title: Actionable reminders did not improve performance over passive reminders for overdue tests in the primary care setting.
abstract: Actionable reminders (electronic reminders linked to computerized order entry) might improve care by facilitating direct ordering of recommended tests. The authors implemented four enhanced actionable reminders targeting performance of annual mammography, one-time bone-density screening, and diabetic testing. There was no difference in rates of appropriate testing between the four intervention and four matched, control primary care clinics for screening mammography (OR 0.81, 95% CI 0.64 to 1.02), bone-density exams (OR 1.29, 95% CI 0.82 to 2.02), HbA1c monitoring (OR 0.91, 95% CI 0.58 to 1.42) and LDL cholesterol monitoring (OR 1.40, 95% CI 0.76 to 2.59). Of the survey respondents, 79% almost never used the system or were unaware of the functionality. In the 9/228 (3.9%) cases with indirect evidence of mammography reminder use, there was a significantly lower proportion with test performance. Our actionable reminders did not improve receipt of overdue testing, potentially due to limitations of workflow integration.
authors.affiliation: Department of Medicine, Divisions of Biomedical Informatics and Hospital Medicine, UCSD, San Diego, California, USA. relkareh@ucsd.edu
authors.forename: Robert E
authors.initials: RE
authors.lastname: El-Kareh
authors.forename: Tejal K
authors.initials: TK
authors.lastname: Gandhi
authors.forename: Eric G
authors.initials: EG
authors.lastname: Poon
authors.forename: Lisa P
authors.initials: LP
authors.lastname: Newmark
authors.forename: Jonathan
authors.initials: J
authors.lastname: Ungar
authors.forename: E J
authors.initials: EJ
authors.lastname: Orav
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Sequist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D001900:Boston; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008403:Mass Screening; D050316:Medical Order Entry Systems; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D017010:Reminder Systems / Q000706:statistics & numerical data