COMPUTER REMINDERS TO IMPLEMENT PREVENTIVE CARE GUIDELINES FOR HOSPITALIZED-PATIENTS

Background: Hospitalizations are an opportunity to provide preventive care. Objective: To determine if computer reminders, which we have sho wn to be effective in our ambulatory care setting, increase the provis ion of inpatient preventive care. Methods: Randomized, controlled tria l on the general medicine inpatient service of an urban, university-af filiated public hospital. Study subjects were 78 house staff rotating on the 6 general medicine services. The intervention was reminders to physicians printed on daily rounds reports about preventive care for w hich their patients were eligible, and suggested orders for preventive care provided through the physicians' workstations. The preventive ca re guidelines were derived from the US Preventive Care Task Force reco mmendations. Compliance with preventive care guidelines and house staf f attitudes toward providing preventive care to hospitalized patients were the main outcome measures. Results: No significant differences we re seen between intervention and control physicians in compliance with preventive care guidelines in the aggregate or when individual preven tive care actions were analyzed. This was true even though most physic ians endorsed providing most kinds of preventive care for hospitalized patients. Conclusions: Despite past success in increasing preventive care in the outpatient setting, we were unable, using a moderately int ensive intervention, to increase the provision of preventive care duri ng hospitalizations. The physicians providing care during the hospital ization were not the patients' primary care physicians, which proved t o be an important barrier. More intensive interventions, or more direc t linkages between inpatient and outpatient care providers, may be req uired to overcome this resistance.