A randomized trial of electronic clinical reminders to improve quality of care for diabetes and coronary artery disease
A randomized trial of electronic clinical reminders to improve quality of care for diabetes and coronary artery disease
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DOI：
10.1197/jamia.m1788
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发表时间：
2005-07-01
影响因子：
6.4
通讯作者：
Bates, DW
中科院分区：
文献类型：
--
作者：
Sequist, TD;Gandhi, TK;Bates, DW
目的：本研究的目的是评估综合患者特异性电子临床提醒系统对糖尿病和冠心病（CAD）护理的影响，并评估医生对该提醒系统的态度。设计：我们招募了194名初级保健医生，他们在20个门诊诊所治疗了4549名糖尿病患者和2199名冠心病患者。诊所是随机的，这样医生要么在病人的电子病历中收到循证电子提醒，要么收到常规护理。糖尿病护理提示5次，冠心病护理提示4次。测量：主要结果是接受糖尿病和冠心病的推荐治疗。我们创建了一个总结结果来评估总体糖尿病护理（基于五项指标）和总体CAD护理（基于四项指标）依从性增加的几率。我们调查了医生对提醒系统的态度。结果：所有质量指标的基线依从率均较低。虽然电子提醒增加了推荐糖尿病护理的几率（比值比[OR] 1.30, 95%可信区间[CI] 1.01-1.67）和CAD (OR = 1.25, 95% CI 1.01-1.55)，但个人提醒的影响是可变的。9个提醒中总共有3个有效地增加了糖尿病或冠心病的推荐护理率。大多数医生（76%）认为提醒提高了护理质量。结论：集成电子提醒系统对糖尿病和冠心病的护理有不同程度的改善。这些改进往往是有限的，质量差距仍然存在。
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.