BACKGROUND/RATIONALE:
Computerized clinical reminders (CCR) have been widely publicized as tools for improving quality of care, but evaluation of CCR patterns of use and the organizational correlates of these patterns is lacking.

OBJECTIVE(S):
To identify patterns of use of CCRs across an integrated national delivery system and describe facilitating factors and barriers.

METHODS:
Cross sectional survey; 104 US Veterans Health Administration (VHA) health care facilities. Measures: (Primary) Number and types of CCRs available at each facility. (Secondary) Perceived ease of use and usefulness of CCRs, training and personnel support for computer use, functionalities of electronic medical record, and availability of performance data feedback to providers.

FINDINGS/RESULTS:
The number of CCRs in use ranged from one to fifteen; most facilities reported implementation of ten of the 15 reminders surveyed. The most common CCRs, used in over 85% of facilities, were for those with VHA national performance measures (e.g., tobacco use cessation, immunizations, diabetes mellitus). The least common CCRs were for post-deployment health evaluation and management, medically unexplained symptoms, and erectile dysfunction. Providers at facilities with a higher number of clinical reminders reported greater ease of use and usefulness of the reminders (p=0.01).

IMPACT:
VHA facilities have varying degrees of implementation of CCRs. This effect may be partly explained by incorporation of clinical reminders as performance measures and differences in perceived ease of use and usefulness of clinical reminders at certain facilities. Studying the barriers and facilitators to widespread implementation is a necessary step to promoting dissemination of this technology.

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External Links for this Project

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PUBLICATIONS:

Conference Presentations

1. Doebbeling BN, Vaughn TE, McCoy KD, Glassman P. Variations in Informatics Technology Implementation in VHA to Improve Care. Paper presented at: VA HSR&D National Meeting; 2004 Mar 10; Washington, DC. [view]

DRA: Health Systems Science
DRE: none
Keywords: Behavior (provider), Decision support, Organizational issues
MeSH Terms: none