A Computerized Reminder System to Increase the Use of Preventive Care for Hospitalized Patients

Dexter, Paul; Perkins, Susan M.; Overhage, J. Marc; Maharry, Kati; Köhler, Richard; McDonald, Clement J.

doi:10.1056/nejmsa010181

Cited by 455 publications

(336 citation statements)

References 35 publications

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“…In this study the physician complied with an unprecedentedly high 89% of the reminders for contact isolation -principally because the reminder was based on specific and accurate data and was consistent with physician's intentions. In prior vaccination studies at the same institution [6,7], our compliance rate peaked at 56%, as a significant portion of the reminders triggered on ineligible patients, based on missing (e.g. prior vaccination) or inaccurate data in the medical record system.…”

Section: Discussionmentioning

confidence: 92%

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An effective computerized reminder for contact isolation of patients colonized or infected with resistant organisms

Kho¹,

Dexter²,

Warvel³

et al. 2008

International Journal of Medical Informatics

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Purpose-To improve contact isolation rates among patients admitted to the hospital with a known history of infection with Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycinresistant Enterococci (VRE).Methods-A before and after interventional study implementing computerized reminders for contact isolation between February 25th of 2005 and February 28th of 2006. We measured rates of appropriate contact isolation, and time to isolation for the four month pre-intervention period, and the 12 month intervention period. We conducted a survey of ordering physicians at the midpoint of the intervention period.Results-Implementing a computerized reminder increased the rate of patients appropriately isolated from 33% to fully 89% (P < 0.0001). The median time to writing contact isolation orders decreased from 16.6 hours to 0.0 hours (P < 0.0001). Physicians accepted the order 80% of the time on the first or second presentation. 95% of physicians felt the reminder had no impact on workflow, or saved them time.Conclusion-A human reviewed computerized reminder can achieve high rates of compliance with infection control recommendations for contact isolation, and dramatically reduce the time to orders being written upon admission.

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Section: Discussionmentioning

confidence: 92%

“…Since then, we have proven that computerized reminders dramatically improve the physician's delivery of preventive care [6,7,22] among eligible patients, but given that computer reminders don't produce 100% acceptance a corollary is also true: Computerized reminders based on human determined protocols are also imperfectable.…”

Section: E Conclusionmentioning

confidence: 99%

An effective computerized reminder for contact isolation of patients colonized or infected with resistant organisms

Kho¹,

Dexter²,

Warvel³

et al. 2008

International Journal of Medical Informatics

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View full text Add to dashboard Cite

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“…The discrepancy between recognized clinical need and failure to institute preventive strategies routinely has led consensus groups such as the American College of Chest Physicians to recommend that all hospitals develop a formal strategy to address VTE prevention in patients at risk in order to increase appropriate prophylaxis use [4]. Clinician education, evaluation of institutional data, and computerized order entry which prompts for VTE prevention have all been shown to improve VTE prophylaxis rates, with computerized order entry leading to the highest compliance rates [72][73][74].…”

Section: Elderly Patientsmentioning

confidence: 99%

Venous thromboembolism prevention in the acutely ill medical patient: A review of the literature and focus on special patient populations

Pendleton¹,

Wheeler²,

Rodgers³

2005

American J Hematol

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Although venous thromboembolism (VTE) is a major public health problem, until recently, our understanding of the risk of VTE in hospitalized acutely ill medical patients has been incomplete. Fortunately, over the past 5 years, there has been an increasing body of literature that highlights the risk of VTE in the nonsurgical patient, identifies unique patient-risk factors, and defines adequate preventative measures. This review highlights the current literature with regard to epidemiology of VTE in hospitalized medical patients and the risk-stratification of these patients and deals with optimal preventative regimens and prevention strategies in special patient groups. Am.

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“…Such trials showed enhanced compliance with cancer prevention guidelines 11,12 and increases in the use of cholesterol-lowering drugs for the secondary prevention of coronary disease 13 . Many of these studies used either computer-prompted "reminders" to physicians occurring during visits or guidelines available to physicians on the EMR.…”

Section: Introductionmentioning

confidence: 99%

An Electronic Medical Record (EMR)-Based Intervention to Reduce Polypharmacy and Falls in an Ambulatory Rural Elderly Population

2008

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BACKGROUND: Falls are the leading cause of injuryrelated deaths in the aging population. Electronic medical record (EMR) systems can identify at-risk patients and enable interventions to decrease risk factors for falls. OBJECTIVE:The objectives of this study were to evaluate an EMR-based intervention to reduce overall medication use, psychoactive medication use, and occurrence of falls in an ambulatory elderly population at risk for falls. DESIGN:Prospective, randomized by clinic site. PATIENTS/PARTICIPANTS:Six-hundred twenty community-dwelling patients over 70 at risk for falls based on age and medication use. INTERVENTIONS:A standardized medication review was conducted and recommendations made to the primary physician via the EMR. MEASUREMENTS AND MAIN RESULTS:Patients were contacted to obtain self reports of falls at 3-month intervals over the 15-month period of study. Fall-related diagnoses and medication data were collected through the EMR. A combination of descriptive analyses and multivariate regression models were used to evaluate differences between the 2 groups, adjusting for baseline medication patterns and comorbidities. Although the intervention did not reduce the total number of medications, there was a significant negative relationship between the intervention and the total number of medications started during the intervention period (p <.01, regression estimate −0.199) and the total number of psychoactive medications (p<.05, regression estimate −0.204.) The impact on falls was mixed; with the intervention group 0.38 times as likely to have had 1 or more fall-related diagnosis (p<.01); when data on self-reported falls was included, a nonsignificant reduction in fall risk was seen. CONCLUSIONS:The current study suggests that using an EMR to assess medication use in the elderly may reduce the use of psychoactive medications and falls in a community-dwelling elderly population.

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A Computerized Reminder System to Increase the Use of Preventive Care for Hospitalized Patients

Abstract: A majority of hospitalized patients in this study were eligible for preventive measures, and computerized reminders significantly increased the rate of delivery of such therapies.

Cited by 455 publications

References 35 publications

An effective computerized reminder for contact isolation of patients colonized or infected with resistant organisms

An effective computerized reminder for contact isolation of patients colonized or infected with resistant organisms

Venous thromboembolism prevention in the acutely ill medical patient: A review of the literature and focus on special patient populations

An Electronic Medical Record (EMR)-Based Intervention to Reduce Polypharmacy and Falls in an Ambulatory Rural Elderly Population

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