Extracted data.

BackgroundSystematic use of Clinical Decision Support (CDS), which provides timely information to assist healthcare practitioners in decision-making, is recommended in the implementation of fall prevention among older adults. This systematic review aimed to evaluate the effects of CDS for fall prevention on healthcare practitioners’ adherence to recommended practice, medication outcomes, and patient outcomes.MethodsWe searched Medline, EMBASE, CINAHL, Cochrane Library, Web of Science, AMED, PEDro, and Google Scholar from the earliest available dates through January 2025. We included randomised and non-randomised studies that directly compared interventions consisting of CDS presented on-screen or on paper to healthcare practitioners aiming to prevent falls in persons aged 65 years or older. We analysed healthcare practitioner performance, medication review and prescribing, fall risk, fall rate, and fall injury rate as primary outcomes. Two reviewers independently screened studies and assessed for risk of bias. We synthesised results using meta-analyses and vote-counting based on direction of effect, when possible, otherwise narratively, and we rated the certainty of the evidence using the GRADE approach.ResultsOf 25 included studies, 20 were randomised and five were non-randomised. Most CDS tools supported healthcare practitioners in performing multifactorial fall risk assessments and follow-up interventions based on identified risks (60%) and most were delivered electronically (60%). CDS may improve healthcare practitioners’ adherence to recommended practice (all eight comparisons favouring CDS; 95% confidence interval [CI] 68% to 100%; low certainty) and likely improve medication review and prescribing (all nine comparisons favouring CDS; 95% CI 70% to 100%; moderate certainty), although the effect sizes are uncertain. CDS may reduce fall risk, but the effect may be small (odds ratio 0.93; 95% CI 0.81 to 1.01; low certainty). CDS likely reduces fall rates in hospitals or residential care (rate ratio [RaR] 0.74; 95% CI 0.63 to 0.88; moderate certainty) and in patients aged 80 years or older (RaR 0.72; 95% CI 0.61 to 0.86; moderate certainty). CDS may reduce fall rates in community-dwelling older adults (RaR 0.97; 95% CI 0.93 to 1.00; moderate certainty) and in patients aged between 65 and 80 years (RaR 0.92; 95% CI 0.84 to 1.01; low certainty), though the effects in both of these subgroups may be small. CDS may reduce fall injury rates in older adults aged between 65 and 80 years (RaR 0.80; 95% CI 0.59 to 1.09; low certainty). The evidence on fall injury rates in patients aged 80 years or older was very uncertain.ConclusionCDS likely enhances healthcare practitioners’ performance in fall prevention among older adults; however, the effect sizes remain unknown. Although CDS may improve patient outcomes in fall prevention, both the effect sizes and the certainty of evidence vary. Results from this study may inform the planning and implementation of CDS in fall prevention. Future studies should strive for clearer reporting of CDS design factors to allow for an evaluation of which factors may influence the success of CDS interventions in fall prevention.Trial registrationRegistration: PROSPERO, CRD42021250500.背景 临床决策支持（Clinical Decision Support, CDS）可提供及时信息以协助医疗从业者开展决策制定，在老年跌倒预防的实施过程中，系统应用CDS已被广泛推荐。本系统综述旨在评估CDS用于跌倒预防时，对医疗从业者遵循推荐诊疗规范、用药结局及患者结局的影响。 研究方法 本研究检索了Medline、EMBASE、CINAHL、考克兰图书馆（Cochrane Library）、Web of Science、AMED、物理治疗证据数据库（PEDro）及Google Scholar数据库，检索时限为各数据库建库起始至2025年1月。纳入直接比较以屏幕或纸质形式呈现的CDS干预与对照措施、用于65岁及以上老年人跌倒预防的随机研究及非随机研究。本研究的主要结局指标包括医疗从业者执业表现、用药审核与处方行为、跌倒风险、跌倒发生率及跌倒损伤发生率。由2名评价者独立筛选研究文献并评估偏倚风险。若条件允许，采用Meta分析及基于效应方向的投票计数法整合研究结果，否则采用叙述性综合方法；并采用推荐分级的评估、制定与评价（Grading of Recommendations Assessment, Development and Evaluation, GRADE）方法对证据质量进行分级。 研究结果 本研究共纳入25项研究，其中20项为随机研究，5项为非随机研究。多数CDS工具可辅助医疗从业者开展多因素跌倒风险评估及基于识别出的风险因素实施后续干预（占比60%），且大多数CDS工具以电子形式提供（占比60%）。CDS或可提升医疗从业者对推荐诊疗规范的依从性（所有8项比较结果均显示CDS组更具优势；95%置信区间（Confidence Interval, CI）：68%~100%；证据质量为低等级）；或可改善用药审核与处方行为（所有9项比较结果均显示CDS组更具优势；95%CI：70%~100%；证据质量为中等级），但效应量仍不明确。CDS或可降低跌倒风险，但效应幅度较小（比值比（Odds Ratio, OR）=0.93；95%CI：0.81~1.01；证据质量为低等级）。CDS或可降低医院或养老机构内的跌倒发生率（率比（Rate Ratio, RaR）=0.74；95%CI：0.63~0.88；证据质量为中等级），以及80岁及以上老年患者的跌倒发生率（RaR=0.72；95%CI：0.61~0.86；证据质量为中等级）。CDS或可降低社区居住老年人的跌倒发生率（RaR=0.97；95%CI：0.93~1.00；证据质量为中等级），以及65~80岁老年患者的跌倒发生率（RaR=0.92；95%CI：0.84~1.01；证据质量为低等级），但上述两类亚组的效应幅度均较小。CDS或可降低65~80岁老年患者的跌倒损伤发生率（RaR=0.80；95%CI：0.59~1.09；证据质量为低等级）。针对80岁及以上老年患者跌倒损伤发生率的相关证据则极不明确。 研究结论 CDS或可提升医疗从业者在老年跌倒预防中的执业表现，但具体效应量仍未明确。尽管CDS或可改善跌倒预防相关的患者结局，但效应量及证据质量均存在差异。本研究结果可为跌倒预防领域CDS的规划与实施提供参考依据。未来研究应更清晰地报告CDS的设计要素，以便评估哪些因素可影响CDS干预在跌倒预防中的实施效果。 试验注册 本研究已在PROSPERO注册，注册号为CRD42021250500。