MS

thesisDiabetes mellitus is a chronic condition with several late complications that can be avoided through proper preventive health care. Although practice guidelines have been established to improve preventive care in diabetics, dissemination of these guidelines has been only moderately successful in changing physicians' practice patterns. The effectiveness of computerized reminders for diabetes preventive care has not been widely studied. We developed a computer-generated reminder system for diabetes care guidelines and implemented it in a randomized controlled study in the outpatient clinics of 35 medical residents. The system successfully flagged items that deviated from guideline recommendations. The residents completed encounter forms used by the system for 37% of patients seen during a six month study period. During this period, compliance with the guidelines significantly improved in both the intervention group that received patient-specific guideline reminders (38.0% at baseline, 54.9% at follow-up) and the control group that received a nonspecific report (34.6% at baseline, 51.0% at follow-up). There was no significant difference between the two groups. Residents who completed encounter forms showed a significantly greater improvement in compliance than those who did not complete forms (19.7% vs. 7.6%, p=0.006). The improvements in guideline compliance were seen in all areas of diabetes preventive care studied. The use of encounter forms by the providers significantly improved documented compliance with the guidelines in almost all categories of preventive care. Physician users exhibited positive attitudes toward the use of guidelines. However, the complexity and length of the encounter forms and the additional time demands proved to be significant obstacles to routine use. These results suggest that computerized reminder systems improve compliance with recommended care more by facilitating the documentation of clinical findings and the ordering of recommended procedures than by providing the clinician with patient-specific information about guideline compliance status. Successful reminder systems must be easy to use and have goals that are understood and accepted by the users. These findings may help improve the design and development of other computerized reminder systems for chronic diseases such as diabetes, especially in the future as health care increasingly makes use of electronic medical record systems