Int J Med Inform - Comparing semi-automatic systems for recruitment of patients to clinical trials.

Tópicos

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Resumo

JECTIVES: (i) To review contributions and limitations of decision support systems for automatic recruitment of patients to clinical trials (Clinical Trial Recruitment Support Systems, CTRSS). (ii) To characterize the important features of this domain, the main classes of approach that have been used, and their advantages and disadvantages. (iii) To assess the effectiveness and potential of such systems in improving trial recruitment rates.DATA SOURCES: A systematic MESH keyword-based search of Pubmed, Embase, and Scholar Google for relevant CTRSS publications from January 1st 1998 to August 31st 2009 yielded 73 references, from which 33 relevant papers describing 28 distinct studies were chosen for review, based on their report of a novel decision support system for trial recruitment which reused already available patient data.METHOD: The reviewed papers were classified using a modified version of an existing taxonomy for clinical decision support systems, using 10 axes relevant to the trial recruitment domain.RESULTS: It proved possible and useful to characterize CTRSS on a relatively small number of dimensions and a number of clear trends emerge from the study. Only nine papers reported a useful evaluation of the effectiveness of the system in terms of trial pre-inclusion or enrolment rate. While all the systems reviewed re-use structured and coded patient data none attempts the more difficult task of using unstructured patient notes to pre-screen for trial inclusion. Few studies address acceptance of systems by clinicians, or integration into clinical workflow, and there is little evidence of use of interoperability standards.CONCLUSIONS: System design, scope, and assessment methodology vary significantly between papers, making it difficult to establish the impact of different approaches on recruitment rate. It is clear, however, that the pre-screening phase of trial recruitment is the most effective part of the process to address with CTRSS, that clinical workflow integration and clinician acceptance are critical for this class of decision support, and that the current trends in this field are towards generalization and scalability.

Resumo Limpo

jectiv review contribut limit decis support system automat recruit patient clinic trial clinic trial recruit support system ctrss ii character import featur domain main class approach use advantag disadvantag iii assess effect potenti system improv trial recruit ratesdata sourc systemat mesh keywordbas search pubm embas scholar googl relev ctrss public januari st august st yield refer relev paper describ distinct studi chosen review base report novel decis support system trial recruit reus alreadi avail patient datamethod review paper classifi use modifi version exist taxonomi clinic decis support system use axe relev trial recruit domainresult prove possibl use character ctrss relat small number dimens number clear trend emerg studi nine paper report use evalu effect system term trial preinclus enrol rate system review reus structur code patient data none attempt difficult task use unstructur patient note prescreen trial inclus studi address accept system clinician integr clinic workflow littl evid use interoper standardsconclus system design scope assess methodolog vari signific paper make difficult establish impact differ approach recruit rate clear howev prescreen phase trial recruit effect part process address ctrss clinic workflow integr clinician accept critic class decis support current trend field toward general scalabl

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