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A Randomized Trial of Electronic Clinical Reminders to Improve Quality of Care for Diabetes and Coronary Artery Disease

Affiliations of the authors: Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School (TDS, TKG, DWB, DGF, EFC, EJO, JMF); the Department of Health Care Policy, Harvard Medical School (TDS); the General Medicine Unit, Massachusetts General Hospital (ASK); and Partners HealthCare System (DB, MS), Boston, MA.

Correspondence and reprints: David W. Bates, MD, MSc, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120; e-mail: <dbates{at}partners.org>.

Received for publication: 12/30/04; accepted for publication: 03/23/05.

Objective: The aim of this study was to evaluate the impact of an integrated patient-specific electronic clinical reminder system on diabetes and coronary artery disease (CAD) care and to assess physician attitudes toward this reminder system.

Design: We enrolled 194 primary care physicians caring for 4549 patients with diabetes and 2199 patients with CAD at 20 ambulatory clinics. Clinics were randomized so that physicians received either evidence-based electronic reminders within their patients' electronic medical record or usual care. There were five reminders for diabetes care and four reminders for CAD care.

Measurements: The primary outcome was receipt of recommended care for diabetes and CAD. We created a summary outcome to assess the odds of increased compliance with overall diabetes care (based on five measures) and overall CAD care (based on four measures). We surveyed physicians to assess attitudes toward the reminder system.

Results: Baseline adherence rates to all quality measures were low. While electronic reminders increased the odds of recommended diabetes care (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.01–1.67) and CAD (OR 1.25, 95% CI 1.01–1.55), the impact of individual reminders was variable. A total of three of nine reminders effectively increased rates of recommended care for diabetes or CAD. The majority of physicians (76%) thought that reminders improved quality of care.

Conclusion: An integrated electronic reminder system resulted in variable improvement in care for diabetes and CAD. These improvements were often limited and quality gaps persist.

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