A computerized decision support system for ovarian stimulation by gonadotropins

Lesourd, Florence; Avril, C.; Boujennah, Arry; Parinaud, Jean

doi:10.1016/s0015-0282(01)03231-9

Cited by 12 publications

(9 citation statements)

References 30 publications

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“…A total of 65 trials reported in 74 papers were included [16-89] (see Figure 1). Twenty-four RCTs [60-62,65-67,69,71-76,78,80-89] had been included in the previous version of our review [2]. Study authors confirmed or supplemented our data extraction for 53 of 65 included studies (82%) [16-20,23,25-33,35-39,42-45,47-49,53-55,57,58,60-62,65-72,74-76,78,81,83-86,88].…”

Section: Resultsmentioning

confidence: 99%

“…Most studies (n = 41, 63%) [16-21,23,24,26,28,31-33,38,40,42-44,47,48,55-57,60,61,63,66-68,70,72-80,82-88] reported public funding; nine (14%) [29,34,35,45,46,49,50,52,53,59,71] reported private funding; six (9%) [22,36,37,41,54,64,65,69] reported public and private funding, and 9 (14%) [25,27,30,39,51,58,62,81,89] did not disclose a funding source (see Additional file 3, Table S3). We were able to determine whether improvement occurred with a CCDSS for process of care outcomes in 59 studies [16-24,26-38,40-70,72-76,80-83,85-87,89]; 29 studies reported patient outcomes [19,25,26,29,33,38,39,43,45,48,49,51-53,56,59-61,64,66-69,71,72,75,77-80,…”

Section: Resultsmentioning

confidence: 99%

“…We were able to determine whether improvement occurred with a CCDSS for process of care outcomes in 59 studies [16-24,26-38,40-70,72-76,80-83,85-87,89]; 29 studies reported patient outcomes [19,25,26,29,33,38,39,43,45,48,49,51-53,56,59-61,64,66-69,71,72,75,77-80,84,86,88], and both patient and process outcomes were extracted from 23 (of 29, 79%) reports [19,26,29,33,38,43,45,48,49,51-53,56,59-61,64,66-69,72,75,80,86] (Table 1 and see Additional file 4, Table S4). Twenty [32,33,38,39,43,48,51-53,56,60,61,66-69,71-73,75,80,84] of 29 (69%) studies reported a patient important outcome rather than an intermediate or surrogate outcome [90]. …”

Section: Resultsmentioning

confidence: 99%

“…Many systems reported use by more than one type of provider. CCDSSs were studied in the United States (n = 44, 68%) [16,18,20-23,26-30,32,33,35-37,40-43,45,47,50-52,54-56,58-61,66,68,72-74,76,80-85,87-89], European Union or European Economic Area countries (n = 13, 20%) [31,34,38,39,44,46,49,53,62-64,69-71,75,77-79], and Canada (n = 3, 5%) [17,24,65,86], with the remaining five studies (8%) [19,25,48,57,67] occurring in multiple or other countries.…”

Section: Resultsmentioning

confidence: 99%

“…Outpatient settings were studied more often (n = 55, 85%) [16,18-23,26-41,43-47,49-67,69-71,73,75-79,81,83,85-89] than other settings of care. Studies were conducted in both academic settings (n = 34, 52%) [18,23,25,26,28,33-35,38,39,42,46,48,51,55-57,60,61,66,68,71-74,76,80-85,87-89] and outside academic centres (n = 31, 48%) [16,17,19-22,24,27,29-32,36,37,40,41,43-45,47,49,50,52-54,58,59,62-65,67,69,70,75,77-79,86].…”

Section: Resultsmentioning

confidence: 99%

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Computerized clinical decision support systems for drug prescribing and management: A decision-maker-researcher partnership systematic review

et al. 2011

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BackgroundComputerized clinical decision support systems (CCDSSs) for drug therapy management are designed to promote safe and effective medication use. Evidence documenting the effectiveness of CCDSSs for improving drug therapy is necessary for informed adoption decisions. The objective of this review was to systematically review randomized controlled trials assessing the effects of CCDSSs for drug therapy management on process of care and patient outcomes. We also sought to identify system and study characteristics that predicted benefit.MethodsWe conducted a decision-maker-researcher partnership systematic review. We updated our earlier reviews (1998, 2005) by searching MEDLINE, EMBASE, EBM Reviews, Inspec, and other databases, and consulting reference lists through January 2010. Authors of 82% of included studies confirmed or supplemented extracted data. We included only randomized controlled trials that evaluated the effect on process of care or patient outcomes of a CCDSS for drug therapy management 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.ResultsSixty-five studies met our inclusion criteria, including 41 new studies since our previous review. Methodological quality was generally high and unchanged with time. CCDSSs improved process of care performance in 37 of the 59 studies assessing this type of outcome (64%, 57% of all studies). Twenty-nine trials assessed patient outcomes, of which six trials (21%, 9% of all trials) reported improvements.ConclusionsCCDSSs inconsistently improved process of care measures and seldomly improved patient outcomes. Lack of clear patient benefit and lack of data on harms and costs preclude a recommendation to adopt CCDSSs for drug therapy management.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Computerized clinical decision support systems for drug prescribing and management: A decision-maker-researcher partnership systematic review

et al. 2011

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Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes

