Coste-efectividad de una intervención basada en las recomendaciones de la Global INitiative for Asthma (GINA), mediante un sistema informatizado de apoyo a la decisión clínica: un ensayo con aleatorización de médicos

Plaza, Vicente; Cobos, Albert; Ignacio-García, José M.; Molina, Jesús; Bergoñón, Salvador; García-Alonso, Fernando; Espinosa, Cristina

doi:10.1157/13071758

Cited by 33 publications

(35 citation statements)

References 24 publications

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“…In this review, we included 35 trials described in 45 publications because they measured the impact on test ordering behavior of CCDSSs that gave suggestions for ordering or performing diagnostic tests [15,25-67]. Thirty-two included studies contributed outcomes to both this review and other CCDSS interventions in the series; four studies [34,37,41,68] to four reviews, 11 studies [25,32,33,35,36,39,40,42-44,46-49,51,57,61] to three reviews, and 17 studies [26-31,38,45,50,52-56,58-60,62-65] to two reviews; but we focused here only on diagnostic test ordering process outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…Fifty-four percent of trials concealed group allocation [26,27,30,32-35,37-40,42-44,50,52-55,60-63,66-68]; 51% allocated clusters ( e.g. , entire clinics or wards) to minimize contamination between study groups [15,25,28-30,34,36,38-44,46,50-53,60,62-64,68]; 77% either showed no differences in baseline characteristics between study groups or adjusted accordingly [15,26-37,39,40,45-55,58,59,61-66,68]; 69% of trials achieved ≥90% follow-up for the appropriate unit of analysis [15,25,28-35,37,39-41,45,50-56,58-61,66,67]; and all but one used blinding or an objective outcome [45]. …”

Section: Resultsmentioning

confidence: 99%

“…In most trials (61%; 20/33) advice was delivered on a desktop or laptop computer [15,26,27,31,34,36-41,50,51,54,58-63,66-68], but other methods included personal digital assistants, email, or existing staff. Seventy-four percent (26/35) of systems were implemented in primary care [15,25-40,42-45,50-54,58,60-65,67]; 56% (14/25) were pilot tested [25,28-33,36,38,42-45,51,54,62,63,66,67]; and users of 59% (17/29) were trained [25-29,31-33,35,37,39-44,46,51,54,58-60,67]. Eighty-three percent of trials (29/35) declared that at least one author was involved in the development of the system [15,25-33,36,37,39-41,45-53,55-60,62-68].…”

Section: Resultsmentioning

confidence: 99%

“…Of those that did, 78% (25/32) were publically funded [15,25-30,36-38,41-51,54,56,58,59,61-64,66-68], 9% (3/32) received both private and public funding [39,40,55,61], and 13% (4/32) were conducted with private funds only [32-35,65]. …”

Section: Resultsmentioning

confidence: 99%

“…One of three trials that focused on dyslipidemia improved monitoring of blood lipids [25]. Another three systems gave suggestions for monitoring of asthma [35,37,39,40], angina [39,40], chronic obstructive pulmonary disease (COPD) [37], and one for a combination of renal disease, obesity, and hypertension [47-49], but all failed to change testing behavior.…”

Section: Resultsmentioning

confidence: 99%

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Can computerized clinical decision support systems improve practitioners' diagnostic test ordering behavior? A decision-maker-researcher partnership systematic review

et al. 2011

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BackgroundUnderuse and overuse of diagnostic tests have important implications for health outcomes and costs. Decision support technology purports to optimize the use of diagnostic tests in clinical practice. The objective of this review was to assess whether computerized clinical decision support systems (CCDSSs) are effective at improving ordering of tests for diagnosis, monitoring of disease, or monitoring of treatment. The outcome of interest was effect on the diagnostic test-ordering behavior of practitioners.MethodsWe conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for eligible articles published up to January 2010. We included randomized controlled trials comparing the use of CCDSSs to usual practice or non-CCDSS controls in clinical care settings. Trials were eligible if at least one component of the CCDSS gave suggestions for ordering or performing a diagnostic procedure. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of test ordering outcomes.ResultsThirty-five studies were identified, with significantly higher methodological quality in those published after the year 2000 (p = 0.002). Thirty-three trials reported evaluable data on diagnostic test ordering, and 55% (18/33) of CCDSSs improved testing behavior overall, including 83% (5/6) for diagnosis, 63% (5/8) for treatment monitoring, 35% (6/17) for disease monitoring, and 100% (3/3) for other purposes. Four of the systems explicitly attempted to reduce test ordering rates and all succeeded. Factors of particular interest to decision makers include costs, user satisfaction, and impact on workflow but were rarely investigated or reported.ConclusionsSome CCDSSs can modify practitioner test-ordering behavior. To better inform development and implementation efforts, studies should describe in more detail potentially important factors such as system design, user interface, local context, implementation strategy, and evaluate impact on user satisfaction and workflow, costs, and unintended consequences.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Can computerized clinical decision support systems improve practitioners' diagnostic test ordering behavior? A decision-maker-researcher partnership systematic review

et al. 2011

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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

362

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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Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes

Arditi

Rège‐Walther

Durieux

et al. 2012

Cochrane Database of Systematic Reviews

120

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Background Clinical practice does not always reflect best practice and evidence, partly because of unconscious acts of omission, information overload, or inaccessible information. Reminders may help clinicians overcome these problems by prompting them to recall information that they already know or would be expected to know and by providing information or guidance in a more accessible and relevant format, at a particularly appropriate time. This is an update of a previously published review. Objectives To evaluate the effects of reminders automatically generated through a computerized system (computer-generated) and delivered on paper to healthcare professionals on quality of care (outcomes related to healthcare professionals' practice) and patient outcomes (outcomes related to patients' health condition). Search methods We searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers up to 21 September 2016 together with reference checking, citation searching and contact with study authors to identify additional studies. Selection criteria We included individual-or cluster-randomized and non-randomized trials that evaluated the impact of computer-generated reminders delivered on paper to healthcare professionals, alone (single-component intervention) or in addition to one or more co-interventions (multi-component intervention), compared with usual care or the co-intervention(s) without the reminder component. Data collection and analysis Review authors working in pairs independently screened studies for eligibility and abstracted data. For each study, we extracted the primary outcome when it was defined or calculated the median effect size across all reported outcomes. We then calculated the median improvement and interquartile range (IQR) across included studies using the primary outcome or median outcome as representative outcome. We assessed the certainty of the evidence according to the GRADE approach.

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Coste-efectividad de una intervención basada en las recomendaciones de la Global INitiative for Asthma (GINA), mediante un sistema informatizado de apoyo a la decisión clínica: un ensayo con aleatorización de médicos

Cited by 33 publications

References 24 publications

Can computerized clinical decision support systems improve practitioners' diagnostic test ordering behavior? A decision-maker-researcher partnership systematic review

Can computerized clinical decision support systems improve practitioners' diagnostic test ordering behavior? A decision-maker-researcher partnership systematic review

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

Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes

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