A METAANALYSIS OF 16 RANDOMIZED CONTROLLED TRIALS TO EVALUATE COMPUTER-BASED CLINICAL REMINDER SYSTEMS FOR PREVENTIVE CARE IN THE AMBULATORY SETTING

Objective: Computer-based reminder systems have the potential to chang e physician and patient behaviors and to improve patient outcomes. We performed a meta-analysis of published randomized controlled trials to assess the overall effectiveness of computer-based reminder systems i n ambulatory settings directed at preventive care. Design: Meta-analys is. Search Strategy: Searches of the Medline (1966-1994), Nursing and Allied Health (1982-1994), and Health Planning and Administration (197 5-1994) databases identified 16 randomized, controlled trials of compu ter-based reminder systems in ambulatory settings. Statistical Methods : A weighted mixed effects model regression analysis was used to estim ate intervention effects for computer and manual reminder systems for six classes of preventive practices. Main Outcome Measure: Adjusted od ds ratio for preventive practices. Results: Computer reminders improve d preventive practices compared with the control condition for vaccina tions (adjusted odds ratio [OR] 3.09; 95% confidence interval [CI] 2.3 9-4.00), breast cancer screening (OR 1.88; 95% CI 1.44-2.45), colorect al cancer screening (OR 2.25; 95% CI 1.74-2.91), and cardiovascular ri sk reduction (OR 2.01; 95% CI 1.55-2.61) but not cervical cancer scree ning (OR 1.15; 95% CI 0.89-1.49) or other preventive care (OR 1.02; 95 % CI 0.79-1.32). For all six classes of preventive practices combined the adjusted OR was 1.77 (95% CI 1.38-2.27). Conclusion: Evidence from randomized controlled studies supports the effectiveness of data-driv en computer-based reminder systems to improve prevention services in t he ambulatory care setting.