The effect of routine use of computer-generated preventive reminders in clinical practice
Computer-generated reminders for patients and physicians can increase provision of preventive services. On July 1, 1989, the Department of Family Medicine at the Medical University of South Carolina extended a computerized prevention reminder system to all physicians and adult patients in the department's clinical practice. The prevention program consisted of computer-generated physician reminders for any deficiencies in five preventive services at the time of patient visits, a personalized patient reminder letter sent just before a patient's birthday, and educational interventions. We defined adherence using a population-based approach, that is, the percentage of all eligible patients who had received the preventive services within the recommended period of time. The data revealed that the percentage of patients who received preventive services either increased or remained stable during the 12-month study period, which ended July 1, 1990. Adherence was greater for women, for older patients, and for those with Medicare/Medicaid and HMO insurance. We noted higher rates of adherence for all five preventive services, compared with baseline rates of adherence recorded on July 1, 1988. A population-based approach to prevention allows physicians to become more active in providing preventive care to patients. Computer-based reminder and tracking systems can integrate population-based prevention into practice.
Available from: epi-ucsf.org
- "Reminders to physicians regarding preventive services were measured by asking a physician group if it reminded its physicians about patient preventive services using either chart stickers, checklists, or computer-generated notes. Reminders to patients and physicians regarding clinical preventive services have been shown to increase the use of such services (Dexter et al. 2001; Garr et al. 1993; Ornstein et al. 1991; Ornstein et al. 1995; Stone et al. 2002; RAND Corporation 1999; Task Force on Community Preventive Services 2000). An overall index was constructed based on the number of the above quality process measures used plus whether or not the organization had received public recognition for its quality performance. "
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ABSTRACT: The performance of medical groups is receiving increased attention. Relatively little conceptual or empirical work exists that examines the various dimensions of medical group performance. Using a national database of 693 medical groups, this article develops a scorecard approach to assessing group performance and presents a theory-driven framework for differentiating between high-performing versus low-performing medical groups. The clinical quality of care, financial performance, and organizational learning capability of medical groups are assessed in relation to environmental forces, resource acquisition and resource deployment factors, and a quality-centered culture. Findings support the utility of the performance scorecard approach and identification of a number of key factors differentiating high-performing from low-performing groups including, in particular, the importance of a quality-centered culture and the requirement of outside reporting from third party organizations. The findings hold a number of important implications for policy and practice, and the framework presented provides a foundation for future research.
Available from: Masahito Jimbo
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ABSTRACT: Information technology is rapidly advancing and making its way into many primary care settings. The technology may provide the means to increase the delivery of cancer preventive services. The aim of this systematic review is to examine the literature on information technology impacts on the delivery of cancer preventive services in primary care offices. Thirty studies met our selection criteria. Technology interventions studied to date have been limited to some type of reminder to either patients or providers. Patient reminders have been mailed before appointments, mailed unrelated to an appointment, mailed after a missed appointment, or given at the time of an appointment. Telephone call interventions have not used technology to automate the calls. Provider interventions have been primarily computer-generated reminders at the time of an appointment. However, there has been limited use of computer-generated audits, feedback, or report cards. The effectiveness of information technology on increasing cancer screening was modest at best. The full potential of information technology to unload the provider-patient face-to-face encounter has not been examined. There is critical need to study these new technologic approaches to understand the impact and acceptance by providers and patients.
Available from: Barbara K Rimer
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ABSTRACT: In spite of the fact that the value of mammography has been demonstrated, it remains underused by those in need, such as older women and minority women. A consideration of lifespan and ethnicity issues may help in designing interventions designed to overcome the barriers women may face at different stages in their lives as well as the barriers that may be most salient for minority women.
There now are reports from a number of published trials indicating the value of different kinds of interventions. Interventions can be characterized as individual-directed, system-directed, social network, or multistrategy. Although little is known about what interventions may be specifically appropriate for women in their 40s, both individual-directed and multistrategy interventions have increased use of mammography significantly among women in their 50s, 60s, and 70s, including African American women.
Although there is a considerable distance to go before all American women are getting regular mammograms, progress is being made. Attention to developing tailored interventions sensitive to lifespan and ethnicity concerns may be helpful.
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