Effect of computerised, knowledge-based, clinical decision support systems on patient-reported and clinical outcomes of patients with chronic disease managed in primary care settings: a systematic review

Objectives: Chronic diseases are the leading cause of disability globally. Most chronic disease management occurs in primary care with outcomes varying across primary care providers. Computerised Clinical Decision Support Systems (CDSS) have been shown to positively affect clinician behaviour by improving adherence to clinical guidelines. This study provides a summary of the available evidence on the effect of CDSS embedded in electronic health records on patient-reported and clinical outcomes of adult patients with chronic disease managed in primary care. Design and eligibility criteria: Systematic review including randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, interrupted time series, and controlled before-and-after studies , assessing the effect of CDSS (vs. usual care) on patient-reported or clinical outcomes of adult patients with selected common chronic diseases (asthma, chronic obstructive pulmonary disease, heart failure, myocardial ischemia, hypertension, diabetes mellitus, hyperlipidaemia, arthritis, and osteoporosis) managed in primary care. Data sources: Medline, Embase, Cochrane Central Register of Controlled Trials, Scopus, Health Management Information Consortium, and trial register clinicaltrials.gov, searched from inception to June 24, 2020. Data extraction and synthesis: Screening, data extraction, and quality assessment were performed by two reviewers independently. The Cochrane Risk of Bias tool was used for quality appraisal. Results: From 5,430 articles, eight studies met the inclusion criteria. Studies were heterogeneous in population characteristics, intervention components, and outcome measurements and focused on diabetes, asthma, hyperlipidaemia, and hypertension. Most outcomes were clinical with one study reporting on patient-reported outcomes. Quality of the evidence was impacted by methodological biases of studies. Conclusions: There is inconclusive evidence in support of CDSS. A firm inference on the intervention effect was not possible due to methodological biases and study heterogeneity. Further research is needed to provide evidence on the intervention effect and the interplay between healthcare setting features, CDSS characteristics, and implementation processes. Review registration: Prospero ID: CRD4202021818