Context Computerized systems to remind physicians to provide appropriate care
have not been widely evaluated in large numbers of patients in multiple clinical
Objective To examine whether a computerized reminder system operating in multiple
Veterans Affairs (VA) ambulatory care clinics improves resident physician
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 blocks to either a reminder group (n
= 132) or a control group (n = 143). During a 17-month study period (January
31, 1995–June 30, 1996), the residents cared for 12,989 unique patients
for whom at least 1 of the studied standards of care (SOC) was applicable.
Main Outcome Measures Compliance with 13 SOC, tracked using hospital databases 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 with
all applicable SOC by their last visit during the study period, the reminder
group had statistically significantly higher rates of compliance than the
control group for all standards combined (58.8% vs 53.5%; odds ratio [OR],
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 proper care, the reminder group also had statistically significantly
higher rates 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 standards examined individually. The benefit of reminders,
however, declined throughout the course of the study, even though the reminders
Conclusions Our data indicate that reminder systems installed at multiple sites
can improve residents' compliance to multiple SOC. The benefits of such systems,
however, appear to deteriorate over time. Future research needs to explore
methods to better sustain the benefits of reminders.