OUP user menu

A Meta-analysis of 16 Randomized Controlled Trials to Evaluate Computer-Based Clinical Reminder Systems for Preventive Care in the Ambulatory Setting

Steven Shea MD, William DuMouchel PhD, Lisa Bahamonde BA
DOI: http://dx.doi.org/10.1136/jamia.1996.97084513 399-409 First published online: 1 November 1996

Abstract

Objective: Computer-based reminder systems have the potential to change physician and patient behaviors and to improve patient outcomes. We performed a meta-analysis of published randomized controlled trials to assess the overall effectiveness of computer-based reminder systems in ambulatory settings directed at preventive care.

Design: Meta-analysis.

Search Strategy: Searches of the Medline (1966–1994), Nursing and Allied Health (1982–1994), and Health Planning and Administration (1975–1994) databases identified 16 randomized, controlled trials of computer-based reminder systems in ambulatory settings.

Statistical Methods: A weighted mixed effects model regression analysis was used to estimate intervention effects for computer and manual reminder systems for six classes of preventive practices.

Main Outcome Measure: Adjusted odds ratio for preventive practices.

Results: Computer reminders improved preventive practices compared with the control condition for vaccinations (adjusted odds ratio [OR] 3.09; 95% confidence interval [CI] 2.39–4.00), breast cancer screening (OR 1.88; 95% CI 1.44–2.45), colorectal cancer screening (OR 2.25; 95% CI 1.74–2.91), and cardiovascular risk reduction (OR 2.01;95% CI 1.55–2.61) but not cervical cancer screening (OR 1.15; 95% CI 0.89–1.49) or other preventive care (OR 1.02; 95% CI 0.79–1.32). For all six classes of preventive practices combined the adjusted OR was 1.77 (95% CI 1.38–2.27).

Conclusion: Evidence from randomized controlled studies supports the effectiveness of data-driven computer-based reminder systems to improve prevention services in the ambulatory care setting.