Systematic review of clinical decision support interventions with potential for inpatient cost reduction

The purpose of this thesis was to systematically review trials of clinical decision support interventions with the potential to reduce inpatient costs, so as to identify promising interventions for more widespread implementation and to inform future research in this area. MEDLINE was searched up to September 2012, and relevant studies were identified using titles and abstracts. Full text articles were reviewed to make a final determination on inclusion. Relevant characteristics of the studies were extracted and summarized. Following a screening of 6,978 articles, 60 manuscripts were included. The majority of manuscripts were published during or after 2007. 63.3% of studies were pre-post comparisons, and 13.3% were randomized controlled trials. 56.7% of the studies were focused on pharmacotherapy. 71.7% of the studies resulted in statistically and clinically significant improvements in an explicit financial measure or a proxy financial measure. Only 15% of the studies directly measured the financial impact of an intervention, whereas the financial impact was inferred in the remainder of studies. Data on cost-effectiveness were available for only one study. Given these results, it is apparent that further research is needed on the cost impact and cost effectiveness of CDS in the inpatient setting.