A Meta-analysis of 16 Randomized Controlled Trials to Evaluate Computer-Based Clinical Reminder Systems for Preventive Care in the Ambulatory Setting
- Affiliations of the authors: Division of General Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY (SS, LB); Division of Epidemiology, Columbia University, School of Public Health, New York, NY (SS); Department of Medical Informatics, College of Physicians and Surgeons, Columbia University, New York, NY (SS,WD); Division of Biostatistics, Columbia University School of Public Health, New York, NY (WD)
- Correspondence and reprint requests to: Steven Shea, MD, Division of General Medicine, 622 West 168th Street, New York
Objective Computer-based reminder systems have the potential to change 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 in ambulatory settings directed at preventive care.
Search Strategy Searches of the Medline (1966-1994), Nursing and Allied Health (1982-1994), and Health Planning and Administration (1975- 1994) databases identified 16 randomized, controlled trials of computer- based reminder systems in ambulatory settings.
Statistical Methods A weighted mixed effects model regression analysis was used to estimate intervention effects for computer and manual reminder systems for six classes of preventive practices.
Main Outcome Measure Adjusted odds ratio for preventive practices.
Results Computer reminders improved preventive practices compared with the control condition for vaccinations (adjusted odds ratio [OR] 3.09; 95% confidence interval [CI] 2.39-4.00), breast cancer screening (OR 1.88; 95% CI 1.44-2.45), colorectal cancer screening (OR 2.25; 95% CI 1.74-2.91), and cardiovascular risk reduction (OR 2.01;95% CI 1.55-2.61) but not cervical cancer screening (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-driven computer-based reminder systems to improve prevention services in the ambulatory care setting.
Supported by a grant from The Commonwealth Fund.