Table-3 The type of CCDSS and its effectiveness
CCDSS
setting
and
Format
CCDSS User
1. Caroll
et al.34
2012,
USA.
Commu
nity/
Integrat
ed with
the
EMR
Practitioners
2.
Hashimo
to et
al.35
2011,
Netherla
nds.
Hospital
/ Stand
alone
(Interne
t based)
Patients
3. Van
der
Meer et
al.36
Commu
nity/
Standalone
Citation
Type of CCDSS
Diagnostic/Drug therapy
management
only/Multifaceted
CCDSS
Effect of CCDSS
Health care process
outcomes
(recommended
preventative care,
clinical study ordered,
treatment ordered)
Clinician prompted to
make an asthma
diagnosis based on the
results of a prescreening questionnaire
Corticosteroid treatment
decision support for the
patients based on
symptoms, lung function
and exhaled NO (nitric
oxide)
Patients
Multifaceted CCDSS:
Weekly asthma
monitoring and advice,
User workload
and Efficiency
outcomes (user
knowledge,
clinician
workload,
efficiency)
Relationship centred outcomes
(patient satisfaction)/ Economic
outcomes(cost and cost
effectiveness)/ Use and
implementation (health care
provider acceptance, satisfaction,
use and implementation)
Significantly more
children diagnosed with
asthma
Diagnostic CCDSS:
Drug therapy
management based
CCDSS:
Clinical outcomes
(morbidity, mortality,
HRQOL, length of stay,
adverse events)
(+ effect)
Significant decrease in
corticosteroid
consumption in
patients with steroid
dependent asthma
No difference in asthma
control, quality of life,
FEV1, exacerbations,
hospitalisations between
groups.
(+ effect)
(+ effect)
Patients asthma
knowledge, inhaler
technique improved
Asthma control, lung
function, asthma related
quality of life improved,
symptom-free days
No difference in patient satisfaction
between groups
2009,
Netherla
nds.
(Interne
t based)
online and group
education and remote
web communications
Medication changes
occurred more often
Health care provider
contacts were fewer
increased, exacerbations
did not differ between
groups
(+ effect)
(+ effect)
4. Van
der
Meer et
al.37
2010,
Netherla
nds.
Commu
nity/
Standalone
(Interne
t based)
Patients
Multifaceted CCDSS:
Weekly asthma
monitoring and selfmanagement advice.
Significant increase in
the corticosteroid dose
in patients with
uncontrolled asthma,
but not in patients
with well or partly
controlled asthma.
(+ effect)
Significant improvement in
asthma control in patients
with partly and
uncontrolled asthma.
(+ effect)
Adherence to ACQ
monitoring gradually
declined in the first
month to the seventh
month and then
remained stable.
No difference after 12
months in dose of
corticosteroids or LABA
or LRTA
5. Taylor
et al.38
2008,
Australia
.
Hospital
/
Integrat
ed
Practitioners
(ED doctors)
Multifaceted CDSS:
Included triage and
registration, clinical
documentation,
treatment orders, order
entry and discharge
documentation.
Significantly
higher rate of
asthma
documentation
(Primary
outcome)
No significant
difference in
The system integrated
asthma management
pathways based on
current guidelines into
clinical and discharge
documentation.
6. Fiks et
al.39
2009,
USA.
Hospital
/Integra
ted into
EHR
Practitioners
7. Bell et
al.40
2010,
USA.
Hospital
/Integra
ted into
EHR
Practitioners
Multifaceted CCDSS:
EHR based clinical alerts
for influenza vaccine
consultation time
(+ effect)
(preventative care)
Increased Influenza
vaccination rates.
(+ effect, but not
significant)
Multifaceted CCDSS:
EHR based CDS alerts
and reminders based on
paediatric asthma
management tool (PACT)
which captured asthma
symptom frequency,
asthma severity,
facilitated ordering of
controller medications,
spirometry and ACP
(asthma action plan)
Increase in the number
of controller
medication
prescriptions, and upto-date asthma action
plan (ACP)
(+ effect, but not
significant)
Increase in the use of
spirometry in the
intervention group
(+ effect, but not
significant)
8.
Rasmuss
en et
al.41
2005,
Denmark
Standalone
(interne
t based)
Patients
Multifaceted CCDSS:
Internet based asthma
monitoring tool
consisting of an asthma
diary, action plan and a
decision support for the
Significantly more
patients using inhaled
corticosteroids in the
internet and specialist
group
Significant improvement in
asthma symptoms, AQLQ,
lung function, airway
responsiveness
(+ effect)
9.
Dexheim
er et
al.42
2013,
USA.
10.
Smith et
al.43
2012,
UK.
Hospital
/
Integrat
ed
Commu
nity/
Integrat
ed (with
the
EHR)
Practitioners
(ED
physician)
Practitioners
physician
(+ effect)
Multifaceted CCDSS:
No difference in
asthma education
charted, medication
prescribed, follow-up
appointment
scheduled
Computerised detection
system screened and
identified patients with
asthma exacerbation
and a guideline based
management protocol
Multifaceted CCDSS:
EHR based alerts to flag
their at-risk status to
improve patient access
and opportunistic
management
No difference in admission
rate or ED length of stay
(no effect)
(No effect)
Significant increase in
LABA usage and
significant decrease in
nebulised B-agonists
No significant
difference in the
time taken to
make a ED
disposition
decision
(no effect)
No significant difference in
the number of people
experiencing
exacerbations (primary
outcome)
(+ effect)
Relative reduction in
people experiencing
hospitalisations, accident
and emergency
attendances, out-of-hour
contacts and other health
care use
Cost –effectiveness outcome:
Adjusted mean health care (NHS)
cost lower among intervention
practices compared to control
practices
(+ effect)
(+ effect, bit not
significant)
11.
