title: Improving delivery of preventive health care with the comprehensive annotated reminder tool (CART).
abstract: OBJECTIVE
  We assessed the effect of the Comprehensive Annotated Reminder Tool (CART) on physician adherence to preventive services recommendations.
  
  
  METHODS
  Using a randomized pretest/posttest control group design, we assigned physicians to the CART group or the control group, followed up prospectively, and evaluated for appropriate adherence to guidelines. The 3 age-specific versions of the CART annotated history and physical examination form contained up to 49 preventive services recommendations.
  
  
  METHODS
  All resident physicians in a large family practice residency program were studied over the course of 1 academic year.
  
  
  METHODS
  We performed blinded chart reviews to assess the appropriateness of preventive services ordered by the physicians before the introduction of the CART, during its use, and after its removal. A multiple-choice test completed before and after the use of the CART forms assessed knowledge.
  
  
  RESULTS
  When the CART was used, the appropriateness of physician preventive behavior increased by 21% overall. The appropriateness of history, physical examination, and laboratory interventions increased by 33%. When the CART was removed, physician behavior returned to baseline (P < or = .0025 for 16 of 20 interventions). No significant differences were observed in the control group over time. Knowledge increased over the study period for all physicians (P < or = .005) but did not differ significantly between the treatment and control groups (P = .608).
  
  
  CONCLUSIONS
  Use of the CART significantly improved physician performance in the appropriate delivery of preventive care.
authors.affiliation: Department of Community and Family Medicine, Dartmouth College, Hanover, NH, USA. Kevin.C.Shannon@Dartmouth.edu
authors.forename: K C
authors.initials: KC
authors.lastname: Shannon
authors.forename: J M
authors.initials: JM
authors.lastname: Sinacore
authors.forename: S G
authors.initials: SG
authors.lastname: Bennett
authors.forename: A M
authors.initials: AM
authors.lastname: Joshi
authors.forename: K M
authors.initials: KM
authors.lastname: Sherin
authors.forename: A
authors.initials: A
authors.lastname: Deitrich
mesh_terms: D003695:Delivery of Health Care; D005194:Family Practice / Q000193:education*; D019983:Guideline Adherence; D006801:Humans; D007396:Internship and Residency; D011314:Preventive Health Services / Q000458:organization & administration*