Priority Setting in Improving Hospital Care for Older Patients Using Clinical Decision Support

Despite rising attention and successful interventions, the quality of hospital care for older people remains suboptimal in some areas. 1 Patterson L. Making our health and care systems fit for an ageing population: David Oliver, Catherine Foot, Richard Humphries. The King's Fund March 2014. Age Ageing. 2014; 43: 731 Crossref PubMed Scopus (9) Google Scholar Health care professionals need to adopt a specific approach for older patients that takes into account the patients' vulnerability to adverse events, as well as individual preferences. 1 Patterson L. Making our health and care systems fit for an ageing population: David Oliver, Catherine Foot, Richard Humphries. The King's Fund March 2014. Age Ageing. 2014; 43: 731 Crossref PubMed Scopus (9) Google Scholar , 2 Labella A. Merel S. Phelan E. Ten ways to improve the care of elderly patients in the hospital. J Hosp Med. 2011; 6: 351-357 Crossref PubMed Scopus (14) Google Scholar Geriatric knowledge needed for this adoption is described in guidelines. However, implementation into daily practice is complex. Clinical Decision Support Systems (CDSSs) can support implementation of guidelines and improve quality of care. 3 Grol R. Grimshaw J. From best evidence to best practice: Effective implementation of change in patients' care. Lancet. 2003; 362: 1225-1230 Abstract Full Text Full Text PDF PubMed Scopus (3227) Google Scholar , 4 Roshanov P. Fernandes N. Wilczynski J. et al. Features of effective computerised clinical decision support systems: Meta-regression of 162 randomised trials. BMJ. 2013; 346: f657 Crossref PubMed Scopus (294) Google Scholar A CDSS is defined as “any computer program designed to help health care professionals to make clinical decisions.” 5 Musen M.A. Shahar Y. Shirtliffe E.H. Clinical decision-support systems. in: Shortliffe E.H. Ciino J.J. Biomedical Informatics—Computer Applications in Health Care and Biomedicine. 3rd ed. Springer, New York2006 Crossref Google Scholar A CDSS can help transfer knowledge to health care professionals and can teach them about the preferred management. 6 Varonen H. Kortteisto T. Kaila M. What may help or hinder the implementation of computerized decision support systems (CDSSs): A focus group study with physicians. Fam Pract. 2008; 25: 162-167 Crossref PubMed Scopus (95) Google Scholar CDSS has already been shown to improve quality of care for older patients. 7 Vedel I. Akhlaghpour S. Vaghefi I. et al. Health information technologies in geriatrics and gerontology: A mix systematic review. J Am Med Inform Assoc. 2013; 20: 1109-1119 Crossref PubMed Scopus (53) Google Scholar , 8 Dalton K. O'Brien G. O'Mahony D. et al. Computerised interventions designed to reduce potentially inappropriate prescribing in hospitalised older adults: A systematic review and meta-analysis. Age Ageing. 2018; 47: 670-678 Crossref PubMed Scopus (47) Google Scholar However, a CDSS is not always successful. The development should follow a user-centered approach and be based on the preferences of health care professionals. 4 Roshanov P. Fernandes N. Wilczynski J. et al. Features of effective computerised clinical decision support systems: Meta-regression of 162 randomised trials. BMJ. 2013; 346: f657 Crossref PubMed Scopus (294) Google Scholar , 9 Gross P. Bates D. A pragmatic approach to implementing best practices for clinical decision support systems in computerized provider order entry systems. J Am Med Inform Assoc. 2007; 14: 25-28 Crossref PubMed Scopus (33) Google Scholar Currently, clinicians' preferences and priorities for CDSS to support geriatric care are not known. Therefore, we conducted an expert consensus study followed by a national survey with the aim to identify causes of suboptimal hospital care for older patients, and set priorities for CDSS as perceived by a multidisciplinary team of health care professionals.