title: Computerized clinical decision support systems for chronic disease management: a decision-maker-researcher partnership systematic review.
abstract: BACKGROUND
  The use of computerized clinical decision support systems (CCDSSs) may improve chronic disease management, which requires recurrent visits to multiple health professionals, ongoing disease and treatment monitoring, and patient behavior modification. The objective of this review was to determine if CCDSSs improve the processes of chronic care (such as diagnosis, treatment, and monitoring of disease) and associated patient outcomes (such as effects on biomarkers and clinical exacerbations).
  
  
  METHODS
  We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for potentially eligible articles published up to January 2010. We included randomized controlled trials that compared the use of CCDSSs to usual practice or non-CCDSS controls. Trials were eligible if at least one component of the CCDSS was designed to support chronic disease management. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of relevant outcomes.
  
  
  RESULTS
  Of 55 included trials, 87% (n = 48) measured system impact on the process of care and 52% (n = 25) of those demonstrated statistically significant improvements. Sixty-five percent (36/55) of trials measured impact on, typically, non-major (surrogate) patient outcomes, and 31% (n = 11) of those demonstrated benefits. Factors of interest to decision makers, such as cost, user satisfaction, system interface and feature sets, unique design and deployment characteristics, and effects on user workflow were rarely investigated or reported.
  
  
  CONCLUSIONS
  A small majority (just over half) of CCDSSs improved care processes in chronic disease management and some improved patient health. Policy makers, healthcare administrators, and practitioners should be aware that the evidence of CCDSS effectiveness is limited, especially with respect to the small number and size of studies measuring patient outcomes.
authors.affiliation: Health Research Methodology Program, McMaster University, 1280 Main Street West, Hamilton, ON, Canada.
authors.forename: Pavel S
authors.initials: PS
authors.lastname: Roshanov
authors.forename: Shikha
authors.initials: S
authors.lastname: Misra
authors.forename: Hertzel C
authors.initials: HC
authors.lastname: Gerstein
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.forename: Rolf J
authors.initials: RJ
authors.lastname: Sebaldt
authors.forename: Jean A
authors.initials: JA
authors.lastname: Mackay
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: D001249:Asthma; D002318:Cardiovascular Diseases; D002908:Chronic Disease; D003299:Cooperative Behavior; D003657:Decision Making; D020000:Decision Support Systems, Clinical / Q000295:instrumentation* / Q000458:organization & administration; D003920:Diabetes Mellitus; D050171:Dyslipidemias; D006801:Humans; D006973:Hypertension; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive