A scoping review of clinical decision support trials for asthma

Abstract

<bold>Background:</bold> Clinical Decision Support Systems (CDSSs) are digital tools designed to assist clinical decision-making practice. While they often demonstrate high accuracy in test setting, real-world effectiveness remains uncertain. A 2014 systematic review concluded that the ‘current generation’ of CDSSs were ‘unlikely to result in improvements in outcomes for patients with asthma’, and highlighted the need for better integration into clinical workflows. A decade later, it remains unclear whether these challenges have been addressed. <bold>Aim:</bold> This study aimed to identify and evaluate the design, outcomes, and effectiveness of implementation trials of CDSS for asthma management. <bold>Methods:</bold> A scoping review was conducted to identify randomised controlled trials (RCTs) of asthma related CDSSs. <bold>Results:</bold> 9 RCTs were identified. In six studies, the comparator was usual care in control practices or patients in six studies, while three compared alternative versions of the intervention algorithm (e.g. alerts on unrelated topics, or decision algorithms omitting key information). The interventions were treatment optimisation algorithms (n=4), alerts flagging high-risk patients (n=3), periodic quality of care reports (n=1), and alerts flagging inappropriate prescribing (n=1). Outcomes varied widely, including medication delivery, asthma control, asthma exacerbations, and quality of life. Seven studies published results. Of the five assessing asthma exacerbations, none found significant improvements. <bold>Conclusion:</bold> A substantial gap remains between the technical abilities of CDSSs and real-world impact. Further research is required to identify new routes to achieving patient benefit.

Ähnliche Arbeiten