Can computerized clinical decision support systems improve diabetes management? A systematic review and meta-analysis.
Diabet Med
; 30(6): 739-45, 2013 Jun.
Article
em En
| MEDLINE
| ID: mdl-23199102
ABSTRACT
AIMS:
To systematically review randomized trials that assessed the effects of computerized clinical decision support systems in ambulatory diabetes management compared with a non-computerized clinical decision support system control.METHODS:
We included all diabetes trials from a comprehensive computerized clinical decision support system overview completed in January 2010, and searched EMBASE, MEDLINE, INSPEC/COMPENDEX and Evidence-Based Medicine Reviews (EBMR) from January 2010 to April 2012. Reference lists of related reviews, included articles and Clinicaltrials.gov were also searched. Randomized controlled trials of patients with diabetes in ambulatory care settings comparing a computerized clinical decision support system intervention with a non-computerized clinical decision support system control, measuring either a process of care or a patient outcome, were included. Screening of studies, data extraction, risk of bias and quality of evidence assessments were carried out independently by two reviewers, and discrepancies were resolved through consensus or third-party arbitration. Authors were contacted for any missing data.RESULTS:
Fifteen trials were included (13 from the previous review and two from the current search). Only one study was at low risk of bias, while the others were of moderate to high risk of bias because of methodological limitations. HbA1c (3 months' follow-up), quality of life and hospitalization (12 months' follow-up) were pooled and all favoured the computerized clinical decision support systems over the control, although none were statistically significant. Triglycerides and practitioner performance tended to favour computerized clinical decision support systems although results were too heterogeneous to pool.CONCLUSIONS:
Computerized clinical decision support systems in diabetes management may marginally improve clinical outcomes, but confidence in the evidence is low because of risk of bias, inconsistency and imprecision.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Sistemas de Apoio a Decisões Clínicas
/
Diabetes Mellitus
/
Melhoria de Qualidade
Tipo de estudo:
Clinical_trials
/
Prognostic_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
Diabet Med
Assunto da revista:
ENDOCRINOLOGIA
Ano de publicação:
2013
Tipo de documento:
Article
País de afiliação:
Canadá