Effects and characteristics of clinical decision support systems on the outcomes of patients with kidney disease: a systematic review

ABSTRACT

Objectives

This systematic review was conducted to investigate the characteristics and effects of clinical decision support systems (CDSSs) on clinical and process-of-care outcomes of patients with kidney disease.

Methods

A comprehensive systematic search was conducted in electronic databases to identify relevant studies published until November 2020. Randomized clinical trials evaluating the effects of using electronic CDSS on at least one clinical or process-of-care outcome in patients with kidney disease were included in this study. The characteristics of the included studies, features of CDSSs, and effects of the interventions on the outcomes were extracted. Studies were appraised for quality using the Cochrane risk-of-bias assessment tool.

Results

Out of 8722 retrieved records, 11 eligible studies measured 32 outcomes, including 10 clinical outcomes and 22 process-of-care outcomes. The effects of CDSSs on 45.5% of the process-of-care outcomes were statistically significant, and all the clinical outcomes were not statistically significant. Medication-related process-of-care outcomes were the most frequently measured (54.5%), and CDSSs had the most effective and positive effect on medication appropriateness (18.2%). The characteristics of CDSSs investigated in the included studies comprised automatic data entry, real-time feedback, providing recommendations, and CDSS integration with the Computerized Provider Order Entry system.

Conclusion

Although CDSS may potentially be able to improve processes of care for patients with kidney disease, particularly with regard to medication appropriateness, no evidence was found that CDSS affects clinical outcomes in these patients. Further research is thus required to determine the effects of CDSSs on clinical outcomes in patients with kidney diseases.

KEYWORDS:

• Kidney disease
• Clinical
• Decision support system
• Systematic review
• Information systems
• Medical informatics

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Nasim Mirpanahi: conception design, data interpretation, draft manuscript. Ehsan Nabovati: conception design, data interpretation, draft manuscript. Reihane Sharif: data acquisition, data interpretation, draft manuscript, article revision. Shahzad Amirazodi: data acquisition, data interpretation. Mahtab Karami: conception design, critical review, article revision, corresponding.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/21548331.2023.2203051.

Additional information

Funding

This paper was not funded.