SEARCH · PubMed Health

Results for “Reminder Systems”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources

PubMed1994

Effects of computer-based clinical decision support systems on clinician performance and patient outcome. A critical appraisal of research.

OBJECTIVE: To review the evidence from controlled trials of the effects of computer-based clinical decision support systems (CDSSs) on clinician performance and patient outcomes. DATA SOURCES: The literature in the MEDLARS, EMBASE, SCISEARCH, and INSPEC databases was searched from 1974 to the present. Conference proceedings and reference lists of relevant articles were reviewed. Evaluators of CDSSs were asked to identify additional studies. STUDY SELECTION: 793 citations were examined, and 28 controlled trials that met predefined criteria were reviewed in detail. DATA EXTRACTION: Study quality was assessed, and data on setting, clinicians and patients, method of allocation, computer system, and outcomes were abstracted and verified using a structured form. Separate summaries were prepared for physician and patient outcomes. Within each of these categories, studies were classified further according to the primary purpose of the CDSS: drug dose determination, diagnosis, or quality assurance. RESULTS: Three of 4 studies of computer-assisted dosing, 1 of 5 studies of computer-aided diagnosis, 4 of 6 studies of preventive care reminder systems, and 7 of 9 studies of computer-aided quality assurance for active medical care that assessed clinician performance showed improvements in clinician performance using a CDSS. Three of 10 studies that assessed patient outcomes reported significant improvements. CONCLUSIONS: Strong evidence suggests that some CDSSs can improve physician performance. Additional well-designed studies are needed to assess their effects and cost-effectiveness, especially on patient outcomes.

Clinical Competence↗

PubMed2003

Improvement of intraoperative antibiotic prophylaxis in prolonged cardiac surgery by automated alerts in the operating room.

OBJECTIVE: To assess the impact of an automated intraoperative alert to redose prophylactic antibiotics in prolonged cardiac operations. DESIGN: Randomized, controlled, evaluator-blinded trial. SETTING: University-affiliated hospital. PATIENTS: Patients undergoing cardiac surgery that lasted more than 4 hours after the preoperative administration of cefazolin, unless they were receiving therapeutic antibiotics at the time of surgery. INTERVENTION: Randomization to an audible and visual reminder on the operating room computer console at 225 minutes after the administration of preoperative antibiotics (reminder group, n = 137) or control (n = 136). After another 30 minutes, the circulating nurse was required to indicate whether a follow-up dose of antibiotics had been administered. RESULTS: Intraoperative redosing was significantly more frequent in the reminder group (93 of 137; 68%) than in the control group (55 of 136; 40%) (adjusted odds ratio, 3.31; 95% confidence interval, 1.97 to 5.56; P < .0001). The impact of the reminder was even greater when compared with the 6 months preceding the study period (129 of 480; 27%; P < .001), suggesting some spillover effect on the control group. Redosing was formally declined for 19 of the 44 patients in the reminder group without redosing. The rate of surgical-site infection in the reminder group (5 of 137; 4%) was similar to that in the control group (8 of 136; 6%; P = .42), but significantly lower than that in the pre-study period (48 of 480; 10%; P = .02). CONCLUSION: The use of an automatic reminder system in the operating room improved compliance with guidelines on perioperative antibiotic prophylaxis.

Antibiotic Prophylaxis↗

PubMed1998

Failed appointments in an academic orthodontic clinic.

OBJECTIVE: To investigate the reasons for patients failing to keep appointments in the orthodontic department of a dental school and related circumstances. DESIGN: Retrospective single centre postal questionnaire. SETTING: University orthodontic department in Belfast, Northern Ireland, 1994. SUBJECTS: All 1995 patients failing to keep appointments during the first six months of 1994 (13.6% of total appointments). MAIN OUTCOME MEASURES: The responses expressed as frequencies. RESULTS: Responses were received from 758 patients (37% male, 55% female). The most frequent reasons for failure to keep appointments were illness, other commitments and forgetfulness. Only half of the patients attempted to cancel the appointment. The majority of failures occurred when appointments were made for the preferred time of attendance. Keenness for treatment exceeded perception of the severity of malocclusion. Seven in ten patients were satisfied with their treatment, more than half thought that they were nearing the end of treatment and 21.2% would not be upset if their appliances were withdrawn. CONCLUSIONS: Parents and patients should be aware of school commitments in advance of making appointments and an automated telephone reminder system should be introduced. The importance of cancelling appointments which cannot be fulfilled should be emphasised. Patients wearing retainers should be overbooked in a special clinical session.

Academic Medical Centers↗

PubMed1995

Childhood immunization: one HMO's experience in benchmarking and improving plan performance.

In 1994, Health Net initiated a childhood immunization campaign and research project to improve health plan member immunization rates by motivating and educating parents of children 20-32 months old as to the importance of fully immunizing their child. The findings indicate that 88 percent of those parents with children who were not fully immunized believed their child had been fully immunized by age two. This lack of awareness may explain the unreliability of self-reported immunization status. Future immunization campaigns must include ongoing member reminder systems, educate members as to the immunization schedule, and must take into consideration the barriers, real and perceived, that block full immunization.

California↗

PubMed1997

Cancer screening and prevention in rural Wisconsin: the Greater Marshfield Experience.

BACKGROUND: Providing medical services to rural residents results in unique challenges to providers and patients. Cancer screening (CS) and early detection services (EDS) are frequently underutilized with rural residents often presenting with advanced cancer at diagnosis. A comprehensive approach to determine barriers and overcome them constitutes "The Greater Marshfield Experience." METHODS: Focus groups with rural residents determined the greatest barriers to receipt of CS and EDS were distance, cost, time from work and self-reliant behavior. Directives to address these concerns were to keep information simple and provide services at the workplace. In response, Marshfield Clinic and its research division developed a collaborative research partnership with public health agencies (PHA), federally funded government programs and volunteer agencies. RESULTS: In-house activities to remove barriers for providing CS and EDS included the development of a separate screening unit for these activities. Reminder systems were employed to notify patients of the need and availability of preventative services. Co-payments for health screening services were eliminated from the clinic owned health plan. Area residents near poverty level were encouraged to enroll in federally subsidized health plans that promoted and paid for CS and EDS. Federally funded cancer screening studies were implemented that funded breast and cervical cancer screening and evaluated the benefits of screening for prostate, lung, colorectal and ovarian cancers (PLCO). Outreach activities included developing partnerships with local PHA and minority groups and providing mobile screening services to remote areas. CONCLUSION: Concentrated, collaborative efforts to develop in-house systems and outreach activities resulted in delivery of CS and EDS in remote areas.

Adult↗

PubMed2002

The role of family physicians in increasing annual fecal occult blood test screening coverage: a prospective intervention study.

BACKGROUND: Colorectal cancer is the second leading cause of cancer mortality in israel. Unfortunately, compliance with annual fecal occult blood testing is very low. OBJECTIVE: To assess the effectiveness of interventions to increase FOBT screening in primary care clinics in Israel. METHODS: A prospective, randomized study included all 50-75 year old enrollees of six family physicians in two primary care clinics. The register of two physicians, one from each clinic, was allocated to one of three groups. Two FOBT reminder strategies were tested: a physician reminder (753 patients), and a patient reminder that was either a phone call (312 patients) or a letter (337 patients). The control group (913 patients) of physicians continued administering their regular level of care. The main outcome measure was the percentage of patients undergoing FOBT screening in each study arm at the conclusion of the one year study period. RESULTS: In the intervention groups 14.3% (201/1,402) were screened using the FOBT over the course of the study year. Using an intent-to-screen analysis, the screening rate in the physician and patient reminder groups was significantly higher than in the control group (16.5 and 11.9%, vs. 1.2% respectively, P < 0.0001). Phone reminders were significantly more effective than letters (14.7 vs. 9.2%, P = 0.01). CONCLUSIONS: Various reminder systems for FOBT are beneficial, especially those centered around the family physician. Further research should focus on this area, in conjunction with other novel approaches.

Aged↗

PubMed2002

Changing physician behavior: a review of patient safety in critical care medicine.

The publication of the Agency for Healthcare Research and Quality (AHRQ) report in July 2001 entitled "Making Health Care Safer: A Critical Analysis of Patient Safety Practices," represents a significant perceptual change in health care ideology. It can be argued that this compilation recognizes not only that medical errors occur in the health care system, but also that there are significant learning opportunities that may arise in the identification of these errors that are otherwise known as medical misadventures. The report concluded and outlined a series of 11 highly rated practices whose usage are associated with increased safety. The AHRQ report also articulated that there is a need to investigate methods used to align medical practice with evidence regarding patient safety. In other words, after the identification of the 11 priority safety practices, it is thus important to determine the most effective methods to change physician behavior toward these practices that will intuitively result in increased safety performance. Five different educational-based strategies have been identified as techniques to change physician behavior: (1) Academic Detailing, (2) Audit and Feedback, (3) Local Opinion Leaders, (4) Reminder Systems, and (5) Printed Material. This article reviews these strategies in the context of critical care medicine and offers some opinions regarding setting the future research agenda in this investigative field.

