title: Provider response to computer-based care suggestions for chronic heart failure.
abstract: OBJECTIVE
  We sought to assess the responses of providers to recommendations generated by a computer-management system for chronic heart failure (CHF).
  
  
  METHODS
  This study is an analysis of primary care providers' responses to evidence-based computer-generated suggestions regarding patients with CHF at one center of a randomized trial. The trial randomized primary care providers from 2 VA Medical Centers to receive care suggestions regarding patients with CHF, with or without inclusion of patient symptom data obtained from pre-visit questionnaires. At one center, providers were asked to respond to the suggestions with hand-written comments and a numerical agreement scale.
  
  
  RESULTS
  Providers responded to 774 care suggestions (62% of the 1246 delivered). They agreed with 41%, had major disagreements with 12%, and had minor disagreements with 22%. For 7% of the care suggestions, providers asked to not see it again for that patient. The most common reasons for major or minor disagreements were a belief that the suggestion was wrong or unnecessary (45%) or would not be tolerated by the patient (32%). External barriers to implementation of guidelines, lack of guideline awareness, or disagreement with guidelines were uncommon reasons cited by providers in this study.
  
  
  CONCLUSIONS
  Providers agreed with less than half of computer-generated care suggestions from evidence-based CHF guidelines, most often because the suggestions were felt to be inapplicable to their patients or unlikely to be tolerated.
authors.affiliation: Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, Washington, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Keeffe
authors.forename: Usha
authors.initials: U
authors.lastname: Subramanian
authors.forename: William M
authors.initials: WM
authors.lastname: Tierney
authors.forename: Edmunds
authors.initials: E
authors.lastname: Udris
authors.forename: Jim
authors.initials: J
authors.lastname: Willems
authors.forename: Mary
authors.initials: M
authors.lastname: McDonell
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Fihn
mesh_terms: D001291:Attitude of Health Personnel; D020000:Decision Support Systems, Clinical; D034462:Dissent and Disputes; D019983:Guideline Adherence; D006333:Heart Failure / Q000628:therapy*; D006787:Hospitals, Veterans / Q000592:standards; D006801:Humans; D007196:Indiana; D018802:Patient-Centered Care; D010821:Physicians, Family / Q000193:education* / Q000523:psychology; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D014861:Washington