Journal of General Internal Medicine

, Volume 18, Issue 12, pp 967–976

Effects of computerized guidelines for managing heart disease in primary care

A randomized, controlled trial

Authors

    • Received from the Regenstrief Institute for Health CareIndiana University School of Medicine
    • Department of MedicineIndiana University School of Medicine
    • Richard L. Roudebush Veterans Affairs Medical Center
  • J. Marc Overhage
    • Received from the Regenstrief Institute for Health CareIndiana University School of Medicine
    • Department of MedicineIndiana University School of Medicine
  • Michael D. Murray
    • Received from the Regenstrief Institute for Health CareIndiana University School of Medicine
    • Richard L. Roudebush Veterans Affairs Medical Center
    • Purdue University School of Pharmacy
  • Lisa E. Harris
    • Received from the Regenstrief Institute for Health CareIndiana University School of Medicine
    • Department of MedicineIndiana University School of Medicine
  • Xiao-Hua Zhou
    • Received from the Regenstrief Institute for Health CareIndiana University School of Medicine
    • Department of MedicineIndiana University School of Medicine
  • George J. Eckert
    • Department of MedicineIndiana University School of Medicine
  • Faye E. Smith
    • Received from the Regenstrief Institute for Health CareIndiana University School of Medicine
  • Nancy Nienaber
    • Received from the Regenstrief Institute for Health CareIndiana University School of Medicine
  • Clement J. McDonald
    • Received from the Regenstrief Institute for Health CareIndiana University School of Medicine
    • Department of MedicineIndiana University School of Medicine
  • Fredric D. Wolinsky
    • College of Public HealthUniversity of Iowa
Original Articles

DOI: 10.1111/j.1525-1497.2003.30635.x

Cite this article as:
Tierney, W.M., Overhage, J.M., Murray, M.D. et al. J GEN INTERN MED (2003) 18: 967. doi:10.1111/j.1525-1497.2003.30635.x

Abstract

BACKGROUND: Electronic information systems have been proposed as one means to reduce medical errors of commission (doing the wrong thing) and omission (not providing indicated care).

OBJECTIVE: To assess the effects of computer-based cardiac care suggestions.

DESIGN: A randomized, controlled trial targeting primary care physicians and pharmacists.

SUBJECTS: A total of 706 outpatients with heart failure and/or ischemic heart disease.

INTERVENTIONS: Evidence-based cardiac care suggestions, approved by a panel of local cardiologists and general internists, were displayed to physicians and pharmacists as they cared for enrolled patients.

MEASUREMENTS: Adherence with the care suggestions, generic and condition-specific quality of life, acute exacerbations of their cardiac disease, medication compliance, health care costs, satisfaction with care, and physicians’ attitudes toward guidelines.

RESULTS: Subjects were followed for 1 year during which they made 3,419 primary care visits and were eligible for 2,609 separate cardiac care suggestions. The intervention had no effect on physicians’ adherence to the care suggestions (23% for intervention patients vs 22% for controls). There were no intervention-control differences in quality of life, medication compliance, health care utilization, costs, or satisfaction with care. Physicians viewed guidelines as providing helpful information but constraining their practice and not helpful in making decisions for individual patients.

CONCLUSIONS: Care suggestions generated by a sophisticated electronic medical record system failed to improve adherence to accepted practice guidelines or outcomes for patients with heart disease. Future studies must weigh the benefits and costs of different (and perhaps more Draconian) methods of affecting clinician behavior.

Key words

ambulatory information systems clinical practice guidelines coronary artery disease decision support systems drug utilization review heart failure

Copyright information

© Society of General Internal Medicine 2003