Abstract
Diabetes mellitus is a chronic condition with several late complications that can be delayed or avoided through proper preventive health care. Although practice guidelines have been established to improve the preventive care in diabetics, dissemination of these guidelines among physicians and educational programs have been only moderately successful in changing physicians' practice patterns. Previous efforts, however, did not utilize computer-generated reminders. We developed a system of computer-generated reminders for diabetic preventive care. We completed an implementation of the system in the outpatient clinics of internal medicine residents at our institution. This paper describes the development and implementation of this system. Our results showed that the system flagged an average of 13 items that deviated from diabetes guideline compliance, out of a possible 21 items per patient. The residents completed encounter forms used by the system for 37% of patients seen during a six month period. Physician users exhibited positive attitudes toward the use of guidelines which they judged improved quality at no additional cost of care. However, the complexity and length of the guideline encounter forms and the additional time demands proved to be significant obstacles to current routine use. Our experience will help to improve the system so that it is more usable and acceptable to physicians, especially in the future as health care increasingly makes use of electronic medical record systems.
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Selected References
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- Anderson R. M. The challenge of translating scientific knowledge into improved diabetes care in the 1990s. Diabetes Care. 1991 May;14(5):418–421. doi: 10.2337/diacare.14.5.418. [DOI] [PubMed] [Google Scholar]
- Deeb L. C., Pettijohn F. P., Shirah J. K., Freeman G. Interventions among primary-care practitioners to improve care for preventable complications of diabetes. Diabetes Care. 1988 Mar;11(3):275–280. doi: 10.2337/diacare.11.3.275. [DOI] [PubMed] [Google Scholar]
- Harris M. I. Testing for blood glucose by office-based physicians in the U.S. Diabetes Care. 1990 Apr;13(4):419–426. doi: 10.2337/diacare.13.4.419. [DOI] [PubMed] [Google Scholar]
- Jacobs J., Sena M., Fox N. The cost of hospitalization for the late complications of diabetes in the United States. Diabet Med. 1991;8(Spec No):S23–S29. doi: 10.1111/j.1464-5491.1991.tb02151.x. [DOI] [PubMed] [Google Scholar]
- Jacques C. H., Jones R. L., Houts P., Bauer L. C., Dwyer K. M., Lynch J. C., Casale T. S. Reported practice behaviors for medical care of patients with diabetes mellitus by primary-care physicians in Pennsylvania. Diabetes Care. 1991 Aug;14(8):712–717. doi: 10.2337/diacare.14.8.712. [DOI] [PubMed] [Google Scholar]
- 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]
- Mazze R., Deeb L., Palumbo P. J. Altering physicians' practice patterns--a nationwide educational experiment: evaluation of the Clinical Education Program of the American Diabetes Association. Diabetes Care. 1986 Jul-Aug;9(4):420–425. doi: 10.2337/diacare.9.4.420. [DOI] [PubMed] [Google Scholar]
- 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]
- Ornstein S. M., Garr D. R., Jenkins R. G., Rust P. F., Arnon A. Computer-generated physician and patient reminders. Tools to improve population adherence to selected preventive services. J Fam Pract. 1991 Jan;32(1):82–90. [PubMed] [Google Scholar]