Critical Care↗

PubMed1994

Evaluation of a simple office-based strategy for increasing influenza vaccine administration and the effect of differing reimbursement plans on the patient acceptance rate.

OBJECTIVE: To study an office-based strategy for increasing influenza vaccine delivery to high-risk patients at a university hospital general medicine practice. DESIGN: Historically controlled study of physician practices in an outpatient general medicine setting. SETTING: A group practice with two separate offices: a fee-for-service (FFS) office, where the patients pay the cost of immunizations, and a health maintenance organization (HMO)-styled office, where the costs for immunizations are fully covered by the insurer. PATIENTS: All outpatients seen at each practice setting from October to December, 1991. INTERVENTION: For each patient visit, a simple reminder data sheet was completed by the clinician detailing the vaccination eligibility (Centers for Disease Control and Prevention criteria) and status of the patient, the reasons for failure to vaccinate eligible patients, and 1990 vaccination information. RESULTS: During the study period, 511 patients were seen by the practice (353 in the FFS office, 158 in the HMO office). 297 patients (58%) were eligible for vaccination; 219 in the FFS office, 78 in the HMO office (p < 0.01). At the end of the study period, 73% of all the eligible patients were vaccinated: 67% of the FFS patients vs 90% of the HMO patients (p < 0.01). 22% of the eligible patients refused vaccination: 27% in the FFS office vs 9% in the HMO office (p < 0.01). 11% of the eligible FFS patients vs 0% of the eligible HMO patients refused vaccination due to vaccine cost (p < 0.05). Of the eligible patients seen at the two offices in both 1990 and 1991. 50% were vaccinated in 1990 (preintervention) vs 66% in 1991 (postintervention) (p < 0.01). CONCLUSIONS: As shown in this study, a simple, low-cost office-based reminder system can significantly increase the influenza vaccination rate for high-risk outpatients and can help meet national vaccination rate goals. Vaccine cost to patients may be a barrier to vaccine acceptance, in some cases.

Aged↗

PubMed2006

Possibilities for cost containment in intensive care.

An intensive care unit (ICU) is valuable but consumes a disproportionately high amount of health-care resources. Accordingly, cost containment has been deemed a mandatory task. A review of the literature from many countries was completed to determine the strategies for reducing the cost of care in the ICU. The results of this review show that cost reduction can be achieved by using a variety of the following strategies: (i) instituting a closed ICU, where all the patient care is directed by intensivists or full-time critical care trained physicians; (ii) the utilization of interdisciplinary approaches to the care of patients in the ICU; (iii) developing and implementing a program of television-guided remote intensivists; (iv) the use of an alerting and reminding system; and (v) increasing the number of intermediate care beds for patients who require only monitoring and intensive nursing. The conclusion reached is that many of these strategies provide evidence for hospital manager decisions regarding cost containment strategies for the delivery of health care in the ICU.

Cost Control↗

PubMed1998

Pap smear screening at an urban aboriginal health service: report of a practice audit and an evaluation of recruitment strategies.

A culturally appropriate women's health service was established at an Aboriginal community-controlled health service in Darwin in 1994. An initial file audit found that 48% of included women had ever been screened with a Pap smear and 37% of women were considered to have been adequately screened. The enhancement of opportunistic screening by file tagging had a modest effect on screening coverage over a 12-month period for women who attended the health service. The proportion of these women who were adequately screened increased from 43% to 48% and of those ever screened increased from 54% to 62%. A randomised trial of recruitment interventions including personal approach, letter and control groups was subsequently performed for women for whom Pap smears were overdue or not recorded. The impact of both interventions on the number of Pap smears performed was low, with 7% of women in the personal approach group, 2% of women in the letter group and no women in the control group having Pap smears during the three-month follow-up period. Low rates of abnormalities were observed for women having Pap smears over a two-year period. The minimal effect of a formal reminder system and letters at this urban Aboriginal health service has resulted in a re-orientation of activities towards strengthening opportunistic screening and the continued promotion of Pap smears in a range of clinic and community settings. It is important to place Pap smear screening in the context of other social, economic and health priorities for Aboriginal women and health workers.

Adolescent↗

PubMed2003

What is the best way to schedule patient follow-up appointments?

