title: Electronic medical record reminders and panel management to improve primary care of elderly patients.
abstract: BACKGROUND
  Most elderly patients do not receive recommended preventive care, acute care, and care for chronic conditions.
  
  
  METHODS
  We conducted a controlled trial to assess the effectiveness of electronic medical record (EMR) reminders, with or without panel management, on health care proxy designation, osteoporosis screening, and influenza and pneumococcal vaccinations in patients older than 65 years. Physicians were assigned to 1 of the following 3 arms: EMR reminder, EMR reminder plus panel manager, or control. We assessed completion of recommended practices during a 1-year period.
  
  
  RESULTS
  Among patients who had not already received the recommended care, health care proxy was designated in 6.5% of patients in the control arm, 8.8% of the EMR reminder arm, and 19.7% of the EMR reminder plus panel manager arm (P=.002). Bone density screening was completed in 17.7% of patients in the control arm, 19.7% of the EMR reminder arm, and 30.5% of the EMR reminder plus panel manager arm (P=.02). Pneumococcal vaccine was given to 13.1% of patients in the control arm, 19.5% of the EMR reminder arm, and 25.6% of the EMR reminder plus panel manager arm (P=.02). Influenza vaccine was given to 46.8% of patients in the control arm, 56.5% of the EMR reminder arm, and 59.7% of the EMR reminder plus panel manager arm (P=.002). Results were similar when adjusted for individual physician performance in the preceding year, patient age, patient sex, years cared for by the practice, and number of visits.
  
  
  CONCLUSIONS
  Electronic medical record reminders alone facilitated improvement in vaccination rates and, when augmented by panel management, facilitated further improvement in vaccination rates and boosted the rates of health care proxy designation and bone density screening.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01313169.
authors.affiliation: Department of General Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA. tloo@bidmc.harvard.edu
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Loo
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Lipsitz
authors.forename: Julie
authors.initials: J
authors.lastname: Irish
authors.forename: Carol K
authors.initials: CK
authors.lastname: Bates
authors.forename: Kathryn
authors.initials: K
authors.lastname: Agarwal
authors.forename: Lawrence
authors.initials: L
authors.lastname: Markson
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Hamel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D057286:Electronic Health Records; D006801:Humans; D007252:Influenza Vaccines; D008403:Mass Screening / Q000379:methods; D010024:Osteoporosis / Q000175:diagnosis; D022242:Pneumococcal Vaccines; D011320:Primary Health Care / Q000458:organization & administration*; D017010:Reminder Systems; D016896:Treatment Outcome; D014611:Vaccination
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines