A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting.

OBJECTIVE

Computer-based reminder systems have the potential to change physician and patient behaviors and to improve patient outcomes. We performed a meta-analysis of published randomized controlled trials to assess the overall effectiveness of computer-based reminder systems in ambulatory settings directed at preventive care.

DESIGN

Meta-analysis.

SEARCH STRATEGY

Searches of the Medline (1966-1994), Nursing and Allied Health (1982-1994), and Health Planning and Administration (1975-1994) databases identified 16 randomized, controlled trials of computer-based reminder systems in ambulatory settings.

STATISTICAL METHODS

A weighted mixed effects model regression analysis was used to estimate intervention effects for computer and manual reminder systems for six classes of preventive practices.

MAIN OUTCOME MEASURE

Adjusted odds ratio for preventive practices.

RESULTS

Computer reminders improved preventive practices compared with the control condition for vaccinations (adjusted odds ratio [OR] 3.09; 95% confidence interval [CI] 2.39-4.00), breast cancer screening (OR 1.88; 95% CI 1.44-2.45), colorectal cancer screening (OR 2.25; 95% CI 1.74-2.91), and cardiovascular risk reduction (OR 2.01; 95% CI 1.55-2.61) but not cervical cancer screening (OR 1.15; 95% CI 0.89-1.49) or other preventive care (OR 1.02; 95% CI 0.79-1.32). For all six classes of preventive practices combined the adjusted OR was 1.77 (95% CI 1.38-2.27).

CONCLUSION

Evidence from randomized controlled studies supports the effectiveness of data-driven computer-based reminder systems to improve prevention services in the ambulatory care setting.