Table 11Types and sources of generalizable knowledge incorporated into CDSSs/KMSs

Type of generalizable knowledgeNumber of studies (%)Example studiesDescription
Primary research
Knowledge identified directly from original studies in the primary literature
5 (3.4)aFrame et al., 1994174Compliance with 11 health maintenance protocols identified in the literature
Ornstein et al., 1991140Recommendations for serum cholesterol measurements, fecal occult blood testing, mammography, Pap smears, and tetanus immunizations identified from the literature
Systematic reviews
Investigations to synthesize the results of multiple primary investigations
1 (0.7)Christakis et al., 2001155Guidance derived primarily from systematic reviews integrated into a CDSS to improve antibiotic prescribing practices for otitis media in children
Research evidence summaries
Synthesis of systematic reviews and meta-analyses to develop summary of evidence for particular clinical circumstances
1 (0.7)Alper et al., 2005171Evaluation of Dynamed, an evidence synthesis tool that incorporates the latest evidence from systematic reviews and primary research to deliver evidence summaries related to different clinic topics
Domain knowledge databases
Repositories of domain-specific knowledge such as drug databases
1 (0.7)Tamblyn et al., 2008127Commercially available drug knowledge database (MentoR, Vigilance Sante, Montreal, Quebec) was integrated into a CDSS to provide customizable alerts
Policy statements and recommendations
Recommendations from professional and national organizations
13 (8.8)bMcPhee et al., 1989139American Cancer Society and National Cancer Institute guidelines for cancer screening
Clinical practice guidelines
Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances
42 (28.4)cBertoni et al., 200992National Cholesterol Education Program clinical practice guidelines
Structured care protocols
Local adaptation and synthesis of evidence-based guidelines and other evidence-based knowledge to develop structured care protocols
61 (41.2)dJudge et al., 2006177CDSS was designed by a team of geriatricians, pharmacists, health services researchers, and information system professionals; team reviewed the types of preventable adverse events based on published research and pharmaceutical drug interaction databases. Medications not on formulary at the facility and medications never used in elderly patients or long-term care settings were excluded.
Locally developed knowledge
Protocols, algorithms, or other forms of knowledge developed locally
15 (10.1)eCavalcanti et al., 200933Locally developed protocol for maintaining blood glucose level between 100 and 130 mg/dL
Hamilton et al., 2004131Mathematical model for evaluating progress of labor in pregnant women
Incorporation of knowledge from multiple sources
9 (6.1)fApkon et al., 200547Knowledge database incorporating content from multiple sources including clinical textbooks, consensus reports, and clinical practice guidelines












Abbreviations: CDSS = clinical decision support system, mg/dL = milligrams per deciliter

From: Results

Cover of Enabling Health Care Decisionmaking Through Clinical Decision Support and Knowledge Management
Enabling Health Care Decisionmaking Through Clinical Decision Support and Knowledge Management.
Evidence Report/Technology Assessments, No. 203.
Lobach D, Sanders GD, Bright TJ, et al.

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