title: Clinical decision support systems in the care of inpatients with diabetes in non-critical care setting: systematic review.
abstract: BACKGROUND
  Computerized clinical decision support systems have been claimed to reduce prescription errors and improve patient care. They may play an important role in the care of hospitalized patients with diabetes.
  
  
  OBJECTIVE
  To collate evidence for the use of clinical decision support systems in improving the care of hospitalized patients with diabetes in a non-critical care setting and to assess their effectiveness.
  
  
  METHODS
  We searched four databases from 1980 to 2010 without language restrictions. All types of studies other than case reports were included. Data extraction and quality assessment were carried out based on the Centre for Review and Dissemination guidance. A narrative synthesis was conducted.
  
  
  RESULTS
  Fourteen studies met the inclusion criteria, including two cluster randomized controlled trials, eight before-and-after studies and four other descriptive studies. Generally, the quality of the studies was not very high. Nine out of 10 studies reported reduction in mean blood glucose or similar measures (patient-day-weighted mean blood glucose) during inpatient stay. The reduction using computerized physician order entry system in patient-day-weighted mean blood glucose ranged from 0.6 to 0.8 mmol/l (10.8-15.6 mg/dl). Other beneficial effects during inpatient stay included reduced use of sliding scale insulin and greater use of basal-bolus insulin regimen. Only one study found a significant increase in hypoglycaemic events.
  
  
  CONCLUSIONS
  Clinical decision support systems have been used, often as part of a complex programme, to improve the care of hospitalized patients with diabetes. There is some evidence that they may have a beneficial effect, but this needs further confirmation.
authors.affiliation: Department of Public health, University of Birmingham, UK. k.nirantharan@bham.ac.uk
authors.forename: K
authors.initials: K
authors.lastname: Nirantharakumar
authors.forename: Y F
authors.initials: YF
authors.lastname: Chen
authors.forename: T
authors.initials: T
authors.lastname: Marshall
authors.forename: J
authors.initials: J
authors.lastname: Webber
authors.forename: J J
authors.initials: JJ
authors.lastname: Coleman
mesh_terms: D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D050316:Medical Order Entry Systems; D055118:Medication Adherence; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin