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PubMedDate not supplied

An appointment reminder system's effect on reducing the number of hypertension patients who drop out from care.

We evaluated the effects of an appointment reminder system on the appointment-keeping behavior and blood pressure control status of hypertensive patients receiving care in an urban medical clinic. The study population consisted of 973 adult hypertensive patients receiving medical care at a family practice clinic affiliated with the Wayne State University School of Medicine, Detroit, Michigan. Of the 973 patients enrolled in the study, 486 were randomly assigned to a group that received appointment reminder cards and telephone calls to reschedule missed appointments, and 487 were assigned to a nonintervention control group. Patients were followed-up with regard to their appointment-keeping behavior and blood pressure control status, five to eight months after being entered in the study. The study results indicate that patients in the appointment reminder group kept significantly more appointments and were less likely to drop out of treatment than patients in the control group. The dropout rate was 46 percent lower among patients in the appointment reminder group than in the control group. Patients in the appointment reminder group also demonstrated slightly better blood pressure control at the end of the study compared with patients in the control group, although none of the differences in blood pressure levels between groups were statistically significant at the 5 percent level.

Adult↗
PubMed1992

Improving influenza vaccination rates in children with asthma: a test of a computerized reminder system and an analysis of factors predicting vaccination compliance.

Fewer than 10% of children with moderate or severe asthma receive an annual influenza vaccination despite their heightened susceptibility to severe infections and recommendations by the American Academy of Pediatrics and the Immunization Practices Advisory Committee that all such children be vaccinated annually. Patient, provider, and system factors leading to this poor vaccination rate are not well understood. This study tested the effectiveness of a computerized reminder system in improving influenza vaccination rates in children with asthma and examined patient barriers to vaccination at one pediatric clinic in an urban teaching hospital. A computer database identified 124 children with moderate or severe asthma. Patients were randomly assigned either to study group (n = 63), who were sent a personalized letter reminder about the need for an influenza vaccination, or to a control group (n = 61), who received no reminder. Study group mothers were interviewed 2 months after the letter was sent to assess factors associated with receipt of vaccination, including demographic features, parental worry about asthma and vaccine side effects, the four dimensions of the Health Belief Model, and health locus of control beliefs. Nineteen study group patients (30%) received an influenza vaccination, compared with only 4 control patients (7%) (P < .01). Forty-three mothers of children in the study group were interviewed; 14 (33%) of these children had received the vaccination. Of the characteristics investigated, two significantly correlated with vaccination compliance: high levels of parental worry about asthma (positively correlated: odds ratio = 23.3, P < .01) and high levels of parental worry about vaccine side effects (negatively correlated: odds ratio = 0.087, P = .025).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

One vendor's experience: preliminary development of a reminder system based on the Arden Syntax.

This article reviews the efforts of HBO & Company in the production of a first phase clinical alerting system based on the Arden Syntax. The alerting system was integrated with a clinical data repository and clinical workstation to process returning laboratory results. Investigations with expert systems resulted in a C language alerting system. GUI prototyping of an authoring environment led to a Smalltalk language authoring system. Future development is expected to broaden the system scope and address the evolution of the Arden Syntax.

Artificial Intelligence↗
PubMedDate not supplied

Providers' reactions to an automated health maintenance reminder system incorporated into the patient's electronic medical record.

BACKGROUND: Automated health maintenance reminder (HMR) systems embedded in electronic medical records systems have been found to improve utilization of preventive services, but underuse persists. Our goal was to learn how to make HMRs more effective by measuring clinicians' self-reported use of HMRs and attitudes toward an HMR system embedded in an electronic medical record. METHODS: We surveyed 43 clinicians using an electronic medical record with an automated HMR system that prompted the provision of preventive or screening interventions. We measured general attitudes toward computers and the HMR, attitudes toward health maintenance, reactions to key features of the HMR system, and use of information provided by the HMR system; and we asked open-ended responses on how to improve the system. RESULTS: Seventy-five percent of clinicians reported not observing or paying attention to the HMR flashing reminder icon when reviewing a chart, and 62.8% reported they either ignored or forgot to address an alert when it appeared. Only 20% reported regularly reviewing health maintenance needs of the patient before the clinical encounter, and 56% reported seldom or never acting on HMR information during an encounter that was not health maintenance. CONCLUSIONS: This HMR system embedded in an electronic medical record was underused by clinicians, causing lost opportunities for provision of preventive care. As electronic medical records become more common, we need to find practical ways that are acceptable to clinicians to use the new capabilities the systems provide.

Adult↗
PubMed2003

The effect of adding Pap smear information to a mammography reminder system in an HMO: results of randomized controlled trial.

BACKGROUND: While reminders can promote cancer screening in primary care, little is known about the potential interaction between multiple reminders. METHODS: We conducted a randomized controlled trial to compare the effect of combined Pap smear plus mammogram reminders and mammogram-only reminders among 2471 women 40 years of age or older enrolled in a health maintenance organization serving a predominantly Medicaid-eligible population. Reminders included both a mailed letter for the woman and a medical record prompt. RESULTS: Intervention assignment was unassociated with differences in rates of visitation to family medicine or internal medicine or completion of mammography during the study year. Compared to women assigned to mammogram-only reminder treatment, those assigned to the combined Pap smear plus mammogram reminder intervention were more likely to visit a gynecologist (34% compared to 29%, adjusted odds ratio = 1.33, 95% confidence interval 1.08-1.63) and to complete a Pap smear (30% compared to 23%, adjusted odds ratio = 1.39, 95% confidence interval 1.07-1.89). CONCLUSIONS: In the study setting, the addition of Pap smear to mammography reminders has a procedure-specific effect, increasing gynecology visits and Pap smear use while neither increasing nor decreasing other primary care visits or mammography. We find no evidence of reinforcement or competition between these reminders.

Adult↗
PubMed2001

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.

Aspirin↗
PubMedDate not supplied

Computerized health maintenance tracking systems: a clinician's guide to necessary and optional features. A report from the American Cancer Society Advisory Group on Preventive Health Care Reminder Systems.

BACKGROUND: To promote preventive health care by primary care physicians and the development of computerized health maintenance tracking systems, the American Cancer Society sponsored an expert advisory group to define necessary and desirable, but optional features of computer-based health maintenance tracking software for use in primary care practice. METHODS: Systematic literature review and structured consensus development were followed by independent expert critique. RESULTS: Necessary input features include a comprehensive, practice-specific health maintenance protocol, multiple entry codes to indicate the current status of each procedure, and a mechanism for patient-specific exclusion or alteration of procedure frequency. Necessary features of the information management system include a linkage to a demographic data system, optional tracking of all or selected patients, identification of each patient's primary provider, and the ability to provide either a paper or electronic interface for the provider. Necessary outputs include provider reminders, patient reminders sent regularly regardless of visit status, and summary reports of provider and patient compliance. CONCLUSIONS: Although the ideal computer-based health maintenance tracking system is still evolving, knowledge of these necessary and optional features can aid clinicians interested in buying or developing a system for their own practice.

Preventive Medicine↗
PubMed1995

Evaluation of a belief-network-based reminder system that learns from utility feedback.

PRETRIEVE is a belief-network-based, unsolicited information-retrieval system that performs machine learning based on user feedback. We report here on the document-ordering and document-retrieval performance of PRETRIEVE. We developed a test collection of 410 judgments of document utility in a simulated medical order-entry context. We characterized the validity of these judgments, which were elicited from domain experts, by measuring interrater and intrarater reproducibility. We developed a measure of the quality of document orderings similar to the ROC-curve analysis used to evaluate document-retrieval systems. We found that the ordering performance of the PRETRIEVE system was (1) substantially better than random, (2) somewhat less than ideal, and (3) superior to that of versions of the PRETRIEVE system that used relevance feedback instead of utility feedback. Under a set of assumptions, which we make explicit, we found that the documents retrieved by a version of PRETRIEVE that modeled time cost were of higher utility than those retrieved by a similar rule-based system.

Artificial Intelligence↗
PubMed1993

Using reminder systems to improve Papanicolaou test follow-up. An example of continuous quality improvement.

