Clinical Decision Support Tools in Older Adults When Considering Disposition Decisions: A Scoping Review

Objectives Alternative models of care are becoming increasingly popular. Clinical decision support (CDS) tools have been developed to assist clinicians in identifying older adults who may be safely directed to alternative care pathways. However, the characteristics, scope, and validation of these tools remain unclear. This scoping review aims to identify and map published decision support tools developed or validated for use in this patient population, and to identify gaps in the existing literature. Methods A comprehensive scoping review of the peer-reviewed and gray literature was conducted across multiple databases to identify CDS tools developed to direct older patients to alternative care pathways. We focused on tools developed for use in health care settings only. Data were charted to compare tool characteristics, domains, implementation settings, and reported outcomes. Results Seven CDS tools were included in the final review. Most of these had been specifically developed for destination decisions regarding alternative care pathways, but a small number evaluated expedition of treatment, assessment, or discharge as an alternative pathway in patient care. Most tools included were constructed for directing patients to out-of-hospital settings. The tools varied widely in structure, clinical parameters, implementation context, and outcome measures. Although several studies suggested that CDS-supported disposition decisions may be associated with safe outcomes and reduced acute care utilization, few tools had undergone formal validation, and diagnostic performance data were limited. Conclusions Existing decision support tools may support structured and consistent disposition decision making for older adults across prehospital, emergency, and post-acute care systems. However, the current evidence base is heterogeneous, and robust validation of older-adult–specific tools is lacking. There is need for the development and validation of decision support tools in disposition decisions in the older population.