A computerized reminder system to increase the use of preventive care for hospitalized patients.

BACKGROUND Although they are effective in outpatient settings, computerized reminders have not been proved to increase preventive care in inpatient settings. METHODS We conducted a randomized, controlled trial to determine the effects of computerized reminders on the rates at which four preventive therapies were ordered for inpatients. During an 18-month study period, a computerized system processed on-line information for all 6371 patients admitted to a general-medicine service (for a total of 10,065 hospitalizations), generating preventive care reminders as appropriate. Physicians who were in the intervention group viewed these reminders when they were using a computerized order-entry system for inpatients. RESULTS The reminder system identified 3416 patients (53.6 percent) as eligible for preventive measures that had not been ordered by the admitting physician. For patients with at least one indication, computerized reminders resulted in higher adjusted ordering rates for pneumococcal vaccination (35.8 percent of the patients in the intervention group vs. 0.8 percent of those in the control group, P<0.001), influenza vaccination (51.4 percent vs. 1.0 percent, P< 0.001), prophylactic heparin (32.2 percent vs. 18.9 percent, P<0.001), and prophylactic aspirin at discharge (36.4 percent vs. 27.6 percent, P<0.001). CONCLUSIONS A majority of hospitalized patients in this study were eligible for preventive measures, and computerized reminders significantly increased the rate of delivery of such therapies.

[1]  V. Dietz,et al.  Impact of measurement and feedback on vaccination coverage in public clinics, 1988-1994. , 1997, JAMA.

[2]  E. Ingenito,et al.  Utilization of venous thromboembolism prophylaxis in the medical intensive care unit. , 1994, Chest.

[3]  L. Brammer,et al.  Influenza surveillance--United States, 1992-93 and 1993-94. , 1997, MMWR. CDC surveillance summaries : Morbidity and mortality weekly report. CDC surveillance summaries.

[4]  William DuMouchel,et al.  A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. , 1996, Journal of the American Medical Informatics Association : JAMIA.

[5]  H. Sacks,et al.  The Efficacy of Influenza Vaccine in Elderly Persons , 1995, Annals of Internal Medicine.

[6]  R. Breiman,et al.  Prevention of pneumococcal disease : recommendations of the Advisory Committee on Immunization Practices (ACIP) , 1997 .

[7]  C. McDonald,et al.  Reminders to physicians from an introspective computer medical record. A two-year randomized trial. , 1984, Annals of internal medicine.

[8]  J. Cairns,et al.  Antithrombotic agents in coronary artery disease. , 1989, Chest.

[9]  C J McDonald,et al.  A tool for provider interaction during patient care: G-CARE. , 1995, Proceedings. Symposium on Computer Applications in Medical Care.

[10]  K. Nichol,et al.  Relation between Influenza Vaccination and Outpatient Visits, Hospitalization, and Mortality in Elderly Persons with Chronic Lung Disease , 1999, Annals of Internal Medicine.

[11]  C J McDonald,et al.  Effects of computer reminders for influenza vaccination on morbidity during influenza epidemics. , 1992, M.D. computing : computers in medical practice.

[12]  S. Ray,et al.  Use of a low-literacy patient education tool to enhance pneumococcal vaccination rates. A randomized controlled trial. , 1999, JAMA.

[13]  G. Clagett,et al.  Antithrombotic therapy in peripheral arterial occlusive disease. , 1992, Chest.

[14]  A J Moskowitz,et al.  Cost-effectiveness of vaccination against pneumococcal bacteremia among elderly people. , 1997, JAMA.

[15]  J. Heit,et al.  Prevention of venous thromboembolism. , 2001, Clinics in geriatric medicine.

[16]  R. Haynes,et al.  Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. , 1998, JAMA.

[17]  C J McDonald,et al.  The Medical Gopher--a microcomputer system to help find, organize and decide about patient data. , 1986, The Western journal of medicine.

[18]  C. McDonald.  Protocol-based computer reminders, the quality of care and the non-perfectability of man. , 1976, The New England journal of medicine.

[19]  T. Koepsell,et al.  Risk factors for acquiring pneumococcal infections. , 1986, Archives of internal medicine.

[20]  C. McDonald,et al.  Computer Reminders to Implement Preventive Care Guidelines for Hospitalized Patients , 1996 .

[21]  Walker,et al.  Collaborative overview of randomised trials of antiplatelet therapy Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients , 1994 .

[22]  J. Marc Overhage,et al.  Research Paper: A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission , 1997, J. Am. Medical Informatics Assoc..

[23]  C. McDonald,et al.  Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. , 1993, JAMA.

[24]  D. Fedson.  Adult immunization. Summary of the National Vaccine Advisory Committee Report. , 1994, JAMA.

[25]  D. Kaiser,et al.  Hospital-based pneumococcal immunization: epidemiologic rationale from the Shenandoah study. , 1990 .

[26]  W. Spitzer,et al.  The public's health is too important to be left to public health workers. A commentary on Guide to Clinical Preventive Services. , 1989, Annals of internal medicine.

[27]  D. Fedson.  The clinical effectiveness of pneumococcal vaccination: a brief review. , 1999, Vaccine.

[28]  R. C. McDonald,et al.  Mailed Reminders for Area‐Wide Influenza Immunization: A Randomized Controlled Trial , 1999, Journal of the American Geriatrics Society.

[29]  J. Mohr,et al.  Antithrombotic Therapy for Cerebrovascular Disorders : An Update , 1995 .

[30]  J. Wennberg,et al.  Geographic variation in the treatment of acute myocardial infarction: the Cooperative Cardiovascular Project. , 1999, JAMA.

[31]  R. Morrow,et al.  Improving physicians' preventive health care behavior through peer review and financial incentives. , 1995, Archives of family medicine.

[32]  et al.,et al.  The Regenstrief Medical Record System: a quarter century experience , 1999, Int. J. Medical Informatics.

[33]  K Y Liang,et al.  Longitudinal data analysis for discrete and continuous outcomes. , 1986, Biometrics.

[34]  D. Hosmer,et al.  Physician practices in the prevention of venous thromboembolism. , 1991, Annals of internal medicine.