Kattan et
al.44
2006,
USA.
Commu
nity/
Standal
one?
Practitioners
Drug therapy
management based
CCDSS:
Computer generated
letter recommending
change in controller
medications based on
NAEPP guidelines
Significant increase in
scheduled visits
Significant decrease in ED
visits
Significant increase in
stepping up of
medications
No difference in maximum
number of symptom days
and school days missed,
decrease in the number of
days with activity
limitation.
(+ effect)
Intervention-reduced asthma
related cost to the health services
and was cost-effective.
(+ effect)
12.
Tierney
et al.45
2005,
USA.
Hospital
/
Integrat
ed
13.
Martens
et al.46
2006,
Netherla
nds.
Commu
nity/
Integrat
ed
14.
Martens
et al.47
2007,
Netherla
nds.
Commu
nity/
Integrat
ed
15.
Martens
et al.48
2008,
Netherla
nds.
Commu
nity/
Integrat
ed
Practitioners
(Physicians
And
pharmacists
)
Practitioners
(GPs)
Multifaceted CCDSS:
Care suggestions
focussing on
immunisation,
prescription and
smoking advice
Drug therapy
management based
CCDSS:
Guideline based
reminders when
prescribing antibiotics,
asthma/COPD and
cholesterol prescriptions
Practitioners
(GPs)
Drug therapy
management based
CCDSS:
Guideline based
reminders when
prescribing antibiotics,
asthma/COPD and
cholesterol prescriptions
Practitioners
(GPs)
Drug therapy
management based
CCDSS:
Guideline based
reminders when
prescribing antibiotics,
asthma/COPD and
cholesterol prescriptions
No difference in the
number of tests and
treatment ordered
(No effect)
No effect on quality of life,
clinical symptoms,
Medication adherence and
compliance, ED visits or
hospitalizations
Significantly higher health care costs
in the group receiving only physician
intervention
Physicians attitude towards
guidelines was mixed
(No effect)
Reductions in the
number of
prescriptions
according to the
guidelines
Providers perceived the CRS as
stable and user friendly
(+ effect, but not significant)
(+ effect, but not
significant))
Clinically meaningful
results seen in not
prescribing certain
drugs in the
intervention group
(+ effect, but not
significant)
Significant
learning curve
was found (shows
improvement in
user knowledge)
(+ effect)
Provider satisfaction: Positive
attitude to the content of the
reminders and satisfied with the
user friendliness
Provider use: Only 9% drop-out rate
(because of technical problems
requiring multiple updates)
16.
Kuilboer
et al.49
2006,
Netherla
nds.
Commu
nity/
Integrat
ed
Practitioners
(General
practitioners
)
Multifaceted CCDSS:
Asthma critic evaluates
whether the patient has
asthma or COPD,
reviews the physicians
treatment , and
generates feedback
Significant decrease in
the average number of
Cromogylate
prescriptions
Antihistamines,
Deptropine, and oral
bronchodilator
prescriptions per
asthma/COPD patient
per practice did not
show statistically
significant changes
Average number of
contacts increased
significantly
(+ effect)
17. Poels
et al.50
2008,
Netherla
nds.
Commu
nity/
Standalone
(spirom
etry
expert
system)
Practitioners
(GPs)
Multifaceted CCDSS:
Presentation of data for
diagnosis and
management of chronic
airway disease
No difference in
between the two
groups (Spirometry
expert system and
sham information) in
the diagnosis of COPD,
asthma and absence of
respiratory disease or
in medication
Slightly more
additional diagnostic
tests in the expert
group
(No effect)
FEV1 (forced expiratory
volume), and peak-flow
measurements per
asthma/COPD patient per
practice increased
significantly
(+ effect)
18. Poels
et al.51
2009,
Netherla
nds.
Commu
nity/
Integrat
ed? (not
clear)
Practitioners
(GPs)
Multifaceted CCDSS:
Spirometry expert
support for change in
diagnosis and
management
No differences in the
proportion of changed
diagnosis between the
three groups
(spirometry expert
system, chest physician
and usual care)
Also no difference
between the groups in
referral rate, additional
diagnostic tests or
medication changes
(No effect)
19.
Frickton
et al.52
2011,
USA.
Commu
nity/
Integrat
ed (with
the
EDR)
Practitioners
(Dentists)
and patients
Multifaceted CCDSS:
(Electronic dental
record) EDR based alerts
notifying the dentists of
the presence of a
medically complex
condition with a link to
appropriate
modifications in dental
care
Significant increase in the frequency
of accessing guidelines (number of
website hits and number of
providers using the guideline)
Only number of hits sustained after
6 months
Significant increase in the number of
patient web hits for 6 months
After 9 months provider use
returned to baseline levels
(+ effect)