Improving residents' compliance with standards of ambulatory care - Results from the VA cooperative study on computerized reminders

Context Computerized systems to remind physicians to provide appropriate ca re have not been widely evaluated in large numbers of patients in multiple clinical settings. Objective To examine whether a computerized reminder system operating in mu ltiple Veterans Affairs (VA) ambulatory care clinics improves resident phys ician compliance with standards of ambulatory care. Design, Setting, and Participants A total of 275 resident physicians at 12 VA medical centers were randomly assigned in firms or half-day clinic block s to either a reminder group (n=132) or a control group (n=143), During a 1 7-month study period (January 31, 1995-June 30, 1996), the residents cared for 12989 unique patients for whom at least 1 of the studied standards of c are (SOC) was applicable. Main Outcome Measures Compliance with 13 SOC, tracked using hospital databa ses and encounter forms completed by residents, compared between residents in the reminder group vs those in the control group. Results Measuring compliance as the proportion of patients in compliance wi th all applicable SOC by their last visit during the study period, the remi nder group had statistically significantly higher rates of compliance than the control group for all standards combined (58.8% vs 53.5%; odds ratio [O R], 1.24; 95% confidence interval [CI], 1.08-1.42; P=.002) and for 5 of the 13 standards examined individually. Measuring compliance as the proportion of all visits for which care was indicated in which residents provided pro per care, the reminder group also had statistically significantly higher ra tes of compliance than the control group for all standards combined (17.9% vs 12.2%; OR, 1.57; 95% CI, 1.45-1.71; P<.001) and for 9 of the 13 standard s examined individually. The benefit of reminders, however, declined throug hout the course of the study, even though the reminders remained active. Conclusions Our data indicate that reminder systems installed at multiple s ites can improve residents' compliance to multiple SOC. The benefits of suc h systems, however, appear to deteriorate over time. Future research needs to explore methods to better sustain the benefits of reminders.