Table 1.
Characteristics of studies included in the systematic review
| Author | Date published | Study type | Intervention | Study location | Sample size | Score | Unit of analysis | Confounding and clustering in analysis | Outcome measured | Results (+: statistically significant change in monitoring rate / –: no effect of the intervention on the monitoring rate) | |
| Feldstein18 | 2006 | RCT–cluster–randomized by clinic | EMR reminder via email as well as two other interventions | OR: Kaiser Permanente HMO, 15 primary care clinics | 44 PCPs with 196 patients in EMR arm | 25 | Patient | Yes | Completed monitoring | +: EMR reminder ↑ baseline laboratory monitoring of 10 medications, from 22.4% to 48.5%: 26.1% absolute ↑/116% relative ↑; HR of 2.5, but less effective than voice message or pharmacy outreach | |
| Hoch19 | 2003 | Pre–post no control | EMR reminder via email | Israel: HMO | 504 physicians | 18 | Patient | No | Completed monitoring | +: Reminders to clinicians ↑ potassium testing (78.5→81.5%; 3.0% absolute effect; 9.8% relative; p<0.001) | |
| Lo20 | 2009 | RCT | EMR reminder | MA: Partners HealthCare | 22 primary care clinics; 3673 events among 2765 patients | 23 | Clinic visit | Yes | Ordering | –: Reminders did not improve ordering of laboratory monitoring significantly | |
| Matheny6 | 2008 | RCT | EMR reminder | MA: Partners HealthCare | 1922 patients seen by 303 physicians in 2507 clinic visits | 24 | Clinic visit | Yes | Completed monitoring | –: Reminders did not improve laboratory monitoring significantly | |
| Palen21 | 2006 | RCT | EMR reminder | CO: Kaiser HMO | 207 PCPs with6 20 104 in the intervention arm caring for 26586 patients | 22 | Dispensing (first) | No | Completed monitoring | –: Reminders did not improve laboratory monitoring significantly. Significant improvement for selected medications. | |
| Raebel22 | 2005 | RCT | Pharmacists reminded electronically about missing tests and then ordered them and reminded patients | CO: Kaiser HMO | 10169 drug dispensings for 9565 patients | 23 | Dispensing (each unique initial drug dispensing) | No | Completed monitoring | +: Statistically significant ↑ monitoring in the intervention group, varying widely by medication (70.2→79.1% overall; 8.9% absolute effect; 12.6% relative; p<0.001) | |
| Raebel23 | 2006 | RCT | Pharmacists reminded electronically about missing tests and then ordered them and reminded patients | CO: Kaiser HMO | 9139 patients with 4871 patient–drug combinations | 22 | Patient–drug combination (ongoing therapy) | No | Completed monitoring | +: Statistically significant improved monitoring in the intervention group for only some of the medications (58→64% overall; 6% absolute effect; 10% relative; p<0.001) | |
| Steele24 | 2005 | Pre–post, no control | EMR reminder | CO: Safety net outpatient clinics | Rule processed 16291 times; 19076 patients seen during the time period | 16 | Orders | No | Ordering | +: Increased ordering of the rule-associated laboratory test when an alert was displayed (39→51%; 12% absolute effect; 31% relative; p < 0.001) | |
↑, increase; CO, Colorado; EMR, electronic medical record; HMO, health maintenance organization; HR, hazard ratio; MA, Massachusetts; OR, Oregon; PCP, primary care physician; RCT, randomized controlled trial.