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A review of randomized controlled trials of medical record powered clinical decision support system to improve quality of diabetes care.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Ali, Syed Mustafa Giordano, Richard Lakhani, Saima Walker, Dawn Marie
Description	Author Affiliation: Ali SM ( mHealth Coordinator at Mercy Corps, Pakistan. Electronic address: Mustafa_30_84@yahoo.com.); Giordano R ( Senior Lecturer, Faculty of Health Sciences, University of Southampton, UK.); Lakhani S ( Manager Quality Assurance, Marie Stopes Society Pakistan, An affiliate of Marie Stopes International, UK.); Walker DM ( Associate Professor, Faculty of Health Sciences, University of Southampton, UK.)
Abstract	BACKGROUND: A gap between current diabetes care practice and recommended diabetes care standards has consistently been reported in the literature. Many IT-based interventions have been developed to improve adherence to the quality of care standards for chronic illness like diabetes. OBJECTIVE: The widespread implementation of electronic medical/health records has catalyzed clinical decision support systems (CDSS) which may improve the quality of diabetes care. Therefore, the objective of the review is to evaluate the effectiveness of CDSS in improving quality of type II diabetes care. Moreover, the review aims to highlight the key indicators of quality improvement to assist policy makers in development of future diabetes care policies through the integration of information technology and system. SELECTION OF STUDY: Setting inclusion criteria, a systematic literature search was conducted using Medline, Web of Science and Science Direct. Critical Appraisal Skills Programme (CASP) tools were used to evaluate the quality of studies. Eight randomized controlled trials (RCTs) were selected for the review. In the selected studies, seventeen clinical markers of diabetes care were discussed. Three quality of care indicators were given more importance in monitoring the progress of diabetes care, which is consistent with National Institute for Health and Care Excellence (NICE) guidelines. The presence of these indicators in the studies helped to determine which studies were selected for review. Clinical- and process-related improvements are compared between intervention group using CDSS and control group with usual care. Glycated hemoglobin (HbA1c), low density lipid cholesterol (LDL-C) and blood pressure (BP) were the quality of care indicators studied at the levels of process of care and clinical outcome. FINDINGS: The review has found both inconsistent and variable results for quality of diabetes care measures. A significant improvement has been found in the process of care for all three measures of quality of diabetes care. However, weak to modest positive results are observed for the clinical measures of the diabetes care indicators. In addition to this, technology adoption of CDSS is found to be consistently low. CONCLUSION: The review suggests the need to conduct further empirical research using the critical diabetes care indicators (HbA1c, LDL-C and BP) to ascertain if CDSS improves the quality of diabetes care. Research designs should be improved, especially with regard to baseline characteristics, sample size and study period. With respect to implementation of CDSS, rather than a sudden change of clinical work practice, there should instead be an incremental, gradual adoption of technology that minimizes the disruption in clinical workflow.
File Format	HTM / HTML
ISSN	13865056
Volume Number	87
e-ISSN	18728243
Journal	International Journal of Medical Informatics
Language	English
Publisher	Elsevier
Publisher Date	2016-03-01
Publisher Place	Ireland
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Medical Informatics Decision Support Systems, Clinical Utilization Diabetes Mellitus Therapy Medical Records Systems, Computerized Quality Improvement Randomized Controlled Trials As Topic Humans Quality Control Journal Article Review
Content Type	Text
Resource Type	Article
Subject	Health Informatics

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
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