Requiring physicians to respond to computerized reminders improves their compliance with preventive care protocols

• HIT Description: Computerized decision support with preventive reminders; Electronic health record More info...
  
• Purpose of Study: Assess computer-generated reminders to improve compliance with preventive services.
  
• Years of study: 1989
  
• Study Design: RCT
  
• Outcomes: Impact on health care effectivness/quality
  

• Settings: Thirty-one general internal medicine faculty, 145 residents, and 5,407 patients participated in the study, which was conducted at an academic primary care general internal medicine practice in Indianapolis, Indiana.
• Intervention: The study groups received either routine computer reminders (control) or the same remainders to which they were required to circle one of four responses: 1) "done/order today," 2) "not applicable to this patient," 3) "patient refused," or 4) "next visit." The computer-generated reminders were to perform fecal occult blood testing (FOBT), mammography, and cervical Papanicolaou (Pap) testing.
• Evaluation Method: Measures of compliance with preventive services.
• Barriers: Intervention physicians felt that the reminders were not applicable 21% of the time (due to inadequate data in patient's electronic medical records) and stated that their patients refused 10% of the time. The authors found that the most common reasons for non-compliance with the reminders were the physicians' lack of time and the patients' lack of belief about the need for or fear of preventive services.
• Quality of Care and Patient Safety Outcome: Intervention physicians complied more frequently than control physicians with all remainders combined (46% vs. 38%, respectively, p = 0.002) and separately with remainders for FOBT (61% vs. 49%, p = 0.0007) and mammography (54% vs. 47%, p = 0.036) but not cervical Pap testing (21% vs. 18%, p = 0.2). Intervention residents responded significantly more often than control residents to all reminders together and separately to reminders for FOBT and mammography but not Pap testing. There was no significant difference between intervention and control faculty, but the compliance rate for control faculty was significantly higher than the rate for control residents for all reminders together and separately for FOBT but not mammography or Pap testing. The intervention's effect was greatest for patients > or = 70 years old, with significant results for all tests, together and singly, for residents but not faculty.