Table 1.
Overview of the main results
| Factor | Outcome | Number of studies* | Absolute improvement (RD)Ɨ | Certainty of evidence (GRADE)ǂ |
|---|---|---|---|---|
| More versus less evidence-based CDS advice | Adherence | – | – | ⊕⊕○○ |
| 2 |
5.0%
Range of ORs: 3.5 (CI 1.1–11.5) to 1.0 (CI 0.3–2.8) |
Low | ||
| More versus less patient-specific CDS (by using additional patient data) | Adherence | 1 | 6.2% | ⊕⊕⊕○ |
| 3 | 3.0%, IQR 1.2 to 5.9 | Moderate | ||
| Patient outcomes | – | – | ⊕⊕○○ | |
| 3 | 8%, IQR 0 to 8.9 | Low | ||
| More versus less explicit CDS advice (by providing recommendations or not) | Adherence | 1 | −0.4% | ⊕⊕⊕○ |
| 1 | 1.0% | Moderate | ||
| Patient outcomes | – | – | ⊕⊕⊕○ | |
| 1 | − 0.7% | Moderate | ||
| More versus less explicit CDS advice (by presenting specific patient data or not) | Adherence | – | – | ⊕⊕○○ |
| 1 | − 4.0% | Low | ||
| CDS that does (versus does not) require users to respond to the advice | Adherence | 1 | 0.1% | ⊕⊕○○ |
| 3 | − 2.0%, IQR − 2.9 to 8.0 | Low | ||
| CDS provided automatically by the system versus on demand by the user | Adherence | – | – | ⊕⊕○○ |
| 3 | 22.2%, IQR 9.4 to 28.0 | Low | ||
| CDS displayed on screen versus delivered on paper | Adherence | 1 | 15.6% | ⊕⊕○○ |
| 1 | Range of ORs 0.3 (CI 0.1–1.0) to 0.7 (CI 0.2–2.1) | Low | ||
| CDS combined with other professional-oriented strategies versus CDS only | Adherence | 3 | 4.8%, IQR − 3.9 to 10.8 | ⊕⊕○○ |
| 1 | 6.2% | Low | ||
| Patient outcomes | – | – | ⊕⊕○○ | |
| 2 | − 0.5, IQR − 5 to 4 | Low | ||
| CDS combined with patient-oriented strategies versus CDS only | Adherence | 10 | 3.1%, IQR − 2.0 to 5.0 | ⊕⊕○○ |
| 5 | 2.8%, IQR 1.5 to 6.5 | Moderate | ||
| Patient outcomes | 1 | − 5% | ⊕⊕○○ | |
| 1 | 18.2% | Low | ||
| CDS aimed at the patient versus CDS aimed at the healthcare provider | Adherence | 3 | 5.1%, IQR − 5.3 to 13.4 | ⊕⊕○○ |
| 2 | 4.2%, IQR 0 to 8.3 | Low | ||
| Patient outcomes | – | – | ⊕⊕○○ | |
| 2 | − 2.4%, IQR − 8.1 to 3.3 | Low | ||
| CDS for physician and another provider type versus CDS for physician only | Adherence | 1 | 4.1%, IQR 3.4 to 7.2 | ⊕⊕⊕○ |
| 2 | 5.2%, IQR 4.4 to 6 | Moderate | ||
| Patient outcomes | – | – | ⊕⊕○○ | |
| 2 | 1.4% (IQR + 1 to + 1.7) | Low |
*The upper row presents the results for the primary analyses (normal print) and the lower row presents the secondary analyses data (in italics). The primary analyses only included studies with risk differences that were adjusted for baseline differences; the secondary analyses present results for studies where it was not possible to adjust for baseline differences
ƗThe results of the studies are presented as absolute improvement (risk difference). We present the median and interquartile range (IQR) if multiple studies were available for an analysis. Odds ratios (OR) and 95% confidence intervals (CI) are presented if no risk data was available
ǂGRADE Working Group grades of evidence: High certainty ⊕⊕⊕⊕: Further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty ⊕⊕⊕⃝: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty ⊕⊕⃝⃝: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low certainty ⊕⃝⃝⃝: We are very uncertain about the estimate