Garg¹,

Adhikari²,

McDonald³

et al. 2005

JAMA

2,585

1,765

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OMPUTERIZED CLINICAL DECIs i o n s u p p o r t s y s t e m s (CDSSs) are information systems designed to improve clinical decision making. Characteristics of individual patients are matched to a computerized knowledge base, and software algorithms generate patientspecific recommendations. Practitioners, health care staff, or patients can manually enter patient characteristics into the computer system; alternatively, electronic medical records can be queried for retrieval of patient characteristics. Computer-generated recommendations are delivered to the clinician through the electronic medical record, by pager, or through printouts placed in a patient's paper chart. Such systems have been developed for a myriad of clinical issues, including diagnosis of chest pain, treatment of infertility, and timely administration of immunizations. These systems provide several modes of decision support, including alerts of critical val-See also pp 1197 and 1261.

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The effects of on-screen, point of care computer reminders on processes and outcomes of care

Shojania

Jennings²,

Mayhew

et al. 2009

Cochrane Database of Systematic Reviews

360

339

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Background The opportunity to improve care by delivering decision support to clinicians at the point of care represents one of the main incentives for implementing sophisticated clinical information systems. Previous reviews of computer reminder and decision support systems have reported mixed effects, possibly because they did not distinguish point of care computer reminders from e-mail alerts, computer-generated paper reminders, and other modes of delivering ‘computer reminders’. Objectives To evaluate the effects on processes and outcomes of care attributable to on-screen computer reminders delivered to clinicians at the point of care. Search methods We searched the Cochrane EPOC Group Trials register, MEDLINE, EMBASE and CINAHL and CENTRAL to July 2008, and scanned bibliographies from key articles. Selection criteria Studies of a reminder delivered via a computer system routinely used by clinicians, with a randomised or quasi-randomised design and reporting at least one outcome involving a clinical endpoint or adherence to a recommended process of care. Data collection and analysis Two authors independently screened studies for eligibility and abstracted data. For each study, we calculated the median improvement in adherence to target processes of care and also identified the outcome with the largest such improvement. We then calculated the median absolute improvement in process adherence across all studies using both the median outcome from each study and the best outcome. Main results Twenty-eight studies (reporting a total of thirty-two comparisons) were included. Computer reminders achieved a median improvement in process adherence of 4.2% (interquartile range (IQR): 0.8% to 18.8%) across all reported process outcomes, 3.3% (IQR: 0.5% to 10.6%) for medication ordering, 3.8% (IQR: 0.5% to 6.6%) for vaccinations, and 3.8% (IQR: 0.4% to 16.3%) for test ordering. In a sensitivity analysis using the best outcome from each study, the median improvement was 5.6% (IQR: 2.0% to 19.2%) across all process measures and 6.2% (IQR: 3.0% to 28.0%) across measures of medication ordering. In the eight comparisons that reported dichotomous clinical endpoints, intervention patients experienced a median absolute improvement of 2.5% (IQR: 1.3% to 4.2%). Blood pressure was the most commonly reported clinical endpoint, with intervention patients experiencing a median reduction in their systolic blood pressure of 1.0 mmHg (IQR: 2.3 mmHg reduction to 2.0 mmHg increase). Authors’ conclusions Point of care computer reminders generally achieve small to modest improvements in provider behaviour. A minority of interventions showed larger effects, but no specific reminder or contextual features were significantly associated with effect magnitude. Further research must identify design features and contextual factors consistently associated with larger improvements in provider behaviour if computer reminders are to succeed on more than a trial and error basis.

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A computerized decision support system for ovarian stimulation by gonadotropins

Cited by 12 publications

References 30 publications

Computerized clinical decision support systems for drug prescribing and management: A decision-maker-researcher partnership systematic review

Computerized clinical decision support systems for drug prescribing and management: A decision-maker-researcher partnership systematic review

Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes

The effects of on-screen, point of care computer reminders on processes and outcomes of care

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