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Proceedings of the AMIA Annual Fall Symposium logoLink to Proceedings of the AMIA Annual Fall Symposium
. 1996:493–497.

Electronically distributed, computer-generated, individualized feedback enhances the use of a computerized practice guideline.

D F Lobach 1
PMCID: PMC2233009  PMID: 8947715

Abstract

Clinical guidelines have been developed to assist with the management of patient care; however, these guidelines are frequently neglected in clinical practice. Computer-generated reminders enhance guideline use, but these systems often fail to achieve high rates of guideline utilization. This study was designed to test the hypothesis that computer-generated, individualized feedback regarding adherence to care guidelines will significantly improve clinician compliance with guideline recommendations presented through a computer-assisted management protocol. Half of the 45 primary care clinicians employed at a primary care clinic affiliated with an academic medical center, were randomized to receive a biweekly electronic mail message consisting of a computer-generated report summarizing his/her response to care guideline recommendations for the diabetic patients seen during the previous 2 weeks. Clinician compliance with guideline recommendations was the primary outcome measure. This study demonstrated that the intervention significantly increased clinician compliance with the guideline recommendations without incurring high maintenance expenses. Median compliance among the intervention group was 35% versus 6.1% among the control group (p < 0.01). Electronically distributed, computer-generated, individualized feedback regarding clinician use of care guideline recommendations is an effective way to enhance compliance with a care guideline.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barnett G. O., Winickoff R., Dorsey J. L., Morgan M. M., Lurie R. S. Quality assurance through automated monitoring and concurrent feedback using a computer-based medical information system. Med Care. 1978 Nov;16(11):962–970. doi: 10.1097/00005650-197811000-00007. [DOI] [PubMed] [Google Scholar]
  2. Ellrodt A. G., Conner L., Riedinger M., Weingarten S. Measuring and improving physician compliance with clinical practice guidelines. A controlled interventional trial. Ann Intern Med. 1995 Feb 15;122(4):277–282. doi: 10.7326/0003-4819-122-4-199502150-00007. [DOI] [PubMed] [Google Scholar]
  3. Grimshaw J. M., Russell I. T. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993 Nov 27;342(8883):1317–1322. doi: 10.1016/0140-6736(93)92244-n. [DOI] [PubMed] [Google Scholar]
  4. Headrick L. A., Speroff T., Pelecanos H. I., Cebul R. D. Efforts to improve compliance with the National Cholesterol Education Program guidelines. Results of a randomized controlled trial. Arch Intern Med. 1992 Dec;152(12):2490–2496. [PubMed] [Google Scholar]
  5. Johnston M. E., Langton K. B., Haynes R. B., Mathieu A. Effects of computer-based clinical decision support systems on clinician performance and patient outcome. A critical appraisal of research. Ann Intern Med. 1994 Jan 15;120(2):135–142. doi: 10.7326/0003-4819-120-2-199401150-00007. [DOI] [PubMed] [Google Scholar]
  6. Lobach D. F. A model for adapting clinical guidelines for electronic implementation in primary care. Proc Annu Symp Comput Appl Med Care. 1995:581–585. [PMC free article] [PubMed] [Google Scholar]
  7. Lobach D. F., Hammond W. E. Development and evaluation of a Computer-Assisted Management Protocol (CAMP): improved compliance with care guidelines for diabetes mellitus. Proc Annu Symp Comput Appl Med Care. 1994:787–791. [PMC free article] [PubMed] [Google Scholar]
  8. Lomas J., Enkin M., Anderson G. M., Hannah W. J., Vayda E., Singer J. Opinion leaders vs audit and feedback to implement practice guidelines. Delivery after previous cesarean section. JAMA. 1991 May 1;265(17):2202–2207. [PubMed] [Google Scholar]
  9. McDonald C. J., Hui S. L., Smith D. M., Tierney W. M., Cohen S. J., Weinberger M., McCabe G. P. Reminders to physicians from an introspective computer medical record. A two-year randomized trial. Ann Intern Med. 1984 Jan;100(1):130–138. doi: 10.7326/0003-4819-100-1-130. [DOI] [PubMed] [Google Scholar]
  10. McDonald C. J. Protocol-based computer reminders, the quality of care and the non-perfectability of man. N Engl J Med. 1976 Dec 9;295(24):1351–1355. doi: 10.1056/NEJM197612092952405. [DOI] [PubMed] [Google Scholar]
  11. Mugford M., Banfield P., O'Hanlon M. Effects of feedback of information on clinical practice: a review. BMJ. 1991 Aug 17;303(6799):398–402. doi: 10.1136/bmj.303.6799.398. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Safran C., Rind D. M., Davis R. B., Ives D., Sands D. Z., Currier J., Slack W. V., Makadon H. J., Cotton D. J. Guidelines for management of HIV infection with computer-based patient's record. Lancet. 1995 Aug 5;346(8971):341–346. doi: 10.1016/s0140-6736(95)92226-1. [DOI] [PubMed] [Google Scholar]
  13. Stead W. W., Hammond W. E. Computer-based medical records: the centerpiece of TMR. MD Comput. 1988 Sep-Oct;5(5):48–62. [PubMed] [Google Scholar]
  14. Tierney W. M., Hui S. L., McDonald C. J. Delayed feedback of physician performance versus immediate reminders to perform preventive care. Effects on physician compliance. Med Care. 1986 Aug;24(8):659–666. doi: 10.1097/00005650-198608000-00001. [DOI] [PubMed] [Google Scholar]
  15. Yarnall K. S., Michener J. L., Hammond W. E. The medical record: a comprehensive computer system for the family physician. J Am Board Fam Pract. 1994 Jul-Aug;7(4):324–334. [PubMed] [Google Scholar]

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