Computer-based vs manual health maintenance tracking. A controlled trial

• HIT Description: Locally developed system for patient and physician computer reminders. The HIT system was designed to assess 11 health maintenance procedures such as a history of tobacco use, blood pressure measurement within two years, weight measurement within four years, etc. More info...
  
• Purpose of Study: Improve screening and prevention
  
• Years of study: 1991-1992
  
• Study Design: RCT
  
• Outcomes: Utilization of services, costs of computer system
  

• Settings: This study was performed in a rural non-profit family medicine group practice.
• Intervention: Families who received care in the group practice were randomized to have health maintenance monitored either with the existing method, which was a manual flow chart based system, or using a computer based tracking system called HTRAK. The HIT system used multiple database inputs to generate patient reminders that were designed to be mailed to patients. For the purposes of the study, however, telephone reminders instead of mailed patient reminders were used. In addition, computer generated provider reminders were also generated.
• Extrinsic Factors in valuing cost and benefits: 1,324 patients were enrolled in the family practice when the study began. Of these 9% had no medical insurance, 9% received Medicaid, 27% were covered by health maintenance organizations and Medicare covered 18% of the patients.
• Costs: Cost data for operating the computer based tracking system were obtained by a time and motion study of different tasks during the second year of the intervention when employees were familiar with the system. Costs of installing the system were not included in the calculations. The authors report that the cost of maintaining the computer system generating provider and patient reminders and mailing patient reminders was 78 cents per patient per year.
• Healthcare Utilization: The reported results of the study were an increase in overall provider compliance of 13.5% in the HIT group and 3.3% in the control group. Representative changes on individual health maintenance processes included an increase from 40-58% in fecal cult blood testing and an increase from 48-65% in cholesterol measurement. he authors also report that there was no increase in revenue generated or the number of office visits during the intervention years and concluded that the computer based tracking system did not lead toward either more office visits or more billings.