The clinical value of computerized information services. A review of 98 randomized clinical trials

Balas, E. Andrew; Austin, Suzanne; Mitchell, Joyce A.; Ewigman, Bernard; Bopp, Kenneth D.; Brown, Gordon D.

doi:10.1001/archfami.5.5.271

Cited by 165 publications

(100 citation statements)

References 47 publications

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“…Previous studies have found that the response of clinicians to such reminders is variable, and a number of reviews have described existing tools, where possible measured their impact, and in some cases attempted to identify factors influencing effect size. [1][2][3][4][5][6][7][8][9][10][11] Reminder systems are diverse in their design. Some are used to support specific clinical areas of care (e.g.…”

Section: Introductionmentioning

confidence: 99%

Changing Clinical Practice Through Patient Specific Reminders Available at the Time of the Clinical Encounter: Systematic Review and Meta-Analysis

2012

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OBJECTIVE: To synthesise current evidence for the influence on clinical behaviour of patient-specific electronically generated reminders available at the time of the clinical encounter. DATA SOURCES: PubMed, Cochrane library of systematic reviews; Science Citation Index Expanded; Social Sciences Citation Index; ASSIA; EMBASE; CINAHL; DARE; HMIC were searched for relevant articles. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: We included controlled trials of reminder interventions if the intervention was: directed at clinician behaviour; available during the clinical encounter; computer generated (including computer generated paper-based reminders); and generated by patient-specific (rather than condition specific or drug specific) data. STUDY APPRAISAL AND SYNTHESIS METHODS:Systematic review and meta-analysis of controlled trials published since 1970. A random effects model was used to derive a pooled odds ratio for adherence to recommended care or achievement of target outcome. Subgroups were examined based on area of care and study design. Odds ratios were derived for each sub-group. We examined the designs, settings and other features of reminders looking for factors associated with a consistent effect. RESULTS: Altogether, 42 papers met the inclusion criteria. The studies were of variable quality and some were affected by unit of analysis errors due to a failure to account for clustering. An overall odds ratio of 1.79 [95% confidence interval 1.56, 2.05] in favour of reminders was derived. Heterogeneity was high and factors predicting effect size were difficult to identify. LIMITATIONS: Methodological diversity added to statistical heterogeneity as an obstacle to meta-analysis. The quality of included studies was variable and in some reports procedural details were lacking. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:The analysis suggests a moderate effect of electronically generated, individually tailored reminders on clinician behaviour during the clinical encounter. Future research should concentrate on identifying the features of reminder interventions most likely to result in the target behaviour.

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Section: Introductionmentioning

confidence: 99%

Changing Clinical Practice Through Patient Specific Reminders Available at the Time of the Clinical Encounter: Systematic Review and Meta-Analysis

2012

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“…If satisfaction levels are low, users may actually become antagonistic and sabotage the system, or develop workarounds that avoid using the system. Randomized controlled trials have shown that there are four generic information interventions that can make a significant difference in patient care (patient education, treatment planning, physician and patient reminders) (Balas et al, 1996). It is therefore important to incorporate these information services into any CDSS that will be used for primary care, in order to improve its effectiveness.…”

Section: Evaluation Of Techniques Adoption and Success Of Cdssmentioning

confidence: 99%

Challenges in Developing Effective Clinical Decision Support Systems

Sartipi¹,

Archer²,

Yarmand³

2011

Efficient Decision Support Systems - Practice and Challenges in Biomedical Related Domain

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“…There is an extensive list of studies that confirm the benefits of using reminders and clinical guidelines (sometimes called protocols) in patient care (E. Balas, S. Austin, et al, , 1996;Hunt, 1998). For example: reminders have proven to increase preventative care by 40% (Frank, 1997);…”

Section: Prompt the Provider To Use Clinical (Evidence-based) Guidelimentioning

confidence: 99%

Information Systems in General Practice: A Framework to Implement the Management and Prevention of Chronic Diseases

Carbone¹

2007

Proceedings of the 2007 InSITE Conference

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The detrimental health and economic impacts due to the growth of chronic condition sufferers worldwide is well documented. The practical application of electronic information systems is expected to provide valuable support to this predicament. The purpose of this study is to develop an information systems implementation framework for the management and prevention of chronic diseases (CD) in general practices (Doctor’s surgeries). Interviews were conducted on key practice personnel where successful CD information systems implementations and adoption occurred. The interviews, in conjunction with the observations of an external IS facilitator to those implementations aimed at corroborating an emerging framework developed from the literature earlier in the study. Results to this date provided a wealth of information to both part validate and re-design the framework. The role of practice champions, external support, motivators, workflow effects and health outcomes are some of the prominent parameters highlighted in the findings. The implications, so far in this study have identified commonalities in capacity, processes and implementations flows that affect the framework. However, additional validation on new findings needs to be further explored.

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The clinical value of computerized information services. A review of 98 randomized clinical trials

Cited by 165 publications

References 47 publications

Changing Clinical Practice Through Patient Specific Reminders Available at the Time of the Clinical Encounter: Systematic Review and Meta-Analysis

Changing Clinical Practice Through Patient Specific Reminders Available at the Time of the Clinical Encounter: Systematic Review and Meta-Analysis

Challenges in Developing Effective Clinical Decision Support Systems

Information Systems in General Practice: A Framework to Implement the Management and Prevention of Chronic Diseases

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