BACKGROUND: What is the best way to schedule follow-up appointments? The most popular model requires the patient to negotiate a follow-up appointment time on leaving the office. This process accounts for the majority of follow-up patient scheduling. There are circumstances when this immediate appointment arrangement is not possible, however. The two common processes used to contact patients for follow-up appointments after they have left the office are the postcard reminder method and the prescheduled appointment method. METHODS: In 2001 the two methods used to contact patients for follow-up appointments after they had left the clinic were used for all 2,116 reappointment patients at an ophthalmology practice at Dartmouth-Hitchcock Medical Center. The number of completed successful appointments, the no-show rate, and patient satisfaction for each method were calculated. RESULTS: A larger number of patient reappointments were completed using the prescheduled appointment procedure than the postcard reminder system (74% vs 54%). The difference between completed and pending appointments (minus no-shows) of the two methods equaled 163 patients per quarter, or 652 patients per year. Additional revenues associated with use of the prescheduled appointment letter method were estimated at $594,600 for 3 years. SUMMARY: Using the prescheduled appointment method with a patient notification letter is advised when patients do not schedule their appointments on the way out of the office.

Academic Medical Centers↗

PubMedDate not supplied

Aging well with smart technology.

As baby-boomers age, the need for long-term nursing care services increases. In the future, there will simply not be enough long-term care facilities to accommodate all of these patients. In addition, many people prefer to grow old at home, a concept known as aging-in-place. Smart home technology facilities aging-in-place by assisting patients with emergency assistance, fall prevention/detection, reminder systems, medication administration and assistance for those with hearing, visual or cognitive impairments. Benefits include making aging-in-place a reality, continuous monitoring, and improved psychosocial effects. Concerns of this technology include cost, availability of technology, retrofitting complications, and potential inappropriate use of the technology. Overall, the concept of smart homes is gaining in popularity and will expand the role of the nurse in the future. It is important for all nurses to understand how their practices will be transformed as smart homes become a reality for the aging population.

Accidental Falls↗

PubMed2001

A report card on quality improvement for children's health care.

OBJECTIVE: Improving the quality of health care is a national priority. Nonetheless, no systematic effort has assessed the status of quality improvement (QI) initiatives for children or reviewed past research in child health care QI. This assessment is necessary to establish priorities for QI programs and research. METHODS: To assess the status of QI initiatives and research, we reviewed the literature and interviewed experts experienced in QI for child health services. We defined QI as activities intended to close the gap between desired processes and outcomes of care and what is actually delivered. We classified reports published between 1985 and 1997 by publication characteristics, study design, clinical problem addressed, site of intervention, the QI method(s) used, and explicit association with a continuous quality improvement program. RESULTS: We reviewed 68 reports meeting our definition of QI. More than half (48) were published after 1994. The reviewed reports included controlled evaluations in 36% of all identified interventions, and 3% of the reports were associated with continuous quality improvement. QI methods demonstrating some effectiveness included reminder systems for office-based preventive services and inpatient pathways for complex care. Reportedly successful QI initiatives more commonly described improvement in administrative measures such as rate of hospitalization or length of stay rather than functional status or quality of life. Interviews found that barriers to QI for children were similar to those for adults, but were compounded by difficulties in measuring child health outcomes, limited resources among public organizations and small provider groups, and relative lack of competition for pediatric tertiary care providers. Research and dissemination of QI for children were seen as less well developed than for adults. CONCLUSIONS: Attempts to improve the quality of child health services have been increasing, and the evidence we reviewed suggests that it is possible to improve the quality of care for children. Nonetheless, numerous gaps remain in the understanding of QI for children, and widespread improvement in the quality of health services for children faces significant barriers.

Acute Disease↗

PubMed1995

Increasing attendance at immunisation clinics: lessons from a trial program that failed.

Previous studies suggested that the use of a baby-enrolment and reminder system for early childhood immunisation increased public immunisation clinic attendance. It was decided to run a trial to assess the effects of introducing a baby-enrolment program on attendances at local government immunisation clinics. Enrolment leaflets were distributed to each mother of a new child in six areas of greater Sydney while the mother was in the postnatal ward of the local hospital. Clinic attendance figures were monitored, interviews were conducted with mothers as well as professionals involved in early childhood health services, and the conduct of clinics was observed. The trial failed to increase attendance at public clinics. Mothers' reasons for choice of service, particularly their desire for what they believed to be a more personalised service, and the attitude of the professionals (particularly community nurses) with whom they came in contact were considered to be more influential in determining their use (or lack of use) of public immunisation services. Baby enrolment may be effective in increasing attendance at public immunisation clinics only where there is willing cooperation of all stakeholders in supporting public immunisation services.

Adult↗

PubMed2003

Quality of health care: informatics foundations.

