A comparison of the effects of electronic reminders and group bonuses on the recording of diagnoses in primary care: a longitudinal follow-up study

Abstract

ObjectiveTo improve the recording of diagnoses in visits to general practitioners, an observational retrospective study based on a before-after design was performed by installing an electronic reminder in the computerized patient chart system, reinforced in feedback delivered in superior-subordinate or development discussions with the general practitioners. The monthly rate of recording diagnoses was observed before and after the intervention. The effect of this intervention on recording of diagnoses was compared with the effects of financial group bonuses on the same parameter in a neighbouring city.ResultsBefore intervention, the level of recording diagnoses was about 45% in the primary care units. Nine months after this intervention there was not yet any statistically significant increase in recording of diagnoses but after 21 months it yielded a recording rate of 90% (P < 0.001). In three years, this percentage reached level over 95%. Group bonuses, a financial incentive serving as a control intervention, increased this parameter from 50 to 80% (P < 0.001) in nine months, and in 21 months the level of recording diagnoses was 90%. The both methods increased the level of recording diagnoses at the same level. Group bonuses acted faster but were also more expensive.

Differences between recorded diagnoses of patients of an emergency department and office-hours primary care doctors: a register-based study in a Finnish town

“…GFS provided a specific place in the EHR where the appropriate diagnosis codes of the 10 th version of the International Classification of Diseases (ICD-10) could be entered during the patients’ visits to the doctors of the ED and GPs. The system assisted the doctors in finding a proper diagnosis code or allowed the doctor to use the right code for the desired diagnosis directly, as described in detail earlier [ 10 , 11 ]…”

“…After that time, the reminders were always active till the end of the follow-up period (December 2014). The GFS-system prompted the ED doctors to enter a diagnosis every time they wanted to close a case [ 10 , 11 ] The follow-up period started in February 2002 and ended in December 2014. In February 2015, the primary care ED was totally outsourced to Helsinki University Hospital (HUS) due to a general restructuring of the local ED system in the HUS-area.…”

“…GFS provided a specific place in the EHR where the appropriate diagnosis codes of the 10 th version of the International Classification of Diseases (ICD-10) could be entered during the patients' visits to the doctors of the ED and GPs. The system assisted the doctors in finding a proper diagnosis code or allowed the doctor to use the right code for the desired diagnosis directly, as described in detail earlier [10,11] This study was carried out directly from the patient register without identifying the patients or ED doctors. The register keepers (the health authorities of Vantaa) and the scientific ethical board of Vantaa City (TUTKE) granted permission (VD/8059/13.00.00/2016) to carry out the study.…”

The influence of electronic reminders on recording diagnoses in a primary health care emergency department: a register-based study in a Finnish town

“…One important function of electronic reminders is the improvement of the quality of documentation in EDs [ 8 ]. Having recently observed that electronic reminders are effective in increasing the recording rate of diagnoses in ordinary visits of primary care physicians [ 9 , 10 ], it is important to study the association of electronic reminders with documentation in an ED setting. We studied changes in the diagnosis recording rate in a primary health care ED which provides care for unscreened emergency patients in its service area [ 11 , 12 ].…”

The effect of electronic reminders on the recording of diagnoses in primary care: A quasi-experimental before and after study

“…In this small-scale pilot study, electronic reminders seemed to improve the recording of diagnoses. 7 The aim of this study was to explore whether the electronic reminders within the electronic health record system increased the rate of recording disease diagnoses during GPs' visits. We also wanted to explore which diagnoses were recorded to find out whether the present intervention produced data which reflected the distribution of diagnoses in real clinical life in primary care.…”