A controlled trial of including symptom data in computer-based care suggestions for managing patients with chronic heart failure.
BACKGROUND
Heart failure is common and associated with considerable morbidity and cost, yet physician adherence to treatment guidelines is suboptimal. We conducted a randomized controlled study to determine if adding symptom information to evidence-based, computer-generated care suggestions would affect treatment decisions among primary care physicians caring for outpatients with heart failure at two Veterans Affairs medical centers.


METHODS
Physicians were randomly assigned to receive either care suggestions generated with electronic medical record data and symptom data obtained from questionnaires mailed to patients within 2 weeks of scheduled outpatient visits (intervention group) or suggestions generated with electronic medical record data alone (control group). Patients had to have a diagnosis of heart failure and objective evidence of left ventricular systolic dysfunction. We assessed physician adherence to heart failure guidelines, as well as patients' New York Heart Association (NYHA) class, quality of life, satisfaction with care, hospitalizations, and outpatient visits, at 6 and 12 months after enrollment.


RESULTS
Patients in the intervention (n = 355) and control (n = 365) groups were similar at baseline. At 12 months, there were no significant differences in adherence to care suggestions between physicians in the intervention and control groups (33% vs. 30%, P = 0.4). There were also no significant changes in NYHA class (P = 0.1) and quality-of-life measures (P >0.1), as well as no differences in the number of outpatient visits between intervention and control patients (6.7 vs. 7.1 visits, P = 0.48). Intervention patients were more satisfied with their physicians (P = 0.02) and primary care visit (P = 0.02), but had more all-cause hospitalizations at 6 months (1.5 vs. 0.7 hospitalizations, P = 0.0002) and 12 months (2.3 vs. 1.7 hospitalizations, P = 0.05).


CONCLUSIONS
Adding symptom information to computer-generated care suggestions for patients with heart failure did not affect physician treatment decisions or improve patient outcomes.
Subramanian
Usha
U
Division of General Internal Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Fihn
Stephan D
SD
Weinberger
Morris
M
Plue
Laurie
L
Smith
Faye E
FE
Udris
Edmunds M
EM
McDonell
Mary B
MB
Eckert
George J
GJ
Temkit
M'Hamed
M
Zhou
Xiao-Hua
XH
Chen
Leway
L
Tierney
William M
WM
D000368:Aged; D020000:Decision Support Systems, Clinical; D005194:Family Practice / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007196:Indiana; D008297:Male; D016347:Medical Records Systems, Computerized; D010044:Outpatient Clinics, Hospital / Q000592:standards / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome; D014861:Washington