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Bioterrorism Preparedness and Response
Evidence Reports/Technology Assessments, No. 59
Dena M Bravata, MD, MS, Project Director, Kathryn McDonald, MM, UCSF-Stanford EPC Coordinator, and Douglas K Owens, MD, MS, Principal Investigator. Section Contributors: David Buckeridge, MD, MPH, Corinna Haberland, MD, Chara Rydzak, BA, Mark Schleinitz, MD, Wendy M Smith, BA, and Herbert Szeto, MD, MS, MPH. Investigators: Dean Wilkening, PhD, Mark Musen, MD, PhD, Bradford W Duncan, MD, Bahman Nouri, MD, Mariana B Dangiolo, MD, Hau Liu, MD, Scott Shofer, MD, PhD, Justin Graham, MD, and Sheryl Davies, MS.
Structured Abstract
Objectives:
This project aimed to synthesize the evidence on information technologies and decision support systems (IT/DSSs) that may serve the information needs of clinicians and public health officials in the event of bioterrorism.
Search Strategy:
To direct literature searches, a conceptual model was developed that specifies the decisions and tasks of clinicians and public health officials in the event of bioterrorism. Searches of MEDLINE® and of other relevant databases for articles describing or evaluating potentially relevant IT/DSSs were performed. Additional references were found from Internet searches (including 16 government agency Web sites), and bibliographies of retrieved articles.
Selection Criteria:
IT/DSSs were included that could potentially support the detection, diagnosis, management, prevention, treatment, guideline implementation, surveillance, reporting, and communication of information during a response to bioterrorism.
Data Collection and Analysis:
All peer-reviewed articles that met the inclusion criteria were blinded to the study authors, and 2 investigators independently abstracted study information. Information from Web sites was abstracted by a single investigator.
Main Results:
More than 20,000 citations and Web sites were reviewed. Of these, 251 articles, 36 government Web sites, and 54 non-government Web sites met selection criteria. From these, 217 IT/DSSs of potential use by clinicians and public health officials in the event of bioterrorism were described. They include 55 detection systems, 23 diagnostic systems, 18 management systems, 90 surveillance systems, 26 communication systems, and 7 systems that integrate surveillance, communication, and command and control functions. Most reports only described IT/DSSs; however, 79 studies evaluated 58 systems for at least 1 performance metric (e.g., timeliness). Few systems have been subjected to comprehensive evaluation. The sensitivity and specificity of rapid detection systems is not generally publicly available, complicating the interpretation of test results. None of the general diagnostic or management systems has been evaluated with respect to bioterrorism response. Syndromal surveillance systems collecting a variety of surveillance data have been deployed for both event-based and continuous bioterrorism surveillance, and evaluations are ongoing. Web-based communication systems are increasingly in use, but few have been formally evaluated. Current national efforts of particular promise include those to develop and evaluate systems that integrate the collection, analysis, and presentation of data from detectors, clinicians, laboratories, and hospitals to public health decision makers.
Conclusions:
IT/DSSs have the potential to help clinicians and public health officials make better decisions regarding detection, diagnosis, management, prevention, surveillance, and communication during a bioterrorism event. However, few of these systems have been evaluated rigorously, and most were not specifically designed to address threats from bioterrorism. Furthermore, many of the systems have not been described in peer-reviewed literature. The lack of evaluative studies creates difficulties in assessing the usefulness of IT/DSSs. We note, however, that lack of evidence about effectiveness is not evidence for lack of effectiveness. Many of the systems we reviewed may be useful for response to bioterrorism and are reasonable candidates for further evaluation. Such evaluations would clarify their value both for response to bioterrorism and for the other purposes for which they were designed.
Contents
- Preface
- Acknowledgments
- Summary
- 1. Introduction
- 2. Methods
- Technical Expert Advisory Panels
- Target Population
- Identification of Key Questions
- Conceptual Model
- Task Decomposition
- Development of Inclusion and Exclusion Criteria
- Literature Sources
- Search Terms and Strategies
- Abstract Review
- Data Abstraction
- Development of Quality Evaluation Systems
- Reviews and Revisions of Draft Evidence Report
- 3. Results
- Conceptual Model
- Task Decomposition
- Search Results
- Overview of Included Systems
- Detection and Diagnostic Systems
- Management and Prevention Systems
- Surveillance Systems
- Reporting and Communication Systems
- Integrated Surveillance, Communication, and Command and Control Systems
- Quality Evaluations
- Technical Information About the IT/DSSs
- Summary: Answers to the Key Questions
- 4. Conclusions
- 5. Future Research
- Evidence Tables
- Appendixes
- Appendix A. Acronyms and Abbreviations
- Appendix B. Alphabetical List of Expert Advisors
- Appendix C. Abstraction Form: Peer-Reviewed Articles
- Appendix D. Alphabetical List of Peer-Reviewers
- Appendix E. Results of MEDLINE® Search
- Appendix F. Results of Searches of Other Databases of Peer-Reviewed Articles and Selected Government Agency Web Sites
- Appendix G. Results of Copernic® Internet Searches
- Appendix H. Sources of Information for Included IT/DSSs
- Appendix I. Index of Systems
- References
- Bibliography
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, U.S. Public Health Service.1 Contract No. 290-97-0013. Prepared by: University of California San Francisco-Stanford Evidence-based Practice Center.
Suggested citation:
Bravata D, McDonald K, Owens D, et al. Bioterrorism Preparedness and Response: Use of Information Technologies and Decision Support Systems (Evidence Report/Technology Assessment No. 59 (Prepared by University of California San Francisco-Stanford Evidence-based Practice Center under Contract No. 290-97-0013). AHRQ Publication No. 02-E028. Rockville, MD: Agency for Healthcare Research and Quality. June 2002.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers -- patients and clinicians, health system leaders, and policymakers -- make more informed decisions and improve the quality of health care services.
Please note that we have neither attempted to independently evaluate the systems described in this Report, nor attempted to validate the information provided by the manufacturers or any other reference. The inclusion of the names of any specific products or companies in this Report does not constitute an endorsement by Stanford University, by the University of California at San Francisco-Stanford Evidence-based Practice Center, by the Agency for Healthcare Research and Quality, or by the Department of Veterans Affairs.
The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.
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