Guidelines for management of HIV infection with computer-based patient's record

• HIT Description: Electronic health record and decision support with guidelines and alerts. More info...
  
• Purpose of Study: Evaluate electronic alerts designed to enhance adherence to clinical practice guidelines.
  
• Years of study: 1992-1994
  
• Study Design: CCT
  
• Outcomes: Impact on health care effectivness/quality, Impact on health care access
  

• Settings: One hundred twenty-six physicians and nurse practitioners caring for 349 patients with HIV infection participated in the study, conducted at a primary care practice of Beth Israel Hospital, Boston, Massachusetts.
• Intervention: An electronic health record with guidelines and alerts for the management of HIV infection.
• Evaluation Method: Measures of response times of clinicians to the situations that triggered alerts and reminders, the number of ambulatory visits, hospitalizations, and survival.
• Healthcare Utilization: There was no effect on visits to the primary care practice. There was, however, a significant increase in the rate of visits outside the primary care practice (p = 0.02), which is explained by the increased frequency of visits to ophthalmologists. There were no differences in admission rates (p = 0.47), in admissions for pneumocystosis (p = 0.09), or in visits to the emergency ward (p = 0.24).
• Quality of Care and Patient Safety Outcome: There were no difference in survival (p = 0.19).
• Changes in efficiency and productivity: The median response times to 303 alerts in the intervention group and 388 alerts in the control group were 11 and 52 days (p 0.0001), respectively. The median response time to 432 reminders in the intervention group was 114 days and that for 360 reminders in the control group was over 500 days (p 0.0001).