Article type
Year
Abstract
Background
Shared decision making requires understandable information, clear options and a sense of the consequences of the different options. Health information support systems (HIS) in health services are used to document health care events. We hypothesised that HIS can be conceived as health workers behaviour changers by providing a visual language to support actual decision pathways; and that by making decision pathways more explicit, decisions and decision-making sharing with users could be better supported.
Objectives
To synthesise the effects of HIS on data quality, use and health outcomes and to gain an in-depth understanding of how HIS are conceived and reported in the research literature.
Methods
Effectiveness systematic review (SR) and framework synthesis (FS).
Results
In the SR we included 16 studies from low- and middle-income countries.
Quality of data outcomes showed mixed effects. From extremely large effects favouring the intervention group (e.g. timelines in TB results and mismatch errors), to moderate or no effects. Use of data outcomes significantly favoured the intervention group. User’s experience outcomes constantly favoured the intervention groups. Behavioural outcomes (e.g. adherence) showed a mix of beneficial effects and no effects. Resource use showed mixed effects in time-related outcomes. Coverage outcomes generally showed beneficial effects with an example of an outcome slightly favouring the control group. Three studies reported on health status outcomes with no effects (see for example, Figure 1).
The FS (50 studies) showed a wide range of barriers in the use of HIS for decision making, some of them common to other health systems areas, but other intimately related on how the HIS are designed and set up. The focus on reporting (as opposed to frontline decision making) seems to be in the root of many of the barriers identified.
Conclusions
Evidence on the effects of HIS interventions to improve data use and decision making is meagre and patchy. Our hypothesis that HIS are designed for reporting purposes rather than to support decision-making was widely confirmed.
Patient or healthcare consumer involvement
At this stage, we involved health workers to understand the human experience in using HIS to support the FS.
Shared decision making requires understandable information, clear options and a sense of the consequences of the different options. Health information support systems (HIS) in health services are used to document health care events. We hypothesised that HIS can be conceived as health workers behaviour changers by providing a visual language to support actual decision pathways; and that by making decision pathways more explicit, decisions and decision-making sharing with users could be better supported.
Objectives
To synthesise the effects of HIS on data quality, use and health outcomes and to gain an in-depth understanding of how HIS are conceived and reported in the research literature.
Methods
Effectiveness systematic review (SR) and framework synthesis (FS).
Results
In the SR we included 16 studies from low- and middle-income countries.
Quality of data outcomes showed mixed effects. From extremely large effects favouring the intervention group (e.g. timelines in TB results and mismatch errors), to moderate or no effects. Use of data outcomes significantly favoured the intervention group. User’s experience outcomes constantly favoured the intervention groups. Behavioural outcomes (e.g. adherence) showed a mix of beneficial effects and no effects. Resource use showed mixed effects in time-related outcomes. Coverage outcomes generally showed beneficial effects with an example of an outcome slightly favouring the control group. Three studies reported on health status outcomes with no effects (see for example, Figure 1).
The FS (50 studies) showed a wide range of barriers in the use of HIS for decision making, some of them common to other health systems areas, but other intimately related on how the HIS are designed and set up. The focus on reporting (as opposed to frontline decision making) seems to be in the root of many of the barriers identified.
Conclusions
Evidence on the effects of HIS interventions to improve data use and decision making is meagre and patchy. Our hypothesis that HIS are designed for reporting purposes rather than to support decision-making was widely confirmed.
Patient or healthcare consumer involvement
At this stage, we involved health workers to understand the human experience in using HIS to support the FS.