Improving Quality With Outpatient Decision Support

NCT00225628 | Completed

• 1 other identifier: 5U18HS011046
• Study Type: interventional
• Target: 3,000
• Locations: 1 country
• Sites: 1

Brief Summary

Assesses physician compliance with paper-based and electronic guidelines, reminders, and alerts for outpatient settings. Target areas for the reminders and alerts are disease management, medication management, and interpretation of abnormal test results.

Conditions

Diabetes Mellitus; Coronary Artery Disease; Osteoporosis; Hypertension; Hyperlipidemia

Keywords

Computerized clinical decision support; Patient Safety; Quality of Care; Electronic Medical Records; Chronic Disease Management; Drug Monitoring; Guideline Adherence; Reminder Systems

Outcome Measures

Primary Outcomes (4)

• 1) Compliance to guidelines regarding the outpatient laboratory monitoring of prescription medication regiments

• 2) Compliance to guidelines regarding the follow-up of abnormal test results, including critically abnormal test results, abnormal cholesterol, abnormal HbA1c, abnormal pap smears and abnormal mammogram

• 3) Compliance to guidelines regarding the management of hypertension in the general ambulatory population and amongst ethnic minority groups

• 4) Compliance to guidelines regarding the screening and management of osteoporosis

Secondary Outcomes (2)

• 1) Patient satisfaction regarding communication with physicians

• 2) Physician satisfaction regarding follow-up of abnormal test results

Interventions

Computerized Reminders Medications Monitoring BEHAVIORAL

Computerized Test Results Management Application BEHAVIORAL

Computerized Reminders Hypertension Management BEHAVIORAL

Computerized Reminders Osteoporosis Screening and Mgt BEHAVIORAL

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• All physicians in on-site and satellite adult outpatient clinics with the Brigham and Women's Hospital and Massachusetts General Hospital.
• All practices must have adopted our home-grown electronic health record system, the Longitudinal Medical Record, for at least 24 months prior to the start of each intervention trial.

You may not qualify if:

• None

Sponsors & Collaborators

• Agency for Healthcare Research and Quality (AHRQ): lead

Study Sites (1)

Brigham and Women's Hospital

Boston, Massachusetts, 02472, United States

Location

Related Publications (9)

• Poon EG, Haas JS, Louise Puopolo A, Gandhi TK, Burdick E, Bates DW, Brennan TA. Communication factors in the follow-up of abnormal mammograms. J Gen Intern Med. 2004 Apr;19(4):316-23. doi: 10.1111/j.1525-1497.2004.30357.x.

  PMID: 15061740 BACKGROUND

• Hickner JM, Fernald DH, Harris DM, Poon EG, Elder NC, Mold JW. Issues and initiatives in the testing process in primary care physician offices. Jt Comm J Qual Patient Saf. 2005 Feb;31(2):81-9. doi: 10.1016/s1553-7250(05)31012-9.

  PMID: 15791767 RESULT

• Poon EG, Gandhi TK, Sequist TD, Murff HJ, Karson AS, Bates DW. "I wish I had seen this test result earlier!": Dissatisfaction with test result management systems in primary care. Arch Intern Med. 2004 Nov 8;164(20):2223-8. doi: 10.1001/archinte.164.20.2223.

  PMID: 15534158 RESULT

• Poon EG, Wald J, Bates DW, Middleton B, Kuperman GJ, Gandhi TK. Supporting patient care beyond the clinical encounter: three informatics innovations from partners health care. AMIA Annu Symp Proc. 2003;2003:1072.

  PMID: 14728575 RESULT

• Gandhi TK, Sequist TD, Poon EG, Karson AS, Murff H, Fairchild DG, Kuperman GJ, Bates DW. Primary care clinician attitudes towards electronic clinical reminders and clinical practice guidelines. AMIA Annu Symp Proc. 2003;2003:848.

  PMID: 14728353 RESULT

• Poon EG, Wang SJ, Gandhi TK, Bates DW, Kuperman GJ. Design and implementation of a comprehensive outpatient Results Manager. J Biomed Inform. 2003 Feb-Apr;36(1-2):80-91. doi: 10.1016/s1532-0464(03)00061-3.

  PMID: 14552849 RESULT

• Murff HJ, Gandhi TK, Karson AK, Mort EA, Poon EG, Wang SJ, Fairchild DG, Bates DW. Primary care physician attitudes concerning follow-up of abnormal test results and ambulatory decision support systems. Int J Med Inform. 2003 Sep;71(2-3):137-49. doi: 10.1016/s1386-5056(03)00133-3.

  PMID: 14519406 RESULT

• Sequist TD, Gandhi TK, Karson AS, Fiskio JM, Bugbee D, Sperling M, Cook EF, Orav EJ, Fairchild DG, Bates DW. A randomized trial of electronic clinical reminders to improve quality of care for diabetes and coronary artery disease. J Am Med Inform Assoc. 2005 Jul-Aug;12(4):431-7. doi: 10.1197/jamia.M1788. Epub 2005 Mar 31.

  PMID: 15802479 RESULT

• Matheny ME, Gandhi TK, Orav EJ, Ladak-Merchant Z, Bates DW, Kuperman GJ, Poon EG. Impact of an automated test results management system on patients' satisfaction about test result communication. Arch Intern Med. 2007 Nov 12;167(20):2233-9. doi: 10.1001/archinte.167.20.2233.

  PMID: 17998497 DERIVED

MeSH Terms

Conditions

Diabetes Mellitus; Coronary Artery Disease; Osteoporosis; Hypertension; Hyperlipidemias

Condition Hierarchy (Ancestors)

Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases; Coronary Disease; Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Vascular Diseases; Bone Diseases, Metabolic; Bone Diseases; Musculoskeletal Diseases; Dyslipidemias; Lipid Metabolism Disorders

Study Officials

• David W Bates, MD MSc

  Brigham and Women's Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: FED

Study Record Dates

• First Submitted: September 22, 2005
• First Posted: September 26, 2005
• Study Start: September 1, 2000
• Study Completion: December 1, 2006
• Last Updated: September 26, 2005

Record last verified: 2005-09

Locations

US (1)