Table 3.

Absolute incremental improvements in desired care by CDSS feature

CDSS feature	Category (No of trials)	Absolute incremental improvement (%; 95% CI)*	P value
Acknowledgement and documentation required	Yes (20) v no (102)	4.8 (0.1 to 9.6)	0.05
Execute desired action through CDSS	Yes (58) v no (64)	4.4 (0.9 to 7.9)	0.01
Behaviour targeted, when reported	Underuse (82) v overuse (37)	4.0 (0.1 to 7.9)	0.05
EHR platform	Epic (25) v other (97)	3.8 (−0.5 to 8.2)	0.09
Interruptive	Yes (55) v no (67)	3.2 (−0.4 to 6.7)	0.08
Mode of delivery, when reported	Push (90) v pull (13)	2.4 (−3.5 to 8.2)	0.43
Other concurrent CDSS	Yes (14) v no (108)	2.1 (−3.4 to 7.6)	0.46
Considered alert fatigue in design	Yes (17) v no (105)	1.7 (−3.5 to 6.8)	0.52
User workflow specifically considered in design	Yes (35) v no (87)	1.2 (−2.7 to 5.2)	0.53
Level of decision support	Complex (40) v simple (82)	0.9 (−2.9 to 4.7)	0.64
Developed in consultation with users	Yes (7) v no (115)	0.1 (−7.3 to 7.5)	0.98
Makes recommendation for care	Yes (98) v no (24)	0 (−4.4 to 4.5)	0.98
Appearance differed based on urgency	Yes (3) v no (119)	−0.5 (−11.4 to 10.4)	0.93
Inclusion of supporting information on screen	Yes (53) v no (69)	−1.1 (−4.7 to 2.5)	0.55
Ambush	Yes (32) v no (90)	−1.3 (−5.4 to 2.7)	0.51
Developed by study investigators	Yes (62) v no (60)	−1.5 (−5.1 to 2.0)	0.40
Requires input of clinical information	Yes (9) v no (113)	−1.9 (−8.8 to 4.9)	0.58
Conveys patient-specific information	Yes (107) v no (15)	−4.4 (−9.8 to 1.0)	0.11

CDSS=clinical decision support system; EHR=electronic health record.

^*The third column shows the estimated pooled difference (and 95% confidence interval) in the percentage of desired care between the trials classified according to the CDSS features in the first column. Results from 122 trials (108 studies) reporting dichotomous outcomes were each estimated in a univariate meta-regression model.