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Submitted on December 30, 2004
Accepted on March 23, 2005
Affiliation of the authors: 1 Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Health Care Policy, Harvard Medical School, Boston, MA; 2 Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; 3 General Medicine Unit, Massachusetts General Hospital, Boston, MA; 4 Partners Healthcare System, Boston, MA
* To whom correspondence should be addressed.
Objective 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 towards this reminder system.
Design We enrolled 194 primary care physicians caring for 4,549 patients with diabetes and 2,199 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 4 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 5 measures) and overall CAD care (based on 4 measures). We surveyed physicians to assess attitudes towards 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 3 of 9 reminders effectively increased rates of recommended care for diabetes or CAD. The majority of physicians (76%) felt 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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