View source for A computerized reminder system to increase the use of preventive care for hospitalized patients

Background

Many established and proven preventive measures for hospitalized patients such as influenza vaccination or deep venous thrombus prophylaxis are not reliably and routinely carried out.  Computerized reminder, as a form of decision support, has been shown to be helpful in increasing the use of out patient preventive care.  Little is known whether it would be similarly effective in preventive care for hospitalized patients.

Objective

To test hypothesis that a computerized reminder system could increase the use of preventive care among hospitalized patients.  

Setting

A urban public teaching hospital in Indianapolis.

Design

Randomized, controlled trial from May 1, 1997 to October 31, 1998.

Patients

All patients admitted to the general medicine service during the specified time period.

Method

Four of the general medicine teams were designated interventional group, and four were designated as controls.  Attending physicians, resident physicians, and medical students associated with the team were given the same status (intervention or control) as the team status already assigned.  Patients were assigned to each of these teams based on a pre-existing mechanism that distribute admissions equitably among the teams, solely on the basis of the order in which patients required hospitalization.  

Care rules, rule-based reminders, were developed based on contemporary national guidelines on influenza vaccination, pneumococcal vaccination, and deep vein thrombosis prophylaxis, and prophylactic aspirin sue for cardiovascular disease.  These reminders were generated based on the demographic information, problem list, diagnosis list, vital signs, current inpatient orders, and previous pharmacy records.  If at least one indication exist for one of these four preventive therapies exist for a given patient in the electronic health record, no contraindication for that therapy, and no active order for that therapy, the reminder will show onscreen for the intervention group but only logged in the system and not shown in the control group.  

Outcome

Primary outcomes were rates at which the various preventive therapies were ordered (pneumococcal vaccinations, influenza vaccinations, deep vein thrombosis (DVT) prophylaxis, and prophylactic aspirin at discharge).

Results

Overall, 53.6% of all enrolled patients were eligible for at least one preventive therapy.  The mean numbers of teims a reminder was displayed to a physician in the intervention group ranged from 3.4 to 5.2 for each hospitalized eligible patient in the intervention group.  

For pneumococcal vaccination was 35.8% in the intervention group compared with 0.8% in the control group.  For influenza vaccination, 51.4% of eligible patients had it ordered in the intervention group but only 1.0% in the control.  DVT prophylaxis with subcutaneous heparin rate was 32.2% with reminders and only 18.9% without.  Prophylactic aspirin at discharge was ordered 36.4% of all eligible patients in the intervention group and only 27.6% in the control group.  All these differences were significantly different with p value less than 0.001.  

Conclusion

Computerized reminders significantly increased the rate of preventive care measures in hospitalized patients.