Supporting the patient's role in guideline compliance: a controlled study.
OBJECTIVE
Clinical messages alerting physicians to gaps in the care of specific patients have been shown to increase compliance with evidence-based guidelines. This study sought to measure any additional impact on compliance when alerting messages also were sent to patients.


METHODS
For alerts that were generated by computerized clinical rules applied to claims, compliance was determined by subsequent claims evidence (eg, that recommended tests were performed). Compliance was measured in the baseline year and the study year for 4 study group employers (combined membership >100,000) that chose to add patient messaging in the study year, and 28 similar control group employers (combined membership >700,000) that maintained physician messaging but did not add patient messaging.


METHODS
The impact of patient messaging was assessed by comparing changes in compliance from baseline to study year in the 2 groups. Multiple logistic regression was used to control for differences between the groups. Because a given member or physician could receive multiple alerts, generalized estimating equations with clustering by patient and physician were used.


RESULTS
Controlling for differences in age, sex, and the severity and types of clinical alerts between the study and control groups, the addition of patient messaging increased compliance by 12.5% (P <.001). This increase was primarily because of improved responses to alerts regarding the need for screening, diagnostic, and monitoring tests.


CONCLUSIONS
Supplementing clinical alerts to physicians with messages directly to their patients produced a statistically significant increase in compliance with the evidence-based guidelines underlying the alerts.
Rosenberg
Stephen N
SN
Division of Outcomes Research, ActiveHealth Management, New York, NY 10018, USA. srosenberg@activehealth.net
Shnaiden
Tatiana L
TL
Wegh
Arnold A
AA
Juster
Iver A
IA
D000328:Adult; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D010349:Patient Compliance; D010358:Patient Participation; D010818:Practice Patterns, Physicians'; D017010:Reminder Systems