Computer-aided quality assurance. A critical appraisal.

Computerized information systems hold the promise of overcoming problems in the management of clinical information Many of the claims of the creators and promoters of these systems, however, are not based on sound clinical studies. To determine the ability of computer information systems to improve the quality of medical care, we applied methodologic criteria to published articles in the field. Only 30 (22%) of 135 articles reported preplanned investigations, and only half of these met minimal criteria for scientific investigations. Fourteen studies were well designed and executed. All studies reported improvements in the process of care. However, patient outcomes were not measured, not affected, or only minimally influenced. While computer information systems show increasing potential, more work is required to enhance their effect on the quality of care and thus on patient outcomes.

[1]  H. Covvey,et al.  Randomised controlled trial of computer assisted management of hypertension in primary care. , 1986, British medical journal.

[2]  D. Cohen,et al.  Influence of Simple Computerized Feedback on Prescription Charges in an Ambulatory Clinic: A Randomized Clinical Trial , 1986, Medical care.

[3]  Q. Whiting-O'Keefe,et al.  A computerized summary medical record system can provide more information than the standard medical record. , 1985, JAMA.

[4]  D. Sackett,et al.  The Ends of Human Life: Medical Ethics in a Liberal Polity , 1992, Annals of Internal Medicine.

[5]  L. Chambers,et al.  The Impact of CME , 1984 .

[6]  R W Jelliffe,et al.  Clinical studies with computer-assisted initial lidocaine therapy. , 1984, Archives of internal medicine.

[7]  W E Hammond,et al.  Improving Drug Prescribing in a Primary Care Practice , 1984, Medical care.

[8]  O. Haring,et al.  Changes in patient attitudes following the implementation of a medical information system. , 1984, QRB. Quality review bulletin.

[9]  R. Haynes,et al.  A critical appraisal of the efficacy of continuing medical education. , 1984, JAMA.

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

[11]  R B Haynes,et al.  Problems in the handling of clinical and research evidence by medical practitioners. , 1983, Archives of internal medicine.

[12]  T Shinozaki,et al.  Medical Information Management: Improving the Transfer of Research Results to Presurgical Evaluation , 1983, Medical care.

[13]  G. Barnett,et al.  A Computer-Based Monitoring System for Follow-Up of Elevated Blood Pressure , 1983, Medical care.

[14]  D W Simborg,et al.  Evaluation Methodology for Ambulatory Care Information Systems , 1982, Medical care.

[15]  P M Wortman,et al.  Medical Information Systems: Assessing Impact in the Areas of Hypertension, Obesity and Renal Disease , 1982, Medical care.

[16]  L. Muhlbaier,et al.  Improving Hypertension Control: Impact of Computer Feedback and Physician Education , 1981, Medical care.

[17]  C J McDonald,et al.  Physician response to computer reminders. , 1980, JAMA.

[18]  J L Rogers,et al.  The Impact of a Computerized Medical Record Summary System on Incidence and Length of Hospitalization , 1979, Medical care.

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

[20]  E C Coles,et al.  Randomised controlled trial of computer-held medical records in hypertensive patients. , 1976, British medical journal.

[21]  Clement J. McDonald,et al.  Use of a computer to detect and respond to clinical events: its effect on clinician behavior. , 1976 .