Computer reminders can increase delivery of preventive care to hospitalized patients

September 27, 2001

INDIANAPOLIS -- In a study published in the September 27, 2001 issue of the New England Journal of Medicine, researchers from the Indiana University School of Medicine and the Regenstrief Institute for Health Care demonstrated that computer reminders can dramatically increase the number of pneumonia and flu vaccinations ordered by physicians for hospitalized adults. Further, the researchers found that a majority of all hospitalized patients are appropriate candidates for preventive care.

This is the first randomized trial to show that computer reminders can increase pneumonia and flu vaccination rates among hospitalized patients. Pneumonia and flu vaccinations are associated with decreased mortality, lower hospitalization rates and cost savings in older adults.

In this 18-month study, the computer reminder system identified 3,416 patients admitted to a general medicine service (54 percent of all patients) as eligible for preventive care measure(s), which were not ordered at the time of admission. When prompted by computer reminders, physicians ordered influenza vaccinations for 51 percent of appropriate candidates (compared to only 1 percent when not reminded). Reminded physicians also ordered pneumonia vaccinations for 36 percent of appropriate candidates (compared to less than 1 percent when not reminded).

"Hospitalization represents an opportunity to 'target' individuals who are particularly likely to benefit from preventive care and prevent future hospitalizations," said the study's first author, Paul Dexter, M.D., clinical assistant professor of medicine at the IU School of Medicine and research scientist at the Regenstrief Institute for Healthcare. "Physicians are appropriately primarily focused on treating the problem that brought the patient into the hospital. Computer reminders can relieve clinicians of having to focus on treatments unrelated to the patient's acute medical problem, yet still maximize the benefits of hospitalization."

The computer tools employed in the study made it extremely convenient for the physician to order preventive care. The computer reminder was an order ready to sign and the physician only had to press the "enter" key to complete a vaccination order. In addition, the reminders were highlighted with a distinctive color scheme and integrated with the physicians' routine workflow.

"Although the reminders in this study were based on a physician order entry system and the Regenstrief Medical Records System, a rich clinical repository, neither of these features is a necessary prerequisite to improving hospital-based preventive care.

The majority of reminders were triggered by information, such as the patient's age, routinely available in hospital information systems," said Clement McDonald, M.D., Indiana University distinguished professor and director of the Regenstrief Institute for Healthcare and senior author of the NEJM study.

It is likely that with a small amount of programming development and the creation of nursing protocols to check for the very rare contraindications and previous vaccinations, many hospitals could implement simple reminders to improve preventive care in the inpatient setting according to Dr. Dexter and Dr. McDonald and their co-authors, Susan Perkins, Ph.D., J. Marc Overhage, M.D., Ph.D., Kati Maharry, M.A.S, and Richard B. Kohler, M.D. of the Indiana University School of Medicine and the Regenstrief Institute for Healthcare. The study was funded by the Agency for Healthcare Research and Quality.
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Regenstrief investigators were the first to implement and study computer reminders for physicians. Their first study examined the effect in an outpatient setting and was published in the New England Journal of Medicine twenty-five years ago: ["Protocol-Based Computer Reminders, the Quality of Care and the Nonperfectibility of Man," NEJM, 1976;295:1351-1355.]

Indiana University

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