Prompting physicians for preventive procedures: a five-year study of manual and computer reminders

• HIT Description: Computerized decision support with reminders. More info...
  
• Purpose of Study: Evaluate computerized physicians prompting for preventive procedures.
  
• Years of study: 1979-1984
  
• Study Design: Time series
  
• Outcomes: Impact on health care effectivness/quality
  

• Settings: The study was conducted at a university-based general medicine practice.
• Intervention: The interventions studied during three successive periods over five years were: no prompting, nurse-initiated prompting for physicians on eight preventive procedures, and computerized prompting for physicians on eight preventive procedures.
• Evaluation Method: Measures of preventive procedures compliance.
• Description: The nurse-initiated prompting was replaced by the computerized prompting in May 1982.
• Quality of Care and Patient Safety Outcome: Performance of seven prompted procedures for all patients (regardless of whether they had been enrolled) was significantly increased over the five-year period from 38% (no prompting) to 43% (nurse prompting) to 53% (computer prompting). Among the procedures, influenza vaccination (12% to 59%) and mammography (4% to 33%) showed the greatest increases in performance, while fecal occult blood testing and Pap smears showed no increase or slight declines. Enrollment of patients in the optional prompting system was strongly related to performance. Overall performance of procedures for the enrolled group increased to 68%, while that of the unenrolled group remained at 37%. However, after adjusting for differences in the percentage of patients enrolled, overall performance for the nurse system (49%) differed little from that for the computer system (55%). Manual and computer prompts had similar effects, but the computer system prompted for more patients. Though prompting remained effective five years after initiation