Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes: Systematic Review (Preprint)

Abstract

BACKGROUND Computerized decision support systems (CDSS) are software programs that support the decision making of practitioners and other staff. Other reviews have analyzed the relationship between CDSS, practitioner performance, and patient outcomes. These reviews reported positive practitioner performance in over half the articles analyzed, but very little information was found for patient outcomes. OBJECTIVE The purpose of this review was to analyze the relationship between CDSS, practitioner performance, and patient medical outcomes. PubMed, CINAHL, and Cochrane databases were queried. METHODS 27 articles were chosen based on year published (last ten years), high quality source, and discussion of the relationship between the use of CDSS as an intervention and links to practitioner performance or patient outcomes. Reviewers used an Excel spreadsheet to collect information on the relationship between CDSS and practitioner performance or patient outcomes. Reviewers also collected observations of participants, intervention, comparison with control group, and outcomes (PICO) along with those showing implicit bias. Articles were analyzed by multiple reviewers following the Kruse Protocol for systematic reviews. Data were organized into multiple tables for analysis and reporting. RESULTS Fourteen articles (52%) discussed positive practitioner performance, three articles (11%) found no difference in practitioner performance, ten articles (37%) did not discuss practitioner performance. Zero articles reported negative practitioner performance. Fifteen articles (56%) discussed positive patient medical outcomes, two articles (7%) found no statistically significant difference in medical outcomes between intervention and control groups, and ten articles (37%) did not discuss medical outcomes. Zero articles found negative patient medical outcomes. CONCLUSIONS Results of this review are commensurate with previous reviews with similar objectives, but unlike these reviews we found significant positive reporting of a positive effect on patient medical outcomes. Our findings support adoption of decision support systems.