CLINICAL Decision Support Systems (CDSS) have shown potential to improve outcomes in maternity care, but the complexities of this field require tailored approaches. While CDSS are increasingly used across healthcare, maternity care poses unique challenges that complicate their implementation. This systematic review aimed to identify and evaluate CDSS used in maternity settings, assessing their effectiveness and synthesizing evidence on their impact.
The review included articles published before May 24, 2024, that described CDSS, evaluated their use, and focused on maternity care. Researchers searched databases including Medline, CINAHL, CENTRAL, and HMIC, and conducted citation tracing for additional relevant studies. Bias was assessed using the Mixed Methods Assessment Tool, and each CDSS was categorized based on its clinical problem, purpose, design, and technical environment. Quantitative data were meta-analysed using a multi-level random effects model to estimate the odds of CDSS improving outcomes, both individually and collectively.
Of the 12,039 papers screened, 87 articles were included, describing 47 unique CDSS. Among them, 24 articles (28%) were randomized controlled trials, 30 (34%) non-randomized interventional studies, and the remainder were qualitative, mixed methods, or economic evaluations. CDSS studies were mostly from High-Income Countries (56%), with no overlap in trials between income categories. A meta-analysis of 35 studies estimated that CDSS improved outcomes with an odds ratio of 1.69 (95% CI 1.24–2.30), although the effects varied widely based on the system and context.
The findings indicate that while CDSS generally improve maternity care outcomes, there is significant variation in their design, evaluation methods, and effectiveness. As CDSS become more integrated into healthcare through tools like Electronic Health Records and mobile health applications, traditional study methods may struggle to keep up with their rapid evolution. To optimize CDSS in maternity care, future approaches should emphasize context-specific development, such as Human-Centered Design, to account for the complexities of maternity systems and improve clinical utility.
Reference
Cockburn N et al. Clinical decision support systems for maternity care: a systematic review and meta-analysis. EClinicalMedicine. 2024;5:76:102822.