OBJECTIVE: To discuss in what ways computer systems can contribute to the quality of healthcare and on which principles of informatics successful systems are based. METHODS: Part of the information was obtained via a literature search and part is based on the knowledge of the authors. RESULTS: The results of the literature search are reported. The answers to the questions whether decision support is useful and which factors determine its success, the foundations of computerized guidelines systems and applications of physician order entry and medical risk management are presented. CONCLUSIONS: Despite many publications concerning diagnostic support systems their use in clinical practice is limited. Reminder systems do appear to have an impact on health outcomes. Standards for guideline models are being developed for effective sharing of guidelines across systems. Electronic patient records and physician order entry systems are useful aids in medical risk management.

Decision Support Systems, Clinical↗

PubMed1997

An information infrastructure for long-term care.

Emerging trends promise to alter the way long-term care is practiced. These include: changing regulation of the nursing home industry with emphasis on outcome and assessment, a trend in medical informatics away from expert systems and toward on-line decision support and reminder systems, and the application of industrial statistical quality management techniques to the realm of human services. Emerging standards such as the Arden Syntax and Unified Medical Language Systems and technologies such as Rapid Application Development Tools will facilitate the use of modern computing to mold and implement these converging trends.

Abstracting and Indexing↗

PubMed2004

Using medical record reminders to improve pneumococcal vaccination rates.

BACKGROUND: Despite widespread recommendations, the pneumococcal vaccination rate of patients 65 years of age or older is below target goals. A reminder system was instituted at the time of the scheduled primary care visit as a pilot quality improvement project. METHODS: Medical records staff used clinic schedules to identify patients 65 years of age or older, stamping that day's progress note with a reminder about pneumococcal vaccination. The physician could note previous vaccination or could order vaccination at the visit. If the patient was previously vaccinated or received a vaccine during that visit, an indicator was placed on the front of the chart. Staff at both clinics received an educational session on the indications and benefits of pneumococcal vaccination. RESULTS: Before implementing the reminder intervention, the pneumococcal immunization recording was comparable at the reminder clinic and at a second clinic that did not use reminders (x2 = 0.324, NS). At 6 months, 95/112 (85%) and 75/115 (65%) patients at the reminder and the second clinic had documentation of pneumococcal vaccination (x2 = 12.66, p < .005); at 12 months, 76% and 58% had such documentation. At the reminder clinic, the reminder stamp was found in 158/205 (77%) of the charts reviewed, with documentation of pneumococcal vaccination in 140/158 (89%) of these charts. DISCUSSION: The simple and inexpensive method of placing selective reminders in charts for elderly patients eligible for pneumococcal vaccination was highly effective in increasing the pneumococcal vaccination rate.

Florida↗

PubMed2004

The Vermont Diabetes Information System (VDIS): study design and subject recruitment for a cluster randomized trial of a decision support system in a regional sample of primary care practices.

BACKGROUND: Despite evidence that optimal care for diabetes can result in reduced complications and improved economic outcomes, such care is often not achieved. The Vermont Diabetes Information System (VDIS) is a registry-based decision support and reminder system based on the Chronic Care Model and targeted to primary care physicians and their patients with diabetes. PURPOSE: To develop and evaluate a regional decision support system for patients with diabetes. METHODS: Randomized trial of an information system with clustering at the practice level. Ten percent random subsample of patients selected for a home interview. SUBJECT: and setting includes 10 hospitals, 121 primary care providers, and 7348 patients in 55 Vermont and New York primary care practices. RESULTS: We report on the study design and baseline characteristics of the population. Patients have a mean age of 63 years and a mean glycosolated hemoglobin A1C of 7.1 %. Sixty percent of the population has excellent glycemic control (A1 C < 7%); 45% have excellent lipid control (serum LDL-cholesterol <100 mg /dL and serum triglycerides <400 mg/dL). Twenty-five percent have excellent blood pressure control (<130/80mmHg). These results compare favorably to recent national reports. However, only 8% are in optimal control for all three of hyperglycemia, lipids and blood pressure. CONCLUSIONS: Our experience to date indicates that a low cost decision support and information system based on the Chronic Care Model is feasible in primary care practices that lack sophisticated electronic information systems. VDIS is well accepted by patients, providers and laboratory staff. If proven beneficial in a rigorous, randomized, controlled evaluation, the intervention could be widely disseminated to practices across America and the world with a substantial impact on the outcomes and costs of diabetes. It could also be adapted to other chronic conditions. We anticipate the results of the study will be available in 2006.

Adolescent↗