Effectiveness of Guideline-Based Clinical Decision Support Systems: Protocol for a Systematic Review

Clinical guidelines (CGs) standardize care through evidence-based recommendations, while clinical decision support systems (CDSS) can assist in applying these guidelines to individual patients. The scientific basis for the decisions offered by decision support systems is often not explicitly stated or not clearly specified in the literature on CDSS. Therefore, a systematic examination of the literature is needed to map the current state of CDSS, with a particular focus on the integration of CGs.

This study aims to systematically collect, describe, and synthesize evidence of randomized controlled studies of interventions using CDSS with a well-defined integration of evidence-based CGs and evaluating direct medical outcomes.

This systematic review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklists. The eligibility criteria for this review are defined using the patient, intervention, control, outcome, and study design framework, including studies involving patients with any medical condition or disease. Study interventions need to include guideline-based CDSS, encompassing all types of interventions used for treatment. Each intervention must provide a sufficiently accessible technical description, including the types of data and algorithms used for decision-support procedures. The guidelines used within these CDSS interventions must be derived from a clearly defined, evidence-based guideline development process published by a discernible guideline-producing body. Studies must use a randomized controlled study design. Only studies evaluating the effectiveness of the interventions on direct medical outcomes are included. Web of Science, including MEDLINE, and Scopus will be searched with search expressions aligned with the eligibility criteria.

On August 11, 2022, the initial search was conducted on Web of Science and Scopus. From a total of 6203 records, 1347 were removed prior to screening as duplicates, 2506 records were excluded during the first screening step, and 2291 were excluded during the second step. Next, 41 papers were excluded based on full-text review, and 18 papers were finally included in the review following this initial search. This review explores whether CDSS based on CGs can improve clinical outcomes, although their effectiveness may vary depending on various factors. Potential limitations, such as high study heterogeneity, have already been identified. An update of the review has been started in April 2025.

To our knowledge, this is the first rigorous systematic review on the effectiveness of guideline-based decision support systems in which the technical integration and algorithmic embedding of CGs have been described or can be inferred from secondary literature. With this review, we aim to address this gap by providing a detailed analysis of existing research and identifying best practices, challenges, and areas for future investigation.