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Press Release
Computerized Reminders Boost Doctors' Compliance with Standards of Care
For immediate release September 26, 2000
CHICAGO – New research from the U.S. Department of Veterans Affairs (VA) suggests that computerized reminders (CRs) could help doctors provide consistently higher standards of care. The study appears in the September 20 issue of the Journal of the American Medical Association.
"This study demonstrates that computerized reminders in multiple sites make a difference when physicians are reminded about adhering to standards of care," said John G. Demakis, M.D., lead author of the study and director of the VA Health Services Research & Development Service.
Demakis and colleagues from 12 VA Medical Centers examined records from 275 resident physicians, who cared for 12,989 patients. Overall, doctors receiving reminders had higher rates of compliance for all standards of care.
"Unlike previous studies, this clinical trial was conducted at multiple medical centers using varying standards of care, including preventive as well as treatment interventions," said co-author William G. Henderson, Ph.D., director of VA’s Cooperative Studies Program Coordinating Center, in Hines, Illinois. "The exciting thing about this research is that it’s the first large-scale study looking at the effects of prompting physicians to follow a specified standard of care."
Researchers selected 13 standards of care that would be widely accepted and easily implemented using the existing hospital database. Standards of care included a variety of patient conditions, such as coronary artery disease, hypertension, diabetes, atrial fibrillation, myocardial infarction, and gastrointestinal bleeding.
Researchers measured adherence to standards in two different ways. One, by general adherence, based on whether patients received proper care by the time of their last visit during the study, and two, specific adherence, which is measured during a specific patient visit. Compliance was higher among doctors using CRs. General adherence improved 10 percent while visit specific adherence improved 47 percent.
The researchers developed a computerized software program to download the information obtained from patients’ visits during this study, and compared it to the hospitals’ prescribed treatments. The program then determined whether the participants received proper care.
While the CRs improved compliance with multiple standards of care, the beneficial effect declined over the course of the study. The authors noted that one possible explanation for this decrease may be that competing demands on the residents’ time in busy clinics lead to neglect of CRs over time. The researchers believe further study is needed to determine the reason for the decline, and to find ways to keep compliance at a high level.
"We need to figure a way to further educate the physicians and emphasize the importance of CRs in order to obtain a better response rate and higher quality of care at all VA medical centers," said Demakis.
VA’s Health Services Research & Development Service and the Cooperative Studies Program supported this research. Co-authors of the paper include Charles Beauchamp, M.D., Ph.D., William Cull, Ph.D., Robbin Denwood, RN, M.S.N., M.B.A., Seth A. Eisen, M.D., M.Sc., Richard Lofgren, M.D., M.P.H., Kristen Nichol, M.D., M.P.H., and James Woolliscroft, M.D.
VA research provides improved medical care for veterans, as well as the general population. Through its unique affiliation with medical schools, VA plays a crucial role in educating future physicians in research and clinically oriented areas.
SPECIAL NOTE FOR REPORTERS: For interviews with Dr. John G. Demakis, lead author for the Computerized Reminders Study, please contact Dan Bruneau at (410) 962-1800, ext. 289. For additional assistance, please contact Jim Blue at (212) 807-3429.
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