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Prevention

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Computerized reminders dramatically improve preventive care for hospitalized patients

Various preventive care measures can save lives, prevent serious complications, and reduce health care costs. However, opportunities for preventive care among hospitalized patients often are missed. The use of computerized reminders can dramatically increase preventive care for such patients, according to a study supported by the Agency for Healthcare Research and Quality (HS07719).

Paul R. Dexter, M.D., and fellow researchers from the Indiana University School of Medicine, found that a computerized reminder system greatly increased rates of pneumonia and influenza vaccinations for elderly and chronically ill patients. It also boosted use of prophylactic heparin (a blood thinner) for patients at risk for blood clots and prophylactic aspirin for patients at risk for stroke or heart attack.

The researchers used a computerized system to process online information for 6,371 hospitalized patients, generating preventive care reminders as appropriate. They randomized doctors to groups who viewed and did not view the reminders when they used a computerized order-entry system to determine the impact of the reminders on the use of four preventive therapies: pneumonia and influenza vaccinations and heparin and aspirin prophylaxis.

The reminder system identified 54 percent of patients as eligible for preventive measures that had not been ordered by the admitting physician. The reminders increased use of pneumonia and influenza vaccination from practically zero to approximately 35 and 50 percent, respectively. Doctors who received the reminders had higher ordering rates than doctors who did not get reminders for pneumonia vaccination (36 vs. 0.8 percent), influenza vaccination (51 vs. 1 percent), prophylactic heparin (32 vs. 19 percent), and prophylactic aspirin at discharge (36 vs. 28 percent) for patients eligible for these types of preventive care.

Details are in "A computerized reminder system to increase the use of preventive care for hospitalized patients," by Dr. Dexter, Susan Perkins, Ph.D., J. Marc Overhage, M.D., Ph.D., and others, in the September 27, 2001 New England Journal of Medicine 345(13), pp. 965-970.

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