Patient-specific Computerized Outpatient Reminders to Improve Physician Compliance with Clinical Guidelines

Methods Using existing well-accepted evidence-based national clinical guidelines, a multidisciplinary team created 16 specific reminders within 4 clinical categories: (1) diabetes care (eye exams, HbA1C and cholesterol studies, nursing education visits); (2) therapeutic recommendations (ACE-inhibitor (ACEI) use in diabetic hypertensives; aspirin, beta-blocker, and statin use in patients with coronary artery disease (CAD)); (3) expensive medication substitution suggestions (for patients on expensive NSAIDs, H2blockers, statins, ACEIs); and (4) health maintenance (Pap smear, mammogram, cholesterol, Pneumovax). Primary care providers (PCPs) participated in the study if they were active PCPs at our tertiary care institution for the entire 1-year study period (9/989/99). For reminder categories (1)-(3) the PCPs were randomized into control and intervention groups; control groups did not get reminders. For category (4) all PCPs received reminders. Patients were included in the study if they were members of any study PCP's panel for the entire study period. Reminders were generated just prior to office visits and were printed on face-sheets (summaries of patient clinical information) that PCPs receive at the time of patient office visits. The reminders were based on data from our clinical information system and ambulatory electronic medical record, including patient age, gender, problem list, medication list, laboratory data, radiology reports, and visit details. For reminders in categories (1)-(3), we compared, using generalized estimating equations, how often patients received the recommended care items after office visits with intervention versus control PCPs. For reminders in category (4) we compared, using ttests, the percentage of patients in compliance with guidelines at the beginning versus the end of the study.