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CPG 97-001 – HSR Study

 
CPG 97-001
Computerized Guidelines Enhanced by Symptoms and History: Clinical Effects
William M. Tierney, MD
Richard L. Roudebush VA Medical Center, Indianapolis, IN
Indianapolis, IN
Stephan Fihn MD MPH
VA Puget Sound Health Care System Seattle Division, Seattle, WA
Seattle, WA
Funding Period: August 1997 - February 2001
BACKGROUND/RATIONALE:
Physician compliance with practice guidelines is imperfect. Computer-generated reminders from electronic medical record systems have been shown to increase compliance with guidelines, but they often require symptom and history data, which limits computer facilitation. Heart failure is a serious condition for which compliance with established guidelines is suboptimal. Physicians’ compliance with heart failure guidelines may improve if such reminders use symptom and history data.

OBJECTIVE(S):
1) Program standard computer-based guidelines for heart failure using data from the electronic medical record systems at the Indianapolis and Seattle VAMCs. 2) Establish a system for capturing data on symptoms and history from heart failure patients before scheduled primary care visits. 3) Incorporate these data into enhanced computer reminders. 4) Conduct a randomized, controlled trial comparing these two types of reminders’ effects on physician prescribing, patient objective and subjective outcomes, and health care utilization.

METHODS:
This controlled trial targets patients with objective evidence of left ventricular dysfunction on cardiac imaging studies and a current outpatient diagnosis of heart failure. Primary care physicians in the Indianapolis and Seattle VAMCs have been randomized to receive either standard heart failure treatment reminders or reminders enhanced by history/symptom data. Study data come from the VAMCs electronic medical record systems (i.e., clinical data, utilization, and costs) and patient interviews (heart failure symptoms and medication compliance, heart failure-specific quality of life, and patients’ satisfaction with their primary care). Data analysis will be performed at the patient level using general estimating equations to account for patient and physician characteristics and clustering of patients within physicians.

FINDINGS/RESULTS:
The intervention has been established in both VAMCs and the controlled trial has been initiated at both sites. Data collection will be completed November 2001.

IMPACT:
The data from this study will help managers of VA primary care practices decide whether collecting subjective information from patients will improve physician prescribing for patients with heart failure and these patients’ clinical outcomes and health-related quality of life.


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PUBLICATIONS:

None at this time.


DRA: Health Systems
DRE: Technology Development and Assessment
Keywords: Chronic heart failure, Clinical practice guidelines, Decision support
MeSH Terms: none

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