JMIR Publications

ABSTRACT

Background:

Clinical Decision Support Systems (CDSSs) form an implementation strategy that can facilitate and support health care professionals in the care for older hospitalized patients.

Objective:

The objective of our study is to systematically review the effect of CDSS interventions for older hospitalized patients. The secondary aim is to summarize implementation and design factors described in (in)effective interventions.

Methods:

Systematic review (registration number CRD42019124470) with a search strategy combining the categories ‘older patients’, ‘geriatric topic’, ‘hospital’, ‘CDSS’ and ‘intervention’ of the databases Medline, EMBASE and SCOPUS. We included controlled studies and we extracted data of all reported outcomes, and potentially beneficial design and implementation factors. We structured these factors using the Grol and Wensing Implementation of Change Model, GUIDES checklist and the Two-Stream Model (2SM). The risk of bias of the included studies were assessed using Cochrane Collaboration's Effective Practice and Organisation of Care (EPOC) risk of bias approach.

Results:

Eighteen interventions were included in our systematic review and thirteen (72%) were effective in improving care. Eight interventions (6 effective) focussed on medication review, 8 (6 effective) on delirium, 7 (4 effective) on falls, 5 (4 effective) functional decline, 4 (3 effective) discharge/aftercare, and/or 2 (0 effective) on pressure ulcer. In 10/13 (77%) effective interventions, the effect was based on process-related outcomes, in 2/13 (15%) interventions on both process and patient-related outcomes and in 1/13 (8%) interventions on patient-related outcomes. The following implementation and design factors were potentially associated with effectiveness: “a priori problem or performance analyses” (described in 69% effective vs 0% ineffective interventions), “multifaceted interventions” (62% vs 20%), and “consideration of the workflow” (69% vs 20%).

Conclusions:

In conclusion, our systematic review shows that CDSS interventions have the potential to improve hospital care of older patients. Almost 75% of the included interventions were effective. The interventions focused on medication review, falls, delirium, discharge/aftercare, functional decline and pressure ulcers. Two implementation factors and one design factor were reported more frequently in articles of effective interventions and show promise for having a positive impact on effectiveness of CDSS interventions in this population. More trials are needed to quantify the impact of these factors on effectiveness. Future studies should measure the effect on geriatric conditions and investigate personalised (data-driven) interventions.