Improving residents' compliance with standards of ambulatory care: results from the VA Cooperative Study on Computerized Reminders

CONTEXT

Computerized systems to remind physicians to provide appropriate care have not been widely evaluated in large numbers of patients in multiple clinical settings.

OBJECTIVE

To examine whether a computerized reminder system operating in multiple Veterans Affairs (VA) ambulatory care clinics improves resident physician compliance with standards of ambulatory care.

DESIGN, SETTING, AND PARTICIPANTS

A total of 275 resident physicians at 12 VA medical centers were randomly assigned in firms or half-day clinic blocks to either a reminder group (n = 132) or a control group (n = 143). During a 17-month study period (January 31, 1995-June 30, 1996), the residents cared for 12,989 unique patients for whom at least 1 of the studied standards of care (SOC) was applicable.

MAIN OUTCOME MEASURES

Compliance with 13 SOC, tracked using hospital databases and encounter forms completed by residents, compared between residents in the reminder group vs those in the control group.

RESULTS

Measuring compliance as the proportion of patients in compliance with all applicable SOC by their last visit during the study period, the reminder group had statistically significantly higher rates of compliance than the control group for all standards combined (58.8% vs 53.5%; odds ratio [OR], 1.24; 95% confidence interval [CI], 1.08-1.42; P =.002) and for 5 of the 13 standards examined individually. Measuring compliance as the proportion of all visits for which care was indicated in which residents provided proper care, the reminder group also had statistically significantly higher rates of compliance than the control group for all standards combined (17.9% vs 12.2%; OR, 1.57; 95% CI, 1.45-1.71; P<.001) and for 9 of the 13 standards examined individually. The benefit of reminders, however, declined throughout the course of the study, even though the reminders remained active.

CONCLUSIONS

Our data indicate that reminder systems installed at multiple sites can improve residents' compliance to multiple SOC. The benefits of such systems, however, appear to deteriorate over time. Future research needs to explore methods to better sustain the benefits of reminders. JAMA. 2000;284:1411-1416.

A profile of the self-poisoner in Michigan

We reviewed the charts of all patients (160) ages 15 and older discharged in 1981 from the four hospitals in Lansing, Michigan with a diagnosis of overdose. Females predominated (65 per cent) and the median age was 27 years. The most common reason for intentional self-poisoning was "significant-other" conflict (54.5 per cent), followed by family conflict and financial problems. Benzodiazepines were most commonly used followed by acetylsalicylic acid and ethanol.

Suppression of immune response in mice by navy bean lectin

A cluster of cases of Hodgkin's disease was observed in a small town which contained a large navy bean elevator. In previous investigations a lectin was isolated from the navy beans and lymphocytes from town residents were shown to be sensitized to this lectin. Mice were exposed to 15 weekly injections of navy bean lectin. Splenic lymphocytes from injected mice incorporated greater amounts of thymidine than did controls when incubated with the lectin. Cell-mediated immunity as measured by a Concanavalin A dose-response curve was significantly suppressed (p < 0.01) in the injected mice. Long term studies are needed to see if the decreased Concanavalin A response in the mice chronically stimulated with navy bean lectin will predispose to lymphoreticular malignancies.

The Structure of Spirochaeta novyi as Revealed by the Electron Microscope

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