title: Improving prompt effectiveness in diabetes care: an intervention study.
abstract: Electronic medical records (EMRs) should support clinical decision making to further quality care delivery. This study describes 1 academic medical group's efforts to leverage their EMR's decision-support functionality to improve quality care delivery. A nested, time-series, quasiexperimental design compared 3 different implementation strategies for EMR prompting at 5 primary care clinics in a single academic medical group. The primary outcome was the ordering of all indicated diabetes monitoring tests before the end of the visit. The authors analyzed 16 511 visits performed on 3730 patients. The rate of ordering all indicated tests at the time of the visit increased from 29% with no prompts to 49% (P < .001) with appropriately designed prompts and training support. EMR-generated prompts may be more likely to increase ordering of recommended monitoring tests when clinic workflow, staff training, and medical culture are incorporated into the prompt delivery.
authors.affiliation: Department of Medicine, University of California, San Diego, CA 92037, USA. jbronner@ucsd.edu
authors.forename: Jason Patrick
authors.initials: JP
authors.lastname: Bronner
authors.forename: John
authors.initials: J
authors.lastname: Fontanesi
authors.forename: Anupam
authors.initials: A
authors.lastname: Goel
mesh_terms: D000046:Academic Medical Centers; D002140:California; D020000:Decision Support Systems, Clinical / Q000295:instrumentation*; D003920:Diabetes Mellitus / Q000628:therapy*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017064:Process Assessment, Health Care / Q000379:methods*; D058996:Quality Improvement / Q000458:organization & administration; D019984:Quality Indicators, Health Care