McDonald CJ et al [1992]
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Reminders to physicians from an introspective computer medical record. A two-year randomized trial.

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Journal Annals of internal medicine
Year 1984
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This article is included in 46 Systematic reviews Systematic reviews (46 references) 1 Broad synthesis Broad syntheses (1 reference)

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We developed a computer-stored medical record system containing a limited set of the total clinical data base--primarily diagnostic studies and treatments. This system responds to its own content according to physician-authored reminder rules. To determine the effect of the reminder messages generated by 1490 rules on physician behavior, we randomly assigned practitioners in a general medicine clinic to study or control groups. The computer found indications for six different actions per patient in 12 467 patients during a 2-year study: 61 study group residents who received computer reminders responded to 49% of these indications; 54 control group residents, to only 29% (p less than 0.0001). Preventive care (occult blood testing, mammographic screening, weight reduction diets, influenza and pneumococcal vaccines) was affected. The intentions of the study group to use a given action for an indication predicted their response to the indications (p less than 0.03, r2 = 0.33). The intentions of the control residents did not.

Primary study

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Effects of computer reminders for influenza vaccination on morbidity during influenza epidemics.

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Authors McDonald CJ , Hui SL , Tierney WM
Journal M.D. computing : computers in medical practice
Year 1992
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This article is included in 11 Systematic reviews Systematic reviews (11 references) 1 Broad synthesis Broad syntheses (1 reference)

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To study the effects of computer-generated reminders for influenza vaccination of patients at high risk of pulmonary disease during the winter, we selected 4555 such patients from a population of 15,000 adults who participated in a three-year randomized trial of preventive-care reminders. The physicians who received the reminders vaccinated eligible patients twice as often as did the control physicians (P = 0.0001). There was a linear increase in the incidence of influenza in our area during the three winters under study (from 1000 to 33,451 to 71,075 cases per year), and we modeled the percentage of patients with hospitalizations, emergency room visits with chest radiography, and blood gas determinations as a logistic function of this increase. The difference in linear trends between the patients in the intervention group (whose physicians received reminders) and those in the control group was significant for emergency room visits (P less than 0.05), hospitalizations (P less than 0.01), and blood gas determinations (P less than 0.001). The most likely explanation for the difference is the greater use of influenza vaccine in the intervention group.