use of a clinical decision support system to increase osteoporosis screening: how similar is the...
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LETTER TO THE EDITOR
Use of a clinical decision support system to increaseosteoporosis screening: how similar is the historicalcontrol?Anis Fuad MS,1,3 Ajit Kumar MS,1 Yao-Chin Wang MD MS1 and Chien-Yeh Hsu MS PhD2
1PhD student, 2Professor, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taiwan3Teaching staff, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
Correspondence
Professor Chien-Yeh HsuGraduate Institute of Biomedical InformaticsTaipei Medical University250 Wu-Xin StreetTaipei(110)TaiwanE-mail: [email protected]
Other contact information: Anis Fuad, E-mail:[email protected].
Accepted for publication: 3 May 2012
doi:10.1111/j.1365-2753.2012.01872.x
To the editor
We congratulate to DeJesus et al. for their recent publicationwhich demonstrates the increase of osteoporosis screening forwomen 65 years old or older after implementing a point-of-careclinical decision support system (CDSS) [1]. This result is also inline with the current review, which confirms the effectiveness ofCDSS to improve health care process measures including preven-tive services [2].
While we positively believed the potential role of CDSS in caredelivery, however, the authors missed providing sufficient evi-dence showing that the comparison groups were similar. The useof historical control comprising the same environment (doctorsand patients), in pre- as well as post-CDSS implementation, issuggested in the literature [3]. Besides mentioning age 65 years orolder and predominantly White, the authors should also compareother risk factors characteristics between those groups [4]. More-over, the mean age comparison of the groups under study is notavailable to the readers, which is crucial given the known fact thatthe osteoporosis risk increases by age [4].
As the authors intended to evaluate CDSS optimized care deliv-ery system, we assume that user’s characteristics, workflow andorganizational environment before and after CDSS implementa-tion should be better elaborated [5] since environment changesover time could probably bias the intervention effect [3].
Competing interest
None declared.
References1. DeJesus, R. S., Angstman, K. B., Kesman, R., Stroebel, R. J., Bernard,
M. E., Scheitel, S. M., Hunt, V. L., Rahman, A. S. & Chaudhry, R.(2012) Use of a clinical decision support system to increase osteoporo-sis screening. Journal of Evaluation in Clinical Practice, 18, 89–92.
2. Bright, T. J., Wong, A., Dhurjati, R., et al. (2012) Effect of clinicaldecision-support systems: a systematic review. Annals of InternalMedicine. Available at: http://www.annals.org/content/early/2012/04/20/0003-4819-157-1-201207030-00450.long#ref-list-1] (last accessed28 April 2012).
3. Friedman, C. P. & Wyatt, J. (2006) Evaluation Methods in BiomedicalInformatics. New York: Springer.
4. Gass, M. & Dawson-Hughes, B. (2006) Preventing osteoporosis-relatedfractures: an overview. The American Journal of Medicine, 119,S3–S11.
5. Brender, J., Ammenwerth, E., Nykanen, P. & Talmon, J. (2006) Factorsinfluencing success and failure of health informatics systems – a pilotDelphi study. Methods of Information in Medicine, 45, 125–136.
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