Long-term changes in compliance with clinical guidelines through computer-based reminders.

We evaluate the effectiveness of computer-based reminders in improving compliance with preventive medicine screening guidelines and examine the long-term impact of these reminders. Physicians in an ambulatory care practice were given a summary health maintenance report of preventive screening items at each scheduled patient visit. The electronic medical record (COSTAR) in use in this practice was programmed to integrate 13 clinical guidelines into the routine flow of care. Mean performance of 10 out of 13 health maintenance measures improved in the year following introduction of the integrated guideline report (p less than .001 by chi-square test for 8 items, p less than .01 for 2 items). Five years after the report was introduced, improvement in mean performance persisted for 7 measures (p less than .001 by chi-square test), compliance improved for one additional measure (p less than .001), and improvement disappeared for three measures that had shown improvement in the first year of the intervention.