OBJECTIVE: Using continuous quality improvement principles, we developed a Papanicolaou test recall system with the goal of increasing first and second follow-up Papanicolaou tests after cryotherapy by 20%. DESIGN: An initial study showed rates of 67% for the first follow-up Papanicolaou test and 31% for the second follow-up test. We formed a dysplasia project team. Using continuous quality improvement principles, we instituted a Papanicolaou test recall system. We remeasured first and second follow-up rates for Papanicolaou tests after cryotherapy. The staff and providers were surveyed regarding their acceptance of the system. No attempt was made to control for confounding factors. SETTING: The study was performed at the Family Medicine Clinic in Eau Claire, Wis. This is a community-based, university-administered family practice residency training clinic. PARTICIPANTS: The first 53 consecutive women who had cryotherapy beginning August 1, 1991, were included in the study. All staff and providers were invited to answer a survey questionnaire. INTERVENTION: Patients received a reminder postcard when they were due for a Papanicolaou test. They received a follow-up letter the next month if no Papanicolaou test was done. MAIN OUTCOME MEASURES: First and second follow-up Papanicolaou test rates after cryotherapy. Staff and provider satisfaction as measured by a survey. RESULTS: Eighty-four percent of the women returned for their first follow-up Papanicolaou test, and 53% returned for their second after cryotherapy. Staff and providers supported the recall system. CONCLUSION: Continuous quality improvement principles led to a Papanicolaou test reminder system. Follow-up Papanicolaou test rates appeared to increase by 17% for the first Papanicolaou test and by 22% for the second.

Cryotherapy↗
PubMedDate not supplied

Semiautomated reminder system for improving syphilis management.

This project utilized an automated record system, COSTAR, to assess and improve the quality of care in managing syphilis in a health maintenance organization. A scoring tool was developed to assess care. There were four experimental periods, each lasting one year. The periods were Baseline (no intervention), Education (publication of guidelines and an educational session), Reminder (deficiencies in care brought to the attention of providers in time to permit correction), and Post-reminder (no intervention). Scores for overall management of syphilis rose from 70.4 to 90.5% during the Reminder period and did not deteriorate significantly in the Post-reminder period. Scores in the Education period were not significantly higher than baseline. The cost of the system was $195 per year. An inexpensive reminder system was effective in bringing about a significant improvement in quality of care for syphilis, and the effect persisted for at least a year after the system was discontinued.

Database Management Systems↗
PubMedDate not supplied

Computerized telephone reminder system facilitates wellness and prevention.

In the near future, the most successful medical practices will have wellness and prevention as their primary objectives of care. Telephoned reminders have proved to be the most effective method of bringing patients in for immunizations, cancer screening, and other preventive measures. Using computer telephony integration (CTI) technology to automate wellness and recall messages makes possible a cost-effective, consistent program of personalized reminders. This technology allows a medical practice to generate revenue from patients overdue for an appointment, to promote wellness through regular checkups or education programs, and to improve patient satisfaction with services.

Humans↗
PubMed1994

Development and implementation of a computer-generated reminder system for diabetes preventive care.

Diabetes mellitus is a chronic condition with several late complications that can be delayed or avoided through proper preventive health care. Although practice guidelines have been established to improve the preventive care in diabetics, dissemination of these guidelines among physicians and educational programs have been only moderately successful in changing physicians' practice patterns. Previous efforts, however, did not utilize computer-generated reminders. We developed a system of computer-generated reminders for diabetic preventive care. We completed an implementation of the system in the outpatient clinics of internal medicine residents at our institution. This paper describes the development and implementation of this system. Our results showed that the system flagged an average of 13 items that deviated from diabetes guideline compliance, out of a possible 21 items per patient. The residents completed encounter forms used by the system for 37% of patients seen during a six month period. Physician users exhibited positive attitudes toward the use of guidelines which they judged improved quality at no additional cost of care. However, the complexity and length of the guideline encounter forms and the additional time demands proved to be significant obstacles to current routine use. Our experience will help to improve the system so that it is more usable and acceptable to physicians, especially in the future as health care increasingly makes use of electronic medical record systems.

Attitude to Computers↗