AHRQ on Improving Health Care Decision-Making

The Agency for Healthcare Research and Quality released another comprehensive report, this one focused on technology to improve health care decision making, or more precisely, knowledge management and clinical decision support systems.   (AHRQ Report)   As usual the report starts by providing an analytic framework and then looks for evidence in the research literature regarding the effects, good or bad, of these systems, and includes interviews with experts.  And as usual, the researchers find limited evidence and most of that is of uneven quality.  Knowledge management tools provide relevant information for the characteristics of a particular situation, but does not provide advice for that situation, whereas clinical decision support tools do provide specific recommendations for a specific patient need.  The literature review found that three characteristics were associated with more effective systems:  automatic provision of decision support as part of clinician workflow; providing support at the time of decisionmaking; and providing a recommendation, not just an assessment.

The survey found no or low evidence on the effect of use of these systems on the organization of health care delivery or on workload and efficiency of clinicians.  There was good evidence that clinical decision support improved receipt of preventive care, appropriate diagnostic testing and the ordering of a recommended treatment.  In terms of clinical outcomes, there was some evidence that use of these systems lessened morbidity, but low evidence of any positive effect on mortality, length of stay or quality of life.  In terms of economic outcomes, there was moderate evidence that treatment cost was lowered, but no evidence on cost-effectiveness of the systems.  There was some evidence of provider satisfaction with the systems, but mostly in sophisticated, large practices.  There was little evidence on acceptance or actual use by clinicians and almost nothing on implementation effects.  Overall, there is a positive trend in regard to clinical decision support, but there is a need for much more research to guide effective use.