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.

中文翻译：

---

重新瞄准临床决策支持中的公平性评估：手术决策支持系统中公平性评估的范围审查

 客观的：

我们严格评估了外科文献，以探讨其患病率并描述使用临床决策支持系统时如何进行公平评估。

 背景：

临床决策支持 (CDS) 系统越来越多地用于促进手术护理的提供。尽管有正式建议这样做，但 CDS 系统并未定期进行公平评估，代表性不足的人群面临受到伤害和进一步健康差距的风险。我们探索了外科文献，以确定 CDS 公平性评估的频率和严格性，并提供通过附加现有框架来提高 CDS 公平性的建议。

 方法：

我们使用 PubMed 和 Google Scholar 对以下搜索词进行了截至 2021 年 8 月 25 日的范围界定审查：临床决策支持、实施、RE-AIM、Proctor、Proctor 框架、公平、创伤、手术、外科。我们确定了 1415 篇引用和 229 篇摘要符合审查标准。如果没有评估电子 CDS 工具的结果或有手术用例，则总共 84 人接受了全面审查，其中 145 人被排除。

 结果：

只有 6% (5/84) 的外科 CDS 系统报告了公平性分析，这表明当前优化外科 CDS 公平性的方法是不够的。我们建议修订 RE-AIM 框架，以包含公平元素 (RE ² -AIM)，指定 CDS 基础分析和算法是在具有社会人口学特征的平衡数据集上执行或训练的，这些特征准确地代表 CDS 目标人群，并通过重点敏感度分析进行评估关于弱势群体。

 结论：

目前的外科 CDS 文献很少报道有关公平性的内容。修订 RE-AIM 框架以纳入公平要素 (RE ² -AIM) 可促进 CDS 系统的开发和实施，该系统至少不会加剧医疗保健差异，并可能提高其普遍性。