There is some benefit to a focused effort to implement electronic clinical reminders, although reminders designed to improve relatively simple tasks may be more beneficial than reminders designed to improve more complex tasks, according to the May 29 issue of Implementation Science.
Electronic clinical reminders available at the point-of-care delivery have been developed to improve lipid measurement and management in the Veterans Health Administration (VHA), according to Anne Sales, PhD, RN, from the VA Puget Sound Health Care System in Seattle, and colleagues.
The implementation used a quasi-experimental design with a comparison group of hospitals, the authors wrote. In three intervention hospitals, the researchers used a multi-faceted intervention to encourage use of the electronic clinical reminders.
A total of 5,438 patients with prior diagnosis of ischemic heart disease received care in the six hospitals (three intervention sites and three comparison sites) throughout the 12-month intervention, according to researchers. The process evaluation showed variation in use of reminders at each site.
The investigators evaluated the degree of reminder use and how patient-level outcomes varied at three intervention and three comparison sites, with and without adjusting for self-reported reminder use.
Without controlling for provider self-report of the reminder uses, there appeared to be a significant improvement in lipid measurement at the intervention sites, Sales and colleagues reported. Controlling for use of reminders, the amount of improvement in lipid measurement in the intervention sites was even greater, the authors wrote.
Adjusting for reminder use demonstrated that only one of the intervention hospitals had a significant effect of the intervention, according to the investigators. There was no significant change in management of hyperlipidemia associated with the intervention.
Sales and colleagues found that relatively simple tasks such as ordering tests, to be more beneficial than complex tasks, such as initiating or titrating medications, because of their less complex nature.
The authors concluded that there is value in monitoring the process, as well as outcome, of an implementation effort.
By the end of the study, the researches reported that the electronic clinical reminders were implemented in all of the intervention sites during the intervention period.
Ischemic heart disease affects at least 150,000 U.S. veterans annually.