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Clinical Decisionmaking

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Decision support systems that minimize clinicians' efforts to receive and act on system recommendations can improve care

Four features are strongly associated with a decision support system's ability to improve clinical practice, according to a recent study conducted by researchers at Duke University Medical Center and Old Dominion University. All four of the features make it easier for clinicians to receive and act on system recommendations. These features include providing decision support automatically as part of clinician workflow, delivering it at the time and location of decisionmaking, providing actionable recommendations, and being computer-based.

For example, systems that provided a recommendation (such as initiation of beta-blocker therapy in patients at high risk of coronary artery disease) were significantly more likely to succeed in improving patient care than systems that provided only an assessment of the patient (such as "Patient is at high risk of coronary disease"). The researchers correlated 15 decision support features with the systems' ability to significantly improve patient care, after analyzing 70 randomized control trials on the topic.

Decision support systems significantly improved clinical practice in 68 percent of trials. Further analysis identified four features as independent predictors of improved clinical practice. Of 32 systems possessing all four features, 30 (94 percent) significantly improved clinical practice. Clinicians and other stakeholders should implement clinical decision support systems that incorporate these features whenever feasible and appropriate, suggest the researchers. Their work was supported in part by the Agency for Healthcare Research and Quality (HS10472 and HS10814).

More details are in "Improving clinical practice using clinical decision support systems: A systematic review of trials to identify features critical to success," by Kensaku Kawamoto, B.A., Caitlin A. Houlihan, M.S., E. Andrew Balas, M.D., Ph.D., and David F. Lobach, M.D., Ph.D., in the March 2005 British Medical Journal 330, available online at

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