title: Computerized clinical decision support systems for acute care management: a decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes.
abstract: BACKGROUND
  Acute medical care often demands timely, accurate decisions in complex situations. Computerized clinical decision support systems (CCDSSs) have many features that could help. However, as for any medical intervention, claims that CCDSSs improve care processes and patient outcomes need to be rigorously assessed. The objective of this review was to systematically review the effects of CCDSSs on process of care and patient outcomes for acute medical care.
  
  
  METHODS
  We conducted a decision-maker-researcher partnership systematic review. MEDLINE, EMBASE, Evidence-Based Medicine Reviews databases (Cochrane Database of Systematic Reviews, DARE, ACP Journal Club, and others), and the Inspec bibliographic database were searched to January 2010, in all languages, for randomized controlled trials (RCTs) of CCDSSs in all clinical areas. We included RCTs that evaluated the effect on process of care or patient outcomes of a CCDSS used for acute medical care compared with 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
  Thirty-six studies met our inclusion criteria for acute medical care. The CCDSS improved process of care in 63% (22/35) of studies, including 64% (9/14) of medication dosing assistants, 82% (9/11) of management assistants using alerts/reminders, 38% (3/8) of management assistants using guidelines/algorithms, and 67% (2/3) of diagnostic assistants. Twenty studies evaluated patient outcomes, of which three (15%) reported improvements, all of which were medication dosing assistants.
  
  
  CONCLUSIONS
  The majority of CCDSSs demonstrated improvements in process of care, but patient outcomes were less likely to be evaluated and far less likely to show positive results.
authors.affiliation: College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, Canada.
authors.forename: Navdeep
authors.initials: N
authors.lastname: Sahota
authors.forename: Rob
authors.initials: R
authors.lastname: Lloyd
authors.forename: Anita
authors.initials: A
authors.lastname: Ramakrishna
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: D000208:Acute Disease; D000465:Algorithms; D035843:Biomedical Research; D003299:Cooperative Behavior; D003657:Decision Making; D020000:Decision Support Systems, Clinical; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*; D005791:Patient Care; D016896:Treatment Outcome