系统评估临床决策支持在低收入国家的医疗效果与服务影响
Impact of clinical decision support systems (cdss) on clinical outcomes and healthcare delivery in low- and middle-income countries: protocol for a systematic review and meta-analysis
- 采用系统综述与元分析方法，整合多类研究设计
- 涵盖19个数据库及灰色文献，确保证据全面性
- 适合政策制定者、医疗信息化从业者参考
临床决策支持系统（CDSS）被用于提升临床与服务成效，但低收入和中等收入国家（LMICs）的相关证据分散。本协议概述了量化CDSS在世界银行定义的LMICs中对患者结局和医疗交付结果影响的方法。纳入比较性定量研究设计（随机试验、对照前后、中断时间序列、对照队列），排除独立的定性研究；混合方法研究仅在报告比较性定量结果时纳入，并提取其定量部分。检索范围涵盖MEDLINE、Embase、CINAHL、CENTRAL、Web of Science、Global Health、Scopus、IEEE Xplore、LILACS、African Index Medicus和IndMED，以及灰色文献，时间从建库至2024年9月30日。筛选与数据提取将双人独立进行。风险偏倚评估使用RoB 2（随机试验）和ROBINS-I（非随机研究）。当结局在概念或统计上可比时，进行随机效应元分析；否则采用结构化叙述性综合。异质性通过相对与绝对指标，以及预先设定的亚组分析或元回归（疾病领域、照护层级、CDSS类型、准备度代理变量、研究设计）进行探索。
原文摘要 · Abstract (English)
Clinical decision support systems (CDSS) are used to improve clinical and service outcomes, yet evidence from low- and middle-income countries (LMICs) is dispersed. This protocol outlines methods to quantify the impact of CDSS on patient and healthcare delivery outcomes in LMICs. We will include comparative quantitative designs (randomized trials, controlled before-after, interrupted time series, comparative cohorts) evaluating CDSS in World Bank-defined LMICs. Standalone qualitative studies are excluded; mixed-methods studies are eligible only if they report comparative quantitative outcomes, for which we will extract the quantitative component. Searches (from inception to 30 September 2024) will cover MEDLINE, Embase, CINAHL, CENTRAL, Web of Science, Global Health, Scopus, IEEE Xplore, LILACS, African Index Medicus, and IndMED, plus grey sources. Screening and extraction will be performed in duplicate. Risk of bias will be assessed with RoB 2 (randomized trials) and ROBINS-I (non-randomized). Random-effects meta-analysis will be performed where outcomes are conceptually or statistically comparable; otherwise, a structured narrative synthesis will be presented. Heterogeneity will be explored using relative and absolute metrics and a priori subgroups or meta-regression (condition area, care level, CDSS type, readiness proxies, study design).
Thank you to arXiv for use of its open access interoperability. PaperDance 不是 arXiv 官方产品；中文卡片由大模型生成，请以原文为准。