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A review of randomized controlled trials of medical record powered clinical decision support system to improve quality of diabetes care

A review of randomized controlled trials of medical record powered clinical decision support system to improve quality of diabetes care
A review of randomized controlled trials of medical record powered clinical decision support system to improve quality of diabetes care
BACKGROUND: A gap between current diabetes care practice and recommended diabetes care standards has consistently been reported in the literature. Many IT-based interventions have been developed to improve adherence to the quality of care standards for chronic illness like diabetes.

OBJECTIVE: The widespread implementation of electronic medical/health records has catalyzed clinical decision support systems (CDSS) which may improve the quality of diabetes care. Therefore, the objective of the review is to evaluate the effectiveness of CDSS in improving quality of type II diabetes care. Moreover, the review aims to highlight the key indicators of quality improvement to assist policy makers in development of future diabetes care policies through the integration of information technology and system.

SELECTION OF STUDY: Setting inclusion criteria, a systematic literature search was conducted using Medline, Web of Science and Science Direct. Critical Appraisal Skills Programme (CASP) tools were used to evaluate the quality of studies. Eight randomized controlled trials (RCTs) were selected for the review. In the selected studies, seventeen clinical markers of diabetes care were discussed. Three quality of care indicators were given more importance in monitoring the progress of diabetes care, which is consistent with National Institute for Health and Care Excellence (NICE) guidelines. The presence of these indicators in the studies helped to determine which studies were selected for review. Clinical- and process-related improvements are compared between intervention group using CDSS and control group with usual care. Glycated hemoglobin (HbA1c), low density lipid cholesterol (LDL-C) and blood pressure (BP) were the quality of care indicators studied at the levels of process of care and clinical outcome.

FINDINGS: The review has found both inconsistent and variable results for quality of diabetes care measures. A significant improvement has been found in the process of care for all three measures of quality of diabetes care. However, weak to modest positive results are observed for the clinical measures of the diabetes care indicators. In addition to this, technology adoption of CDSS is found to be consistently low.

CONCLUSION: The review suggests the need to conduct further empirical research using the critical diabetes care indicators (HbA1c, LDL-C and BP) to ascertain if CDSS improves the quality of diabetes care. Research designs should be improved, especially with regard to baseline characteristics, sample size and study period. With respect to implementation of CDSS, rather than a sudden change of clinical work practice, there should instead be an incremental, gradual adoption of technology that minimizes the disruption in clinical workflow.
clinical decision support system, electronic medical record, electronic health record, quality of diabetes care, clinical performance in diabetes care, diabetes patient outcome
1386-5056
91-100
Ali, Syed Mustafa
491389b4-dcaf-42f0-a241-25fbd6d643b4
Giordano, Richard
13c61925-de2b-48ae-beab-6aedac3ed14c
Lakhani, Saima
e25a7809-571e-4f72-a05f-743f37b255a6
Walker, Dawn-Marie
5d4c78b7-4411-493e-8844-b64efc72a1e8
Ali, Syed Mustafa
491389b4-dcaf-42f0-a241-25fbd6d643b4
Giordano, Richard
13c61925-de2b-48ae-beab-6aedac3ed14c
Lakhani, Saima
e25a7809-571e-4f72-a05f-743f37b255a6
Walker, Dawn-Marie
5d4c78b7-4411-493e-8844-b64efc72a1e8

Ali, Syed Mustafa, Giordano, Richard, Lakhani, Saima and Walker, Dawn-Marie (2016) A review of randomized controlled trials of medical record powered clinical decision support system to improve quality of diabetes care. International Journal of Medical Informatics, 87, 91-100. (doi:10.1016/j.ijmedinf.2015.12.017). (PMID:26806716)

Record type: Article

Abstract

BACKGROUND: A gap between current diabetes care practice and recommended diabetes care standards has consistently been reported in the literature. Many IT-based interventions have been developed to improve adherence to the quality of care standards for chronic illness like diabetes.

OBJECTIVE: The widespread implementation of electronic medical/health records has catalyzed clinical decision support systems (CDSS) which may improve the quality of diabetes care. Therefore, the objective of the review is to evaluate the effectiveness of CDSS in improving quality of type II diabetes care. Moreover, the review aims to highlight the key indicators of quality improvement to assist policy makers in development of future diabetes care policies through the integration of information technology and system.

SELECTION OF STUDY: Setting inclusion criteria, a systematic literature search was conducted using Medline, Web of Science and Science Direct. Critical Appraisal Skills Programme (CASP) tools were used to evaluate the quality of studies. Eight randomized controlled trials (RCTs) were selected for the review. In the selected studies, seventeen clinical markers of diabetes care were discussed. Three quality of care indicators were given more importance in monitoring the progress of diabetes care, which is consistent with National Institute for Health and Care Excellence (NICE) guidelines. The presence of these indicators in the studies helped to determine which studies were selected for review. Clinical- and process-related improvements are compared between intervention group using CDSS and control group with usual care. Glycated hemoglobin (HbA1c), low density lipid cholesterol (LDL-C) and blood pressure (BP) were the quality of care indicators studied at the levels of process of care and clinical outcome.

FINDINGS: The review has found both inconsistent and variable results for quality of diabetes care measures. A significant improvement has been found in the process of care for all three measures of quality of diabetes care. However, weak to modest positive results are observed for the clinical measures of the diabetes care indicators. In addition to this, technology adoption of CDSS is found to be consistently low.

CONCLUSION: The review suggests the need to conduct further empirical research using the critical diabetes care indicators (HbA1c, LDL-C and BP) to ascertain if CDSS improves the quality of diabetes care. Research designs should be improved, especially with regard to baseline characteristics, sample size and study period. With respect to implementation of CDSS, rather than a sudden change of clinical work practice, there should instead be an incremental, gradual adoption of technology that minimizes the disruption in clinical workflow.

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Accepted/In Press date: 23 December 2015
Published date: January 2016
Keywords: clinical decision support system, electronic medical record, electronic health record, quality of diabetes care, clinical performance in diabetes care, diabetes patient outcome
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 388250
URI: https://eprints.soton.ac.uk/id/eprint/388250
ISSN: 1386-5056
PURE UUID: 2b2ac52b-3c7b-47bb-98c6-f03cd6acc31a
ORCID for Richard Giordano: ORCID iD orcid.org/0000-0002-2997-9502
ORCID for Dawn-Marie Walker: ORCID iD orcid.org/0000-0003-2135-1363

Catalogue record

Date deposited: 23 Feb 2016 09:23
Last modified: 15 Aug 2019 00:38

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