Users' Guides to the Medical Literature
Guyatt G, Rennie D, Meade MO, Cook DJ
Part B Therapy
Chapter 9.6. Clinical Decision Support Systems
Adrienne Randolph, Anne Holbrook, Amit Garg, Brian Haynes, Pierre Durieux, Deborah J. Cook, Gordon Guyatt
Were Study Participants Randomized?
Topics Discussed:
antibiotics, clinical decision support systems, control groups, inappropriate drug prescribing, outcome assessment (health care), pediatrics, randomization, validity of evidence
Excerpt:
"In keeping with the approach of other chapters of this book,
we will consider 3 primary questions related to the validity of
research methods, the results, and clinical application of the results
(Table 9.6-3). We will periodically refer
to the article by Samore et al1 evaluating the
effect of clinical decision support on antibiotic prescribing.The validity of observational studies often
used to evaluate a CDSS is limited (see Chapter 5, Why Study Results Mislead: Bias and Random
Error). One observational design, the before-after
design, compares outcomes before a technology is implemented
with those after the system is implemented. The validity of
this approach is threatened by the possibility that changes over
time (called secular trends) in patient mix
or in other aspects of health care delivery are responsible for
changes that investigators may be tempted to attribute to the CDSS...."
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