Clinical guidelines have been developed to assist physician clinical decision making in many areas of care. However, even generally accepted guidelines are often not followed. In order to improve adherence to guidelines we are developing, implementing, and assessing the impact of a patient-specific computerized outpatient reminder system.

Using well-accepted guidelines, a multidisciplinary team initially created 16 reminders within 4 clinical categories: (1) diabetes care; (2) cardiovascular disease; (3) expensive medication substitution; and (4) health maintenance. Initially, reminders were generated just prior to office visits and were printed on patient clinical summary sheets that PCPs receive at the time of patient office visits. The reminders were based on data from our clinical information system and ambulatory electronic medical record.

Randomized and pre-post evaluations showed that the reminders generally improved adherence to clinical guidelines. In category (1), diabetic patients seeing intervention PCPs more often received overdue HbA1C studies (60 vs. 46%, p<0.0001), cholesterol studies (39 vs. 20%, p<0.0001), eye exams (17 vs. 10%, p<0.04), and nursing visits (3.1 vs. 1.4%, p=0.64). In category (2), diabetic hypertensive patients seeing intervention PCPs were started on ACEIs more frequently (14 vs. 8%, P<0.01). CAD reminders did not lead to statistically significant differences between groups. In category (3), reminders led to switching expensive medications to lower cost alternatives in the ACEI (4.9 vs. 2.7%, p<0.04), H2-blocker (5.4 vs. 0.8%, p<0.001) and statin (7.3 vs. 4.4% p=0.15) classes. In Category (4), health maintenance reminders led to increased compliance rates in all areas studied (all p<0.001).

The success of the paper-based patient-specific computerized outpatient reminders has lead to the development and evaluation of on-screen patient-specific computerized outpatient reminders as well as the development of reminders in additional areas of care.