title: Adherence to computerized clinical reminders in a large healthcare delivery network.
abstract: OBJECTIVE
  To evaluate clinicians' adherence with clinical reminders (CRs) across multiple ambulatory practice settings in an integrated health care network.
  
  
  METHODS
  Adherence rate to 15 CRs, integrated into a computerized patient record system, was evaluated for 451 clinicians in 49 clinics from eight Veterans Affairs (VA) medical centers.
  
  
  RESULTS
  Overall, mean rate of adherence to CRs for all clinics was 86.2%, with a range of 66.59% to 97.08% (P<.001). The hepatitis C risk assessment reminder was found to have the highest overall adherence rate (95.9%) and the tobacco use cessation had the lowest adherence rate (62.9%). Mean adherence rate for all reminders was 80.34% (P<.001). Mean adherence rate for individual clinicians was 82.6%, with a range of 29% to 100%.
  
  
  CONCLUSIONS
  While overall adherence to CRs was high, there is significant variation by clinic, individual clinician and individual CR. Understanding this variation is critical in directing future efforts to improve the contribution of computerized CRs to quality and cost-effectiveness of care, and to decrease undesirable variation in clinical practice. Further research is needed to systematically evaluate clinician, reminder and systems related factors that influence adherence to CRs.
authors.affiliation: VA New England Healthcare System, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA. abha.agrawal@med.va.gov
authors.forename: Abha
authors.initials: A
authors.lastname: Agrawal
authors.forename: Michael F
authors.initials: MF
authors.lastname: Mayo-Smith
mesh_terms: D000553:Ambulatory Care; D000555:Ambulatory Care Information Systems; D020000:Decision Support Systems, Clinical; D019033:Delivery of Health Care, Integrated; D019983:Guideline Adherence; D006526:Hepatitis C; D006787:Hospitals, Veterans; D006801:Humans; D016347:Medical Records Systems, Computerized; D009511:New England; D009722:Nurse Practitioners; D010044:Outpatient Clinics, Hospital; D010823:Physician Assistants; D010820:Physicians; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D017010:Reminder Systems; D016540:Smoking Cessation; D014584:User-Computer Interface