Using a claims data-based sentinel system to improve compliance with clinical guidelines: results of a randomized prospective study

• HIT Description: Decision support- Clinical guidelines More info...
  
• Purpose of Study: To assess the effect of a sentinel system that scans administrative claims information and clinical data to detect and mitigate errors in care and deviations from best medical practices
  
• Years of study: Not Available
  
• Study Design: Randomized controlled trial
  
• Outcomes: Impact on health care effectiveness and quality, impact on efficiency, utilization, and costs
  

• Settings: Managed care plan headquartered in Cleveland, Ohio
• Intervention: Treating physicians of intervention patients received clinical recommendations triggered by a computerized sentinel system.
• Evaluation Method: claims data for costs of care, admissions and hospital LOS
• Description: A rule-based artificial intelligence engine combined with an automated message generator that conveys clinical recommendations and supporting literature to MDs. Software coding was programmed in a combination of C++ and Visual Basic that draws data from an Oracle 8i-based data warehouse. Daily data inputs include insurance claims, hospital discharge and outpatient claims, laboratory claims and test results, and pharmacy claims.
• Strategy: Issues for inclusion in the clinical rules engine were identified from national clinical trials, published guidelines, and FDA approved labeling by an in-house committee of MDs, working in consultation with health plan medical directors and a panel of medical consultants
• Cost of HIT systems: Intervention costs $1.00 to $150 per member per month. ROI estimated at $8.07 per member per month
• Healthcare Utilization: There were 19% fewer hospitalizations in the intervention group compared with the control group (p.001). Sub-analysis revealed that the entire difference in hospitalization was attributable to admission for cardiac and peripheral vascular disease.
• Quality of Care and Patient Safety Outcome: Physicians of intervention patients complied with 24% of recommendations to add a drug compared to 17% for control patients (p0.007).
• Changes in healthcare costs: Charges in the intervention group were $18.62 per member per month lower and paid claims were $8.07 per member per month lower.