Table 3.
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.