TY - JOUR
T1 - Re-Aiming Equity Evaluation in Clinical Decision Support
T2 - A Scoping Review of Equity Assessments in Surgical Decision Support Systems
AU - Ingraham, Nicholas E.
AU - Jones, Emma K.
AU - King, Samantha
AU - Dries, James
AU - Phillips, Michael
AU - Loftus, Tyler
AU - Evans, Heather L.
AU - Melton, Genevieve B.
AU - Tignanelli, Christopher J.
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/3/1
Y1 - 2023/3/1
N2 - Objective: We critically evaluated the surgical literature to explore the prevalence and describe how equity assessments occur when using clinical decision support systems. Background: Clinical decision support (CDS) systems are increasingly used to facilitate surgical care delivery. Despite formal recommendations to do so, equity evaluations are not routinely performed on CDS systems and underrepresented populations are at risk of harm and further health disparities. We explored surgical literature to determine frequency and rigor of CDS equity assessments and offer recommendations to improve CDS equity by appending existing frameworks. Methods: We performed a scoping review up to Augus 25, 2021 using PubMed and Google Scholar for the following search terms: clinical decision support, implementation, RE-AIM, Proctor, Proctor's framework, equity, trauma, surgery, surgical. We identified 1415 citations and 229 abstracts met criteria for review. A total of 84 underwent full review after 145 were excluded if they did not assess outcomes of an electronic CDS tool or have a surgical use case. Results: Only 6% (5/84) of surgical CDS systems reported equity analyses, suggesting that current methods for optimizing equity in surgical CDS are inadequate. We propose revising the RE-AIM framework to include an Equity element (RE2-AIM) specifying that CDS foundational analyses and algorithms are performed or trained on balanced datasets with sociodemographic characteristics that accurately represent the CDS target population and are assessed by sensitivity analyses focused on vulnerable subpopulations. Conclusion: Current surgical CDS literature reports little with respect to equity. Revising the RE-AIM framework to include an Equity element (RE2-AIM) promotes the development and implementation of CDS systems that, at minimum, do not worsen healthcare disparities and possibly improve their generalizability.
AB - Objective: We critically evaluated the surgical literature to explore the prevalence and describe how equity assessments occur when using clinical decision support systems. Background: Clinical decision support (CDS) systems are increasingly used to facilitate surgical care delivery. Despite formal recommendations to do so, equity evaluations are not routinely performed on CDS systems and underrepresented populations are at risk of harm and further health disparities. We explored surgical literature to determine frequency and rigor of CDS equity assessments and offer recommendations to improve CDS equity by appending existing frameworks. Methods: We performed a scoping review up to Augus 25, 2021 using PubMed and Google Scholar for the following search terms: clinical decision support, implementation, RE-AIM, Proctor, Proctor's framework, equity, trauma, surgery, surgical. We identified 1415 citations and 229 abstracts met criteria for review. A total of 84 underwent full review after 145 were excluded if they did not assess outcomes of an electronic CDS tool or have a surgical use case. Results: Only 6% (5/84) of surgical CDS systems reported equity analyses, suggesting that current methods for optimizing equity in surgical CDS are inadequate. We propose revising the RE-AIM framework to include an Equity element (RE2-AIM) specifying that CDS foundational analyses and algorithms are performed or trained on balanced datasets with sociodemographic characteristics that accurately represent the CDS target population and are assessed by sensitivity analyses focused on vulnerable subpopulations. Conclusion: Current surgical CDS literature reports little with respect to equity. Revising the RE-AIM framework to include an Equity element (RE2-AIM) promotes the development and implementation of CDS systems that, at minimum, do not worsen healthcare disparities and possibly improve their generalizability.
KW - PROCTOR
KW - REAIM
KW - equity
KW - evidence-based medicine
KW - machine learning
UR - http://www.scopus.com/inward/record.url?scp=85147128069&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85147128069&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000005661
DO - 10.1097/SLA.0000000000005661
M3 - Article
C2 - 35943199
AN - SCOPUS:85147128069
SN - 0003-4932
VL - 277
SP - 359
EP - 364
JO - Annals of surgery
JF - Annals of surgery
IS - 3
ER -