Sequist Thomas D, Gandhi Tejal K, Karson Andrew S, Fiskio Julie M, Bugbee Donald, Sperling Michael, Cook E Francis, Orav E John, Fairchild David G, Bates David W
Division of General Medicine, Brigham and Women's Hospital, Harvard Medcal School, 1620 Tremont Street, Boston, MA 02120, USA.
J Am Med Inform Assoc. 2005 Jul-Aug;12(4):431-7. doi: 10.1197/jamia.M1788. Epub 2005 Mar 31.
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.
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.
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.
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.
An integrated electronic reminder system resulted in variable improvement in care for diabetes and CAD. These improvements were often limited and quality gaps persist.
本研究旨在评估针对患者个体的综合电子临床提醒系统对糖尿病和冠状动脉疾病（CAD）护理的影响，并评估医生对该提醒系统的态度。
我们招募了20家门诊诊所的194名初级保健医生，这些医生负责照顾4549名糖尿病患者和2199名CAD患者。诊所被随机分组，以便医生在患者的电子病历中接收基于证据的电子提醒或接受常规护理。糖尿病护理有五条提醒，CAD护理有四条提醒。
主要结果是接受针对糖尿病和CAD的推荐护理。我们创建了一个综合结果来评估提高总体糖尿病护理（基于五项指标）和总体CAD护理（基于四项指标）依从性的几率。我们对医生进行了调查，以评估他们对提醒系统的态度。
所有质量指标的基线依从率都很低。虽然电子提醒增加了接受推荐糖尿病护理的几率（优势比[OR]为1.30，95%置信区间[CI]为1.01 - 1.67）和CAD护理的几率（OR为1.25，95%CI为1.01 - 1.55），但各个提醒的影响各不相同。九条提醒中共有三条有效地提高了糖尿病或CAD推荐护理的比例。大多数医生（76%）认为提醒改善了护理质量。
综合电子提醒系统在糖尿病和CAD护理方面带来了不同程度的改善。这些改善往往有限，质量差距仍然存在。
