Can computer-generated evidence-based care suggestions enhance evidence-based management of asthma and chronic obstructive pulmonary disease? A randomized, controlled trial
Can Computer-Generated Evidence-Based Care Suggestions Enhance Evidenced-Based Management of Asthma and Chronic Obstructive Pulmonary Disease
A Randomized, Controlled Study
This is another paper from the group of Tierney and Overhage at the Indiana University Medical Group that looks at the effectiveness of computer generated suggestions on compliance with evidence-based care. A previous study’s results showed that suggestions related to cardiac care did not increase compliance to guidelines or patient well being and satisfaction. This similar study looks at the effect of computerized care suggestions in the management of chronic pulmonary disease, both Asthma and COPD. Although widely accepted guidelines for the care of asthma and COPD exist, many physicians fail to comply with them. This study was designed to see if guideline–based suggestions could improve the management and outcomes of these illnesses.
This study took place in an inner city outpatient primary care facility focused on the training of medical residents. Patients were over 18 and had clearly defined diagnoses of asthma or COPD. Care suggestions, approved by physician committees, were available to the provider at the time of the visit. The workstation displayed suggested orders and they were also printed out on paper encounter forms.
Outcome assessments after a year of study showed no difference in the providers’ (residents, faculty or pharmacists) adherence to the guidelines, patient self-assessed quality of life, emergency department visits or hospitalizations. As in the previous study by Tierney et.al, the intervention group’s health care costs was significantly higher. Docctors surveyed felt the tools were useful for education, but oversimplified medical care and were too rigid to apply to individual patients. They also felt the tools were mainly focused on the reduction of health costs.
Although this group previously found success with interventions in computerized care suggestions for preventative care, this and other studies in cardiac and renal disease did not show compliance with chronic care suggestions.
Many questions are raised by these studies. Can computer generated suggestions improve the compliance with chronic disease care guidelines or will they only work for preventative care? Can the timing and content of suggestions make them more effective? Are periods of longer than a year needed to establish improvements? should clinicians be required to respond to each suggestion and not allowed to delete them? Is a residency-based office unique, can this be generalized into regular care? Would financial incentives to providers increase compliance?