Ea. Balas et al., THE CLINICAL-VALUE OF COMPUTERIZED INFORMATION-SERVICES - A REVIEW OF98 RANDOMIZED CLINICAL-TRIALS, Archives of family medicine, 5(5), 1996, pp. 271-278
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.