Q000175:diagnosis; D055088:Early Detection of Cancer; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis; D010043:Outcome and Process Assessment, Health Care; D011315:Preventive Medicine / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D011787:Quality of Health Care; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors