Abha Agrawal1, Michael F Mayo-Smith. 1. VA New England Healthcare System, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA. abha.agrawal@med.va.gov
Abstract
OBJECTIVE: To evaluate clinicians' adherence with clinical reminders (CRs) across multiple ambulatory practice settings in an integrated health care network. MATERIALS AND METHODS: Adherence rate to 15 CRs, integrated into a computerized patient record system, was evaluated for 451 clinicians in 49 clinics from eight Veterans Affairs (VA) medical centers. RESULTS: Overall, mean rate of adherence to CRs for all clinics was 86.2%, with a range of 66.59% to 97.08% (P<.001). The hepatitis C risk assessment reminder was found to have the highest overall adherence rate (95.9%) and the tobacco use cessation had the lowest adherence rate (62.9%). Mean adherence rate for all reminders was 80.34% (P<.001). Mean adherence rate for individual clinicians was 82.6%, with a range of 29% to 100%. CONCLUSION: While overall adherence to CRs was high, there is significant variation by clinic, individual clinician and individual CR. Understanding this variation is critical in directing future efforts to improve the contribution of computerized CRs to quality and cost-effectiveness of care, and to decrease undesirable variation in clinical practice. Further research is needed to systematically evaluate clinician, reminder and systems related factors that influence adherence to CRs.
OBJECTIVE: To evaluate clinicians' adherence with clinical reminders (CRs) across multiple ambulatory practice settings in an integrated health care network. MATERIALS AND METHODS: Adherence rate to 15 CRs, integrated into a computerized patient record system, was evaluated for 451 clinicians in 49 clinics from eight Veterans Affairs (VA) medical centers. RESULTS: Overall, mean rate of adherence to CRs for all clinics was 86.2%, with a range of 66.59% to 97.08% (P<.001). The hepatitis C risk assessment reminder was found to have the highest overall adherence rate (95.9%) and the tobacco use cessation had the lowest adherence rate (62.9%). Mean adherence rate for all reminders was 80.34% (P<.001). Mean adherence rate for individual clinicians was 82.6%, with a range of 29% to 100%. CONCLUSION: While overall adherence to CRs was high, there is significant variation by clinic, individual clinician and individual CR. Understanding this variation is critical in directing future efforts to improve the contribution of computerized CRs to quality and cost-effectiveness of care, and to decrease undesirable variation in clinical practice. Further research is needed to systematically evaluate clinician, reminder and systems related factors that influence adherence to CRs.
Authors: Constance H Fung; Jerry S Tsai; Armine Lulejian; Peter Glassman; Emily Patterson; Brad N Doebbeling; Steven M Asch Journal: J Gen Intern Med Date: 2008-04 Impact factor: 5.128
Authors: Tim A Holt; Margaret Thorogood; Frances Griffiths; Stephen Munday; Tim Friede; David Stables Journal: Br J Gen Pract Date: 2010-04 Impact factor: 5.386