title: Computer-Based Clinical Decision Support Systems and Patient-Reported Outcomes: A Systematic Review.
abstract: BACKGROUND
  Evidence-based treatment guidelines embedded in computer-based clinical decision support systems (CCDSS) may improve patient-reported outcomes (PRO). We systematically reviewed the literature for content and application of CCDSS, and their effects on PRO.
  
  
  METHODS
  A systematic review in MEDLINE and EMBASE was conducted according to PRISMA standards. Searches were limited to the publication period 1996-May 2014 and the English language. The search terms covered "computerized clinical decision systems" and "patient-reported outcomes". Screening and extraction was done independently by two reviewers according to predefined inclusion (computer and guideline) and exclusion criteria (no trial, no PRO). Study and CCDSS quality was rated according to predefined criteria.
  
  
  RESULTS
  The database searches identified 1,331 references. Eighty-seven full-text articles were analyzed. The main reason for exclusion was no PRO as a study outcome measure. Fifteen studies met the inclusion criteria, representing 13,480 patients. Nine studies used a computerized device to fill in data; in four studies, this was used by the patients themselves. Most of the studies presented the data to the clinician at point of care and incorporated international guidelines. Three studies showed a positive effect on PRO, but only on symptoms. Overall, no negative effects were reported. There was no association with study quality or year of study publication.
  
  
  CONCLUSIONS
  There are marginal positive effects of CCDSS on specific PRO. Factors that facilitate the use and effect are identified. Easy to use systems with difficult to ignore evidence-based advice need to be developed and tested.
authors.affiliation: Faculty of Medicine, European Palliative Care Research Centre (PRC), Norwegian University of Science and Technology (NTNU), Cancer Clinic, St. Olavs Hospital, University Hospital in Trondheim, Trondheim, Norway. david.blum@ntnu.no.|Department of Cancer Research and Molecular Medicine NTNU, Faculty of Medicine, European Palliative Research Center, 7491, Trondheim, Norway. david.blum@ntnu.no.
authors.forename: David
authors.initials: D
authors.lastname: Blum
authors.affiliation: Faculty of Medicine, European Palliative Care Research Centre (PRC), Norwegian University of Science and Technology (NTNU), Cancer Clinic, St. Olavs Hospital, University Hospital in Trondheim, Trondheim, Norway. sunil.raj@ntnu.no.
authors.forename: Sunil X
authors.initials: SX
authors.lastname: Raj
authors.affiliation: Kantonsspital St. Gallen, St. Gallen, Switzerland. rolf.oberholzer@gmail.com.
authors.forename: Rolf
authors.initials: R
authors.lastname: Oberholzer
authors.affiliation: Unit for Applied Clinical Research, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. Ingrid.i.riphagen@ntnu.no.
authors.forename: Ingrid I
authors.initials: II
authors.lastname: Riphagen
authors.affiliation: Kantonsspital St. Gallen, St. Gallen, Switzerland. florian.strasser@kssg.ch.
authors.forename: Florian
authors.initials: F
authors.lastname: Strasser
authors.affiliation: Faculty of Medicine, European Palliative Care Research Centre (PRC), Norwegian University of Science and Technology (NTNU), Cancer Clinic, St. Olavs Hospital, University Hospital in Trondheim, Trondheim, Norway. stein.kaasa@ntnu.no.
authors.forename: Stein
authors.initials: S
authors.lastname: Kaasa
mesh_terms: D016206:Databases, Bibliographic; D020000:Decision Support Systems, Clinical; D055317:Evidence-Based Practice; D006801:Humans; D063868:Patient Outcome Assessment