THE CLINICAL-VALUE OF COMPUTERIZED INFORMATION-SERVICES - A REVIEW OF98 RANDOMIZED CLINICAL-TRIALS

Objective: To review all randomized clinical trials addressing the eff icacy of clinical information systems and to determine the clinical se ttings, types of interventions, and effects studied. Data Sources: Ext ensive and systematic MEDLINE searches were conducted using a combinat ion of medical subject headings (MeSH) and textword terms to collect t rial reports. Manual searches of books and monographs as well as infor mal contacts were also used. Study Selection: The eligibility criteria were (1) randomized controlled clinical trial, (2) computerized infor mation intervention in the study group, and (3) effect measured on the process or outcome of care. Data Extraction: Two research assistants independently abstracted from the selected reports the following struc tured information: trial sires, computerized interventions, effect var iables, and outcomes. Three investigators evaluated the combined list of trial features for setting, intervention, and effect. The statistic al analysis included an evaluation of agreement in developing classifi cations and an analysis of the ratio of positive trial outcomes. Data Synthesis: Most information services were tested in outpatient care (8 2%), particularly in primary care (66%). The information intervention targeted the provider in 64% of the trials. The effect was primarily m easured for the process of care (76%). Provider prompt/reminder, compu ter-assisted treatment planner, interactive patient education/therapy, and patient prompt/reminder were significantly successful interventio ns (sign test, P<.05). Conclusions: Randomized clinical trials confirm that four generic information interventions are active ingredients of computer systems and can make a significant difference in family medi cine (physician and patient reminders, treatment planner, and patient education). To manage care and improve quality, primary care computer systems should incorporate these